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�� �''� � <br />APPLICATI��N FOR CONSTRUC � ON PEF3MIT <br />fhe Eveipreen <br />CIN OF <br />everett <br />BUILDING DEPARTMENT TO BE COMPLETED IN INK—PLEASE PRINT <br />259•B810 <br />❑ DEMOLITION ❑ COMBINATIOIV ❑ BUILDING �MECHANICAL <br />OWNEfl MAIIADORESS CIN ZIP PHONE <br />' '� db�p �y.1,E - 99CCJCn � '�— <br />everett <br />e <br />PLUMBING ❑ SIGN <br />V vs � s 13a�-,d,A,.� S� u �d <br />TENALNT'_ MAILALCflESS CITY ZIP PHONE 1� � . <br />Jf� �1- SOU�< — f '� <br />APCHITECTOflDE51GNER MAILADOPESS CIiY ZIP PHONE ', <br />I <br />OENERALCONTPACTOF MAILAOOBE55 CITV 21P PHONE LICENSEI i <br />MECHANICALCONiRACTOR MAILAODRE55 CITV ZIP PHONE LICENSEp <br />_ _ �_ _ '. _ ' _ _ ' —''_ <br />MAIL <br />cin <br />PHONE LICENSE! <br />��iYYI r^ <br />cuss oF wonK <br />n.i��u f'I enninnnl Srf AI TFRATION fl REPAIR ❑ DEMOLITION ❑ WOODSTOVFJFRPL INSERT ❑ BUILDING RELOCATION <br />TENANT IMPROVEMENT Ofi INTEflIOR FEMODEL ONLV <br />� _. _ c7 <br />DESCRIBE WOFlKAND SOUARE FOOTAGE <br />LEOAL DESCRIPTION OF PROPERN (SHOWN BELO� <br />LOT BLOCN OF <br />rAaecr <br />WATER CI <br />BATHTUB <br />DISH\VASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAI <br />FLOOR DRAIN — l <br />ROOF <br />j FRONTfiETBACK <br />� <br />� USEZONE <br />i�TYPEOFC9NSLAlLOWABLE <br />1 <br />i _ <br />� SRE OF BLD(3. ' <br />i <br />� � OCCUPANCYLOAD <br />• REASON FOR SPRINKLEPS <br />� APPLICATION ACC.BV <br />OR <br />SUB TOTAL 5 <br />PERMIT 5 <br />TOTALFEE $ <br />pEARSE?BACY, SIDESET6ACH <br />LOTAHEA <br />TYPE OF CONSi. M1CiWI <br />NO.OF STORIES <br />FIflE SPRNKLERS FE�'D <br />❑ YES ❑ NO <br />PLANS APPROVED BV <br />VACANT SITE <br />❑ YES ❑ NO <br />pttll>AN4Y NO.OfOWflLiN01 <br />OROIIP <br />BASEMENT <br />❑ YES ❑ NO <br />MEIOHT LIMITATION <br />CITY Of EYERETT <br />L(1CAL SALES <br />TAX COUE IS 3105 <br />CONTACT PERSON AND PHONE NO. <br />.�w _ i <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PFOVISIONS OF LAWS AND OFl�INANCES 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 GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT i AM AUTHORIZED BY THE <br />OWNEFi OF THIS PROPERTY TO PERFORM THE WORK FOfl WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTflACTORS LAN' 7827 HCVJ AND 296.200 WAC. <br />SIGNANREOFCONTflACTOROflA THOFIZEDAG NT O�TE <br />�(l�.a,,,,,,7�� • 11�q0 <br />XC�SRo � � <br />APPLICANTS CITV 9USINE55 LICENSE NO. AND BUSINESS NAME <br />FORCED AIR SYSTEMS—B. <br />UNIT HEATERS--B.T.U. M <br />CLOTHES DRYERS <br />VENTILATION FAN <br />RANGEHOOD <br />WOOD STOVE <br />METAL FIREPLACE ! <br />FIREPLACE INSERT <br />GAS PIPING <br />EXHAUSTFAN <br />SUDTOTAL $ <br />PLANCHECKNUTABER � FEE � RECEIPTNO. <br />BUILDINO <br />PLUMBINO <br />MECHANICAL <br />OTHER <br />STATE BUILDINO SURCHARGE <br />STATEENERGYSURCHARGE <br />PUBLIC WORKS <br />TOTAL <br />