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H (� "t+9 <br />� C^ <br />y <br />C H <br />� H N <br />y � H <br />O y O <br />� N M <br />� H � <br />O M <br />a n o <br />� :' R <br />� H � <br />N H <br />N <br />O N <br />C C <br />��y �y � <br />H O N <br />J, '1 \� <br />��' t " <br />APPLICATIOIVI FOR CONSTRUGT�.�N PERMIT ��«e1 <br />ma[�-e.preen TO BE COMPLETED IN INK—PLEASE PRINT � <br />CITV Of <br />everett HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />BUILDING DEPARTMENT <br />259-8810 <br />DEMOLITION COMBINATION ,X BUILDING MECHANICAL 7 PLUMBING SIGN <br />OWNEN 1AAiLADDRE55 Gil' ZiP PHONE <br />/ <br />�i�� /�'1���� A� ii ��,�i," ir� �.i�� in�ii., 0��� �. �j ^.cf--'( <br />TENNIT �/ 4ULLADDRE55 . CITv ZiP PHONE <br />RfiCNITECTO{IDESIGNER MAILADDRESS �iry zip pH�E <br />GENEIULCONTPACTOR MAILMDqE55 � CITY zlP P�IpiE LIGENSE/ <br />/� � <br />�� �<n�� R-:...��.... � /UC _'7i" � �,i �Y '�'., .. !J �A'l:fi ..�., , ... . ... .. _ ,. _ .i. . :� <br />��P -PHOHE UCENSE <br />PLUMBttiGGONTiULiOR MALLADWiE55 C�iV ZIP PIqNE 4CENSE� <br />..- NEW .. ADDITION _i ALTERAiION iC REPAIR .�: DEMOLITION C: WOpDSTOVE/FRPLiNSERT G BUILDINGRELOCATION <br />n CONTACTPERSpNANDPHONENO. <br />LOHTR�LTPRIGEOFWOPK � �ipL(I�I,/��) <br />DESCHIBE WORN AND SW�ViE FOOTAGE IM'OIVED <br />LOT �.����-I5�'g�p[K F � OF _ <br />.�/�/��715 eiCll� �/' �/f <br />i�cc `� 3,�?�y-i�f/ -ill3 - <br />PROJ[CiApDRE55 <br />/' <br />✓1)��i��" �i[) 'i. <br />BING <br />TVPE OF FI%TURE OF <br />WATER CLOSET �TOILET) <br />BATHTUB <br />LAVATORY�WASH BASIN) <br />SHOWER <br />KITCIIEN SINK 8 DISP <br />DISHWASHER <br />LAUNDRVTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />� $UB <br />PER <br />TOT� <br />FOR OFFICE USE ONLY: <br />FRONTSETBRCN qEM SETBAGK <br />USE20N[ LOi�qER <br />tYCEO(CONiSAILOWABIE h'PEOiLOHSi.ALTII�L <br />52[ OF OLDG. NOAF STORiES <br />OCCUPANCVLOA� FlRESPRNKLER'. <br />RE�SON FOR SPRMKLERS <br />iNinKEOY PUNSAPPROVE <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />FouqcoviEsl PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS 7YPE OF <br />� WORK WILL BE COlAPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUTAE TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL TNE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHOR12ED BY THE <br />r�/ OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTOAS LAW 18.27 RCW AND 296.200 WAC. <br />SKaNATUREOFGONTRACTOqORAUiHOfjIZE0A6ENT DATE <br />VACNiTSItE <br />occu>��r xaawrtwxcurrts <br />LPWP <br />BASEMEN7 <br />HEIGMi LIMIiATION <br />CITY Of EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />TYPE OF <br />N�AMNDLG UNI' <br />FORCED AIR SYST[ <br />UNIT HEATERS—B: <br />CLOTHESDPYERS <br />VENTILATION FAN <br />RANGEHOOD <br />WATERHEATER <br />VJOOD STOVE <br />METAL FIREPLACE � <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />E%HAUSTFAN <br />NUMOEP <br />FEES <br />6UILDING <br />PLUMOING <br />MECHANICAL <br />ADDITIONAL PLAN CHECK <br />OTHER <br />STATE BUILDING SURCHARGE <br />aueuc wor+Ks <br />TOTAL <br />FEE <br />)TAL $ <br />f 5 <br />FEE $ <br />RECEIPi NO. <br />fION FEE <br />/1J.3 �5 � <br />