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APPLICATIOti' FOR CONSTRUCTI✓N PERMIT everett <br />TO BE COMPLETED IN INK —PLEASE PRINT j <br />rho Evergroon <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />259.8810 <br />n DEMOLITION 17 COMBINATION <br />OWNER CASL,'A'E MAILADDRESS $J�T(c °iGn I CITY <br />L�bFr/ 1321"SF <br />yy <br />TENANT MAIL ADDRESS CITY <br />-77e'T krlyFr2t <br />CITY <br />ARCHITECT OR OESICNER MAIL ADDRESS <br />MAIL <br />HEATING SYSTEM: ❑ GAS 0 ELECTRIC Ci <br />I I BUILDING I 1 MECHANICAL PLUMBING <br />ZIP <br />!v <br />Z'P <br />✓. <br />ZIP <br />r� CITY ZIP <br />64 b4gF, tip: LN,�r <br />CITY ZIP <br />PHONE <br />(o Y3 V3oc) <br />PHONE <br />n c.. _Cu ? i <br />0 <br />LICENSE M <br />17 SIGN <br />FRACTOR MAIL ADDRESS TY,QO¢ CITY ZIP Ynunt <br />CClNYZ ?f/t(C(�2 /3YJG 5r` 27 jlC OELC'f'C'r= %�% 9i/ �391 Loih!>rESG /23 �C <br />=7 DEMOLITION ❑ WOODSTOVEIFRPL INSERT F3 BUILDING RELOCATION <br />❑ ADDITION 1-1 ALTERATION Cl REPAIR 1 <br />CONTACT PERSON AND PHONE NO. <br />4-IIIE-1121 <br />PROPOS USE OF BUILDING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />e PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />LEGAL DESCflIPTION OF PROPERiY1SF10WNBEL WOR ATTACH FOUR COPIE�I WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />L.E BLOCK of NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />SIGNATURE OFF CONTRACTOR OR <br />AAAUTHORIZED AGENT DATE <br />X <br />P3QIECT ADDRESS APPLICANTS CITY BUSINESS LICENSE NO. AND BUSINESS NAME <br />NO. TYPE OF FIXTURE OR <br />8 <br />AIR SYSTEMS—B.T.U. M E.A. <br />LTERS—B.T.U. M <br />METAL FIREPLACE 8 <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN <br />—I <br />SUBTOTAL <br />TOTALI FEE <br />$ r ' — <br />$ 1 / � <br />iaun <br />wln� <br />PERMIT <br />TOTAL FEE <br />$ <br />$ <br />FOR OFFICE USE ONLY: <br />RECEIPT NO. <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBERFEE <br />FEES <br />VALUATION <br />FEE <br />USE ZONE <br />LOTAREA <br />VACANT SITE <br />1 <br />BUILDING <br />TYPE OF CONIS. ALLOWABLE <br />TYPE OF CONST ACNAI <br />OCWPA.1 no ov oADuu0urvu5 <br />GPWP <br />PLUMBING <br />SIZE OF BLDG. <br />NO. OF STORIES <br />BASEMENT <br />MECHANICAL <br />I <br />ADDITIONAL PLAN CHECK <br />OCCUPANCY LOAD <br />FIRE SPRINKLERS PEOD <br />HEIGHT LIMITATION <br />-- <br />OTHER <br />REASON FOR SPRINKLERS <br />STATE BUILDING SURCHARGE <br />PUBLIC WORKS <br />i <br />INTAKE BY <br />PLANS APPROVED BY <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />TOTAL <br />