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(�" 1 w;,., <br />APPLI�ATION�'FOR CONSTRUCTIIyr�l PERIVIIT <br />fhe Everyreen <br />CITY OF <br />everett <br />BUILDING DEPARTMENT TO BE COMPLETED IN INK—PLEASE PRINT <br />259-8810 <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING �i MECHANICAL <br />OWNEfl MAILAD�RE55 CITV ZIP PHONE <br />STr�lc � s h� us �7�s r�vr�g���m �t �d'1p� <br />TENANT MAI AODRE55 CITY ZIP PHONE <br />AfiCHITECTOHDE514NEfl MAILADDRESS CITY ZIP PHONE <br />GENEMLCONTRACTOR MAILADOflEuS CIN ZIP PHONE <br />� <br />:TOR FIAILADOPE55 ' <br />L Ivl �'S?jr'�S /� 3.�5� 2 0�- �v <br />CONTRACTOR <br />MAIIADOPE55 <br />arv <br />�,� <br />5��� L�ln�. <br />❑ PLUNiBING <br />� <br />everett <br />e <br />fl SIGt� II <br />II <br />LICENSE / <br />IC NSE / <br />-p � <br />IHkT/rL NI � <br />LICENSE / <br />�NEW V❑ ADDITION ❑ AL7ERATION ❑ REPAIR ❑ DEMOLITION O WOODSTOVE/FRPL INSERT ❑ BUILDING RELOCATION <br />TENANTIMPROVEMENTORIMERIOflREMO�ELONLY � O� CONTACiPER50NANOPHONENO. � <br />[:oNTRACTPflICEOFWORK: JJ.Z.O � <br />0 <br />lEOAL UESCPIPTION OF PROPE <br />�p7 B�OCK <br />TYPE OF <br />LAVATORY(WASH BA: <br />SHOWER <br />KITCHEN SINK & DIS° <br />DISHWASHER <br />IAUNDRYTRAY <br />CLOTHES WASIIER <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVEN' <br />ROOF DRAINS-RAIN <br />SINK (SERVICE-BAF <br />j FflONT5ET8ACK <br />{ USEZONE <br />� NPEOFCONSLALLOWAOIE <br />! <br />� 6REOFBLIX3. "� <br />, OCCUPANCYLOAD <br />�REASON FOR 6PRINKLERS <br />� APPUCATIONACC.BY <br />BELOW OR AT7ACH <br />OF <br />�bcrt wq, <br />SUB TOTAL $ � <br />PERMIT $ —r <br />'(OTAL FEE S ' <br />REARSETBACN SIDESETBACK <br />LOTAREA VACANTSITE <br />❑ YES ❑ NO <br />TYPEOFWNSi.ACiURI OctuvuKr xO.aiVMuiXai <br />GRWP <br />NO.OF STORIES BASEMENT <br />❑.YES ❑ NO <br />FIPESPRNKLENSf1E0'0 riEIGNTLIMITATION <br />❑ YES ❑ NO <br />PLrWS APPHOVED BY <br />CITY OF EVERETT <br />LOCALSALES <br />� TAl( CODE IS 3105 <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS Of ! AWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVt <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONST(�UCTION. THAT I AM AUTHORIZED BY THE <br />GWNER OF THIS PROPERTY TO PEflFORM THE WORK FOR WriICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />SIGNANREOPCONTRACTOfiORAUTHORIZEDAOENT DATE <br />X <br />APPLICANTS CI1V BUSIkES$ LICENSE NO. AND Bl15MESS NAME <br />mc�.nniv�..... <br />NO. TYPE OF EOUIPMENT <br />AIC-A/HNDLG UNITS-H.P. <br />FORCED AIR SYSTEMS-B.T.U. M E.A. <br />UNIT HEATERS-B.T.U. M <br />CLOTHES DRYERS <br />VENTIIAT�ON FAN <br />WATER HEATER <br />WOOD STOVE <br />METAL FIREPLACE 8 <br />FIfiEPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN <br />PLANCHECKNUMBER <br />BUILDING <br />PLUMBINO <br />MECHANICAL <br />OTHER <br />STATE OUILDINCa SURCHAROE <br />STATEENERGYSURCHARGE <br />PUBLIC WORKS <br />TOTAL <br />FEt <br />SUBTOTAL $ "— I��' <br />PERMIT S � '-' � <br />TOTALFEE S '-� <br />FEE PECEIPTNO. <br />VALUATION FEE <br />i <br />i <br />i <br />� <br />�✓i <br />�"1i i <br />� <br />� <br />�•^�-.�+-1,....., s-Tr..�-.-e..�-r-l_c:..3�F:r:4.r,+T�.7:. r.�^;-..�.'r.•"._-" .. . . ....... . .�:-�'-.,T.+,--�-^�'G�:."�'_nL•�.�.n�.� <br />