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e <br />u <br />u <br />�`.`.� �(;`:°,� <br />APPLICATIii(� FOR CONSTPtUCI-rVN PERrVIIT <br />ma e�reroree� <br />cirv oF <br />everett <br />BUILDING DEPARTMENT <br />259-8810 TO BE COMPLETED IN INK—PLEASE PRINT <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING � MECHANICAL <br />py,M q MAILAODRESS � /JCIiV 21P PHONE <br />i.l � i S �� M1 SG /.�P��U(J..�E� i�OUiD <br />�..-T �inn ennoocc CITY 21P PHONE <br />❑ PLUMBING <br />F� <br />everett <br />� <br />❑ SIGN <br />0 <br />ARCHRECTOROESIGNER MAILADDRESS CITY ZIP PHONE <br />OENERALCONTfiACTOF MAILAUDRESS CITY ZIP PHONE LICENSEII <br />MECMANICALCONTRACTOfl MAILAODRESS CITY 21P PHONE LICENSE/ <br />P UMOINOCON RACTOfl MAILADLRE55 CITY ZIP PHONE LICENSE� <br />�,//.; �/�i� i�o3ox S�al l;�nnu�000L 9Z��� 7�/3-y9�lc� 6�.cLs��v�a� <br />CLAuS 0F WORN <br />❑ NEW ❑ ADDIT�ON ❑ ALTERATION ❑ REPAIR O DEMOLITION ❑ WOODSTOVFJFRPL INSERT ❑ BUILDING RELOCATION <br />TENANT IMPNOVEMENT Ofl INTEfiIOR REMODEL ONLV CONTACT PERSON AND PHONE NO. � <br />CONTRACT PRIGE OF WORK' <br />oE.SCHIBE WOflK ANO SOUAqE FOOiA�E INVOLVED <br />LEOAL �ESCflIPTION OF PROPERN (SHOWN BELOV <br />LOT BLOCN OF <br />iQ1ECTADDRE55 <br />%lv0/ �11+��,�e <br />PLUMBING <br />N0. TYPE OF FIXTI <br />WATEF CLOSET (TOIL <br />BATHTUB <br />LAVATORY(WASH BA: <br />SHOWER <br />KITCHEN SINK 8 DISP <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DfiAIN <br />BACKFLOW PREVENTERS <br />ROOF DRAiNS—RAINLEADERS <br />FPONT6EiBACK <br />iUSEZONE <br />I IYPE aF CONSL AILOWABLE <br />� 6REOFBLO(3. ' <br />. OCCUPANCYLOAD <br />PEASON FOR SPRINNLEqS <br />SUB TOTAL S <br />REAR SETBACK <br />l0T AREA <br />TYPE OF CONSi. RCIUAL <br />NO.OF STOfiIES <br />O YES ❑ NO <br />APPLICATIONACC.BY I PlANSAPPROVEUBY <br />COPIE5) <br />FEE <br />I HEREBY CERTIFY THAT I HAVE FlEAD AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AtJD ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE C01dPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OFi CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTFUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY � Ht <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHIGH <br />APPLICATION IS MADE AND I COMPLY WITH THE STAIE <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />SIGNATUflEOFCONTflACTOF70RAUTHOFIZEDAGENT OATE <br />X <br />APPLICANTS CITV BUSINE55 LICENSE NO. AND BUSINESS NAM� <br />I�AECHANICAL ' <br />JO. TYPE OF E�UIPMENT FEE <br />A/C—AIHNDLG UNITS—H.P. �_ <br />FORCED AIR SYSTEMS—B.T.U. M E.A. ' <br />UNIT HEATEtiS—B.T.U. M � <br />CLOTHES DRYERS ! <br />RANGEHOOD <br />WATEfl HEATER <br />WOOD STOVE <br />METAL FIREP:ACE 8 CHIMNEY <br />FIREPLACEINSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN <br />SIDESETBACH PLANCHECKNUMBEfl <br />VACANTSITE FF.ES <br />❑ YES ❑ NO BUILDING . <br />OGCUPANLV NO.OfpWElUM00Hli6 <br />CAWP PLUId81NG <br />BnSEMENT h1ECHANICAL <br />❑ YES ❑ NO <br />HEIGHTLIMITATION OTHER <br />STATE BUILDINO SURCHARGE <br />STATEENERGYSURCHARGE <br />CITY OF EYERETT PU�LIC WOqKS <br />LOCAL SALES <br />TAX COD� IS 3105 rorn� <br />SUB TOTAL $ <br />PERMIT $ <br />TOTALFEE $ <br />FEE RECEIPTNO. <br />VALUATION <br />,,.., , ,� -- <br />*n:<:: -._, �.: �.; w . s;,,��:::::: � • ._ �,.� :,�. _ <br />