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.-�, <br />APPLICATICirI FOR CONSTRUCT�c�N PERMIT <br />IM Ewrpreen <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />259-8810 TO BE COMPLETED IN INK—PLEASE PRINT <br />❑ DEMOUTION ❑ COMBINATION �, BUILDING CI MECHANICAL <br />0�1�� NV.`Zy\�IMAIL�DFES��O �1L��PREC'.U���`��I�ET?1��LI�NE <br />TENMli MqILADDPE55 CITY ZIP PHONE <br />1� .1.� _O � 1 • � � � �(. ..��_�_ � %� . ..�..rl i� <br />.\PCHITECT <br />PLUMBINO GONTR�CTOB <br />LUSS OF WORK <br />❑ NEW ❑ ADDITION <br />� uti <br />MAIL ADDNE55 <br />� <br />M�IL ��URE55 <br />3R2�(• <br />M�IL �DDHE55 <br />1\ A <br />an <br />arv <br />Cltt <br />ZIP <br />21P <br />c <br />� <br />21P <br />PMONE <br />PMONE <br />5r4- <br />PHONE <br />PNONE <br />❑ PLUMBING <br />everett <br />� <br />❑ SIGN <br />I <br />� <br />i <br />LICENSE • <br />(UA1pI$C.SI$$ R[% <br />LICENSE I <br />LICENSE a <br />"ION I I REPAIR f I DEMOLITION I l WOODSTOVE/FRPL INSERT �I BUILDING RELOCATION <br />� TENANTIMPPOVEMENTORINTERCIOHPEMOOE•L^ONLV <br />� CONTMCT PRICE OF WORN: J). ���J �� <br />. DESCRIBE VIORK AND SOU�PE FOO AGE INVOIVED <br />. �-N�s�1 oFF iic�s;�4 R�,, r <br />� PROiO5EDU5EOFBUILDIN6 <br />��(-,c-ryUcr (Ze.T'v1; L <br />� LE6ALUESCHIPT OFPPOPER7Y�SHOWNBELOWOAA <br />� LOT �� Z"' BLOCK �__ OF � <br />� �i �� ��. � <br />vRaecr <br />� n� <br />TY^E OF <br />CLOSET <br />; SHOWER <br />NITCHEN SINK 8 DI; <br />1 OISHWASHER <br />' LAUNDRYTRAY <br />� CLOTHES WASHER <br />• UFINAL <br />� DRINKING FOUNTAIN <br />FLUOR DRAIN <br />� BAC;(FLOW PREVENTERS <br />� ROOF DRAINS—RAIt�LEADERS <br />� � SINK (SEFiVIi <br />i <br />� FflONTSETBICK <br />� }� jl 15i7 � 9 <br />USEZONE ,_ I <br />� C <br />� TlPEOFCDNSI�LLOWA6lE <br />, � �� <br />SIZCEOuFBLW, � <br />�M ��/�� <br />OLCUPANGtLOAO <br />� �^'�� <br />� REl50NFOR:iPRINNLERS <br />i <br />' APPLICATIONACC.BY <br />i ��� <br />'�t �1 �{ 0 6J�, <br />SUB TOTAL S � <br />PERMIT $ --r <br />TOTAL FEE S ' <br />REAR SETBACK SIOE SETBACK <br />�x•�s-r1.0 CKisT;.� <br />LOT FflE4 VACAN7 SITE <br />[. i 1lES I�O <br />iYPEOFCONSI.ACIUAL aCUP�Ar:r NOOrNHWx01 <br />_ - I lt'� i�'='�_ -6�.- <br />NO. UF STORIFS <br />RRF. SPfl�Nl5R5 f7E0'0 <br />❑ YES yXNO <br />PIANSAPP VEDBV <br />BRSEMENT <br />f 1 YPS I' <br />PEfISON AND PHONE NO. <br />, Lu,Jci_ 25R" <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME T`J BF TRUE AND COflRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCC:S GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETEO WITH WHETHER SPECIFIED HEREIN OR �. <br />NOT. THE GRAIJTING OF A PFRMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY ��.. <br />OTHER STATE OR LOCAL LAW RF.GULATING CONSTRUCTION OR THE <br />PERFOflMANCE OF CONSTflUCTIOPJ. THAT I AM AUTHORIZED BY THc <br />OINNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICA7�ON IS MADE AKD I COMPLY WITH THE STATE <br />CONTFAG?ORS LAW 1827 r�CW AND 296.e00 WAC. <br />SIGNATUREOFCONTRRCT OHAUTHOFRED�GENT DATE <br />x � ��/��i� �-' �l <br />NO. AND BUS�NESS NAME <br />E�UIPMENT <br />FORCED A1R SYSTEMS—B <br />UNIT HEATEqS—O.T.U. M <br />CLOTHES DRYERS <br />WOOD STO\ <br />METAL FIRE <br />FIREPLACE <br />HEATPUMP <br />( FEES <br />BUILDING <br />PLUMB�NO <br />HEIGHTLIMITATION '• �"� <br />�— ._ Bl11LDING SURCHARGE <br />STATE ENEflGY SURCHARGE <br />CI7Y OF EVERETT PUBLIC WCRKS <br />L6CALSALES <br />TAl( CODE IS 3105 70TAL <br />SUBIOTAL <br />�ERMiT <br />TOTAI FEE <br />FEE /� / � '�'7 <br />/ / .JJC- <br />t t <br />E.A. <br />$ <br />/ <br />Xp <br />N <br />