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" APPLICATIO� FOR CONSTRUCT�N PERMIT <br />.M�e EerDreen <br />TO BE COMPLETED IN INK-PLEASE PRINT <br />CITV OF <br />�' everett HEATING SYSTEM: O GAS ❑ ELECTRIC ❑ <br />BUILDING DEPARTMENT <br />� 259-8810 <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING <br />I`�QyOrtdEq MALL�DDRESS CITV ZIP PHONE <br />`�� T U(m�cT �� e ltw�t�n+�i .,..,�� <br />. �N/�{ MAIL�DDHESS ��TY ��r <br />�RCHRECTORDESIGNEfl MAILADDBESS . CITY ZIP PHONE <br />GENERiV.CONTRACTOR MAILADDPE55 GITY ZIP PHONE LICENSER <br />MECHANICALCAIITRACTOR MAILADOflESS CITY ZIP PHONE LIGENSEI <br />� T��Z R��� /��v sbv41 r��s�—�E4�nncniQ �1`bo5� 4,1�1-/al't4, 'T�•� <br />_..................a......o wn �nnn[a.c CITY ZIP PNONE LICEN5E• <br />everett <br />e <br />❑ SIGN <br />❑ NEW •V ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION � WOODSTOVE/FRPL INSERT ❑ BUIIDING RELOCATION <br />%% CONT�CT PERSON AND PXONE NO. <br />.� .��. _ /A %i7i� /_ " "..�. �n �.`Z. crJ n..\ R/PI — L�\isi <br />�GTGL�iCP''p <br />LEMLDESCNIPTIONOFPROPERTY(SHOWNBEL ORATT�CHFWRCOPIES� <br />LOT BLOCN OF <br />a�� <br />UIVATORY <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />LAUNDRYTRAV <br />FLOOR DRAIN <br />SINK <br />� FOR OFFICE USE ONLY: <br />4 <br />r FRONTSETBACK RE�RSETI <br />� USEZONE LOTAREA <br />AILOWAeLE <br />� SIZE OF BLDG. <br />OCCIIPANCY L <br />PEASONFOR: <br />INTANE BV <br />� - � <br />NO.OF <br />(TEM <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNINO THIS TYPE OF � <br />WOflK WILL BE COMPLETED WI?N WHETHER SPECIFIED HERcIN OR e <br />NOT. THE GRANTING OF A Fth'tw� � DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY 4, <br />OTHER STATE OR LOCAL U1W REGULATING CONSTRUCTION OH THE . <br />PERFORMANCE OF CONSTHUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH � <br />APPLICATION IS MADE AND 1 COMPLY WITH THE STATE <br />CONTRACTORS LAW 1827 RCW AND 296200 WAC. � <br />SNiNATURE OF CONTRACTOF OR �UTMO:��iED AGENT OATE ' <br />X /�n;,� _/._/�� <br />rrPe <br />UNIT <br />CLOTHES DRYERS <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />WOOD STOVE <br />HEAT PUMP <br />GAS PIPING <br />TOTAL $ <br />d1T $ <br />REO'D <br />SIOE SETBRCK P� <br />VACANT SITE <br />�B.T.U. <br />M <br />8 CHIMIJEY <br />BUILDING <br />acuvu¢v xaawrtuixcuxrts <br />GPWP PLUMBING <br />BASEMENT MECHANICAL <br />NEIGHT LIMITATION ADDITIONAL PLAN CHECK <br />OTHER <br />STA'E 6UILDING SURCHARGE <br />CITY OF EVERETT PUBLIC WORK3 <br />LOCALSALES <br />TAX CODE IS 3105 ror�� <br />TOTAL <br />a <br />0 <br />