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r��a ,v.,,, <br />AIPPLICATION FOR CONSTRUCTION PERMIT <br />Iho Evorgmon <br />CIiV OF <br />everett <br />BUILDING DEPARTMENT <br />259-8810 <br />TO BE COMPLETED IN INK—PLEASE PRINT <br />C] DEMOLITION ❑ COMBINATION <br />MAIL �ODfiE55 <br />❑ BUILDING <br />cin <br />everett <br />� <br />�MECHANICAL �3-e�#►�+IB1NG ❑ SIGN <br />ZIP PHONE <br />9'`�CfJCo �'�D-�' Z�, ej 31t <br />IENANT � I' nMAILADOHESS CITV ZIP PMONE - <br />�"crr.(� y- Sr�u�C< <br />A(IGHITECT OR �ES�GNEA 1 MAIL AOORESS CITV ZIP PHONE <br />GEtlEilA�CONiRACTOR MAILA�OIlE55 CITV ZIP PIIONE LICEHSEk <br />MECHA�S Nl�_P�j ��-HDflES���L���N`rCIT����Zl��n �^ ��� LICENS�m11C�� <br />]��yp NC h .0 J <br />PWIA�IN6CONTMCTOfi MAIIA��(1E55 CIfY 21P PIIONE LICENSER <br />��A YVl C <br />CLASS OP WORN <br />❑ NEW ❑ ADDITION � ALTERATION O REPAIP [ 1 DEMOLITION l7 WOODSTOVE/FFiPL INSERT ❑ BUILDING RELOCATION <br />TENANT IMPflOVEMEIlT OR IN7 ERIOR REMODEI ONLV <br />CONipACiPRICEOFWORK: ��(��� <br />lOPN ANO SOUAPE <br />US�E O 8 ILO� <br />Pf10PEflTY (SHO\YN OEIOY/ OR ATTACfI <br />l0T OLOCK OF <br />reaecr <br />TYPE OF FIXTURE OR ITEM <br />BATHTUB <br />LAVATORY <br />SHOWER <br />DISHWASHEF <br />LAUNDRYTRAY <br />URINAL <br />DFlINKING FOUNTAIN <br />FLOOR �RAIN — �,..,�,p <br />BACKFLOW PREVENTERS <br />ROOF DRAINS—RAINLEAC <br />SINK (SERVICE—BAR, ETC <br />FiIONT SETBACK <br />SUB TOTAL� <br />PERMIT $ <br />TOTAL FEE $ <br />REAfI SETBACK SIDE SET�ACK <br />USEZONE I LOTAREA <br />TYPEOPCONSLALLOW�BIE I TYFEOFCONSLACIOAL <br />s2e oF o�oc. <br />OCCUPANCVLO�D <br />flE�SON FOR SPNNNLERS <br />NO.OF STOfiIES <br />FIfiE SPFNKlERS f1E0'D <br />❑ YES ❑ NO <br />vncnNrsrce <br />❑ YES ❑ NO <br />ocaraxc xoormvnuxruxns <br />6AOUP <br />OASEMENT <br />O.YES ❑ NO <br />HEIGHT LIMITATION <br />nPrucnncr+ncc.or a�nnsnarnoveonv CITYOFEVERETT <br />�� LOCAL 5.",lES <br />� C,cJ TAX COUE IS 3105 <br />�/Z � 1'� 2. <br />CONTdCT PEPSON ANO PHONE NO. <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TPUE AIJD CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIF�ED HEREIN OR <br />NOT. THE GRANTING OF A PEFMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAI LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONRTRUCTION. THAT I AM AUTHORIZED BV THE <br />OINNER OF THIS PRO'- _RTY TO PERFORM THE WORK FOR WHICH <br />APPIICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 1827 RCW AND 296.200 WAC. <br />SIGNATUREOFCONTRACTORORAUTHOFlIZEUAGENT DATE <br />�I1'1-a''�'7�����'�.--,� l�lc�go <br />Xep ws�oAas �r -�.���� ,��� <br />APPLICANiS CITY BUSINESS LICENSE NO. AN� DUSINE55 N�ME <br />MEGHANIGAL <br />!O. TYPE OF EQUIPMENT FEE <br />L NC—NHNDLG UNITS—H.P. <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />UNIT HEATERS—B.T.U. M <br />CLOTHES DRYERS <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />WOOD STOVE <br />METAL FIREP CE & CHIMNEY <br />FIREPL/10E INSERT <br />HEATPUMP <br />GAS PIPING <br />EXHAUSTFAN <br />SUB TOTAL $ '�/ <br />PLANCHECKNUAI�EA FEE <br />FEES <br />BUILDING <br />PLUMBING <br />MECHANICAL <br />OTHER <br />STATc BUILDING SUPCHARGE <br />ST/,TE ENERGY SURCHARGE <br />�UBLIC WORKS <br />TOTAL <br />TOTAL FEE $ � <br />RECEIPT NO. <br />VALUATION I FEE <br />L <br />