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APPLICATIO�:'�FOR CONSTRUCTI�.N PERIVII'T <br />Tn RF C(1MP1 FTFII IN INK—PLEASE PRINT <br />fne CVBIp/aun <br />CITV OF <br />everett � <br />BUILDING DEPARTMENT <br />259•8810 <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />1 <br />everett <br />� <br />❑ DEMOLITION I.7 COMBINATION i I BUILDING I�CHANICAL O PLUMDING ❑ SIGN <br />OWNER MA 'AO�RESS CITV ZIP PHONE <br />� � � ii - ' -e:. ['=-C ' <br />TENANT MAI� AO RE55 CITY ZIP ' PMO <br />ARCHITELT OF DESIGNER MAIL ADORE55 CITY ZIP PMONE <br />GENERQCONTRACTOR MA'ILaAD�RE55 CITV ZIP PMONE LICENSE� <br />� . 1 _ _ �.. �n r-f / . /'7.. e i <br />ME�RISFltiCACZ�dNTfLACfidH p� IfAILADORESS QTV ZIP PMONt uGGrv�t■ <br />J� �.S � �.c.�t u.L7 �x[.�' �1 r�- Gtt�Zl t� `�l ��-o D' �'`T,5 - 3 3�3 / CU�I sti �n'6' a.85 CtZ <br />FIUMBINO CONTRACTOR MAIL pDURESS CITY ZI" PHONE UCENSE � <br />CUSS OF WOflK�� <br />❑ N[W ld ADDITION O ALTERATION I I REPAIR I I DEMOLITION I l WOODSTOVE/FRPL INuERT ❑ BUILDING RELC'•ATION <br />1 '— CONTACT PERSON AND PMONE NO. � <br />I7.. <br />Fv�� ���¢ <br />PflOP0.5E0 USE OF BUILDIN� <br />Q� <br />lEOALDESCflIPTIONO PHOPE <br />�OT BLOLN <br />TYPE OF <br />. <br />SHOWER <br />KITCHEN SINK & DISP <br />FOUNTAIN <br />FOR OFFICE USE ONLY: <br />USEZONE <br />OCCUPANCYLOAD <br />INTANE BY <br />OF <br />TOTAL <br />I HEREBY CERTIFV THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE ANU CORRECT. ALL ��� <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNIN6 THIS TVPE OF � <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY �� <br />O fHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORRED BY THE , <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH � <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTflACTORS LAW 18.27 RCW AND 296200 WAC. <br />SIGNnTUREOFCONTR�CTOflOflAUTH EDAGENT DATE <br />X � �-2Z-g/ <br />G <br />APPLtCANTS CIN BIISINESS UCENSE NO. AND BIl51NESS NAME � <br />FEE NO. TYPE OP EOUIPMENT <br />� /VC-AMNDLG UNITS-H.P. <br />; FORCED AIR SYSTEMS-B.T.U. M <br />--� 11NIT HEATERS-B.T.U. M <br />RANGEHOOD <br />WATER HEATER <br />WOOD STOVE <br />METAL FIREPLAi <br />FIREPLACEINSF <br />HEAT PUMP <br />GAS PIPING <br />EXHAUST FAN <br />HEAR SET011CK SIDE SETBACK PLAN GNECK NUAIBER FEE <br />LOTAREA VACANTSITE FEES <br />BUILOING <br />TVPE OF CONST ACTUAL OLLUF�MCY HO Oi PMIIIN � IINRS <br />cna> pLUM81NCa <br />NO.OF STORIES BRSEMENT MECHANICAL <br />LIflESPHNNLER5PE0'D MEIGNTLIlAITATION ADDITIONALPLANCHECK <br />OTHER <br />oInTE BUILOING SURCHARGE <br />PLANSAPPf10VEDBY CITY OF EUEREIT PUBLIC WORKS <br />LOCALSALES <br />TAX COUE IS 3105 TOTAL <br />SUB TOTAL $ �_ <br />PERMIT S � � <br />TOTALFEE $ .�D!— <br />i <br />i <br />