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F9 <br />yHt~n <br />HC W <br />H 0 <br />`O F-I IV <br />NH <br />OH <br />�cm,8 <br />H <br />H <br />yY. H <br />rHH <br />CA <br />ggdqy <br />H to <br />HOEA <br />C: <br />! 1 <br />APPLL..:ATION FOR CONS? AUCTION <br />PERMIT <br />IN[Fvmpn.en rn•11 <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />259-8810 TO BE COMPLETED IN INK — PLEASE PRINT <br />OWNER MAILADDNE55 Utv ZIP PHONE <br />TnnTn Mc A/r-AL ('Ra6 REQI!SHIRE DR. LV6RCTT 99203 35S- GLt7o <br />ARCHITECTORDESKINER MAIL ADDRESS COY ZIP PHONE <br />GENERAL CONTRACTOR MAIL ADDRESS LILY ZIP PHONE LCEN9E[ <br />OrDAAARwr /A/DUSTRI[5 /ti521 Hwv49 LVAIAA*etq 98037 lf3-)553 R=RMAW 179 <br />PLUMBING CONTRACTOR MAIL AOGRESS CITY ZIP PHONE LICENSEE <br />NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION Cl WOODSTOVEJFRPL INSERT ❑ BUILDING RELOCATION <br />CONTRACT PRICE Of WORK I'V�l IA IIw/ <br />DESCRIBE WORK AND SQUARE FOOTAGE INVOLVED F <br />FoLE sU11-v/A/G sQ. FT <br />PROPOSE D USE Of BUILDING <br />�RI VATL" G/{AnGL <br />LEGA. DESCRIPTION OP PPOLLPffER��TY 19NOWN BELOW OR ATTACH FOUR C�O/RE& <br />LOT_ BLOCKS OF �EVC 2L7 _ <br />1{ILL5 D1VIS/OAi <br />PROJECT ADDRESS <br />6gQ6 i3cimri IRC J?p, <br />PLUMBING <br />TYPE OF <br />TRAY <br />PERMIT 5 <br />TOTAL FEE <br />i <br />TEAR SETBACK <br />k.OT <br />AREA <br />Goo-17,Ao <br />FIRE SPRINKLERS RFMIKL <br />16 1�m <br />—17JJ <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND <br />KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS AND <br />ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLETED WITH <br />WHETHER SPECIFIED HEREIN OR NOT. [HE GRANTI NG OF A PERMIT DOES NOT <br />PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANYOTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PER- <br />FORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE OWNER OF <br />THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MAD: <br />AND I COMPLY WITH THE STATE CONTRACTORS LAW 10.27 RCW AND <br />298.200 WAVT10 <br />&ONATUPEOOPAUINOPIZED AGENT DALE <br />APPIIf,AN19 CITY B...... 9LIC EN AND BUSINESS NAME <br />MECHANICAL <br />NO. TYPE OF EOUIPMI <br />MC—A/HNDLG UNITS —H.P. <br />FORCED AIR SYSTEMS— ST.U. <br />UNIT HEATERS— BT.U. M <br />CLOTHES DRYERS <br />VENTILATION FAN <br />RANGE HOOD _ <br />WATER HEATER <br />WOOD STOVE <br />METAL FIREPLACE 6 CHIMNEY <br />FIREPLACE INSERT <br />HEAT PUMP <br />OAS PIPING <br />EXHAUSTFAN <br />1N CNft/NUMfeR I r[. 6 q <br />I �InN I LEI �. �, <br />BUILDING <br />PLUMBING <br />MECHANICAL <br />OTHER <br />STATE BUILDING SURCHARGE <br />STATE ENERGY SURCHARGE <br />PUBLIC WORKS <br />TOTAL <br />FEE <br />flnsAl- <br />