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APPLICATIOrrr FOR CONSTRUCTIr�►N PERMIT everett <br />�E�� TO BE COMPLETED IN INK—PLEASE PRINT � <br />cm oF <br />everett �- <br />BUILDING DEPARTMENT <br />259-8810 <br />0 DEMOLITION ❑ COMBINATION <br />�� <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />❑ BUILDING ❑ MECHANICAL <br />cm ��r <br />� ,,. �O / <br />PMONE <br />PLUMBING ❑ SIGN <br />,G �,� �2�Ds <br />l./� _ . � n � <br />�RCXITECT OR DESIGNtn ��� w�^'-�^' <br />MAILADDRESS CITV ZIP PHONE LICENSEI . <br />OENEML CONTN�CTOR . <br />��Hµ�/�LCONTq/�CTOR IMILADDflESS <br />CITY ZIP PHONE LICENSEI �. <br />. _. �.., vunuo LICENSE� <br />f � <br />G OF W�fll( � <br />❑ NEW ❑ ADDITION <br />80UARE <br />ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVFJFRPL INSERT ❑ BUILDING RELOCATION <br />CpNTACT PERSON AND PMONE NO. <br />LOT BLOCK OF <br />�: •�:idl <br />SHOWER <br />KITCHEN SINK <br />FOR OFFICE USE ONLY: <br />r FHONTSETBACK REARS <br />e <br />USEZONE LOTAR <br />' TYPEOFCONTS.�LLOW�bLE lYPEOF <br />d <br />SIZE OF BLDO. <br />i OCCUPANCYLOAD <br />RFA$ON FOR SPflll <br />INTAKE BY <br />FIRE <br />TOTAL <br />I HEREBY CERTIFY THAT I HAVE READ AND E%AMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TVPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE 6RANTING OF A PERMIT DOES NOT PRESUME TO QIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OP ANY <br />OTHER STATE OR LOCAL LAW REGULATIN6 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 1827 RCW AND 296200 WAC. <br />SIGNANRE OF CONTRACTOR Ofl AUT110NIZED A6ENT DATE <br />X ��.. _ _ � /�/3�! / <br />._ ..�...... e�mmceciiccucr.No. SI SSNAME <br />FORCED AIR SYSTEMS--B.T.U. M E.A. <br />I INI7 HEATERS—B.T.U. M <br />FAN <br />� I I HEAT PUMP <br />8 <br />VACANT SITE r�w <br />BUILDING <br />ocwvaxc xo.o�rtxcuixcuxirs <br />�ROUP PLUMBING <br />BASEMENT MECHANICAL <br />MEIGHT LIMI7A7ION ADDITIONAL PUN CHECK <br />OTHER <br />STATE BUILDING SURCHARGE <br />C LOCAL SALES PUBLIC WORKS <br />TAX CODE IS 9105 roTAL <br />SUB TO' <br />PERMIT <br />0 <br />a <br />