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1 <br />' fn�t�A� l,�:,'. <br />? APPLICAT14��i�1 FOR CONSTRUCTri�N PERMIT <br />i� , <br />n» Ew�n,s.� everett <br />CI7V OF e <br />i everet# <br />� BUILDING DEPARTMENT <br />� 259-8810 TO BE COMPLETED IN INK—PLEASE PRINT <br />i ❑ DEMOLITI�ON ❑ COMBINATION U BUILDING 1�MECHANICAL ❑ PLUMBING ❑ SION <br />� OMMER M�ILAUDflESS � CITV ZIP PHONE <br />MAIL �DDliESS <br />21P <br />MCHRECTORDESqNER MAILADDflESS CIiY ZIP PHONE i <br />� <br />OENEIW.COHTMCTfNi MMLADDRESS � CITY 21P PNONE LICENSE/ � <br />MECNANICALC�NTMIC�_70H MAILADDRESS � CITY ZIP PHONE �ICENSE� I <br />/b .. �.. d flL �.(r-sJ ?/ �� /1. // /L�- t-. �! o��i./ J� GC _ r-,-.� � w. .. •� � i.s h. i.ti- � <br />CITY ZIP <br />O ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL INSERT � BUILDING RELOCATION <br />i iE1uNTYPqO'YEMENTOR <br />� CONIRIICTPRICEOFWOIU <br />. OEBCRBE WOIIK AND 6o1L <br />mvuveu <br />� �or_ e�xx oF <br />� <br />FN�NiBETBACK <br />USE iq1E <br />WASHER <br />SUB TOTAL <br />PERMIT <br />TOTAL FEE <br />REAR SETBACN <br />lAT APEA <br />lYPEOiCONST.ALLOWABLE lYPEOitONSL�CTUAI <br />i <br />i BIZE OF BLDO. <br />I <br />t <br />1 OCCUPANCYLOAU <br />i <br />� <br />RFASON FOq SPRINKLEqS <br />i APMIC�TIONACC.BV <br />NO.OF STIX7:ES <br />FIflE SPRNKLERS REO'D <br />❑ YES U NO <br />PUNS APPPOVEO BY <br />fAPIES) <br />S <br />S <br />SIDE SEIHACN <br />LONTACT PERSON AND PIIONE NO. <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 60VERNINQ THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO OIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANV <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTV TO PERFORM THE WOHK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 7827 RCW AND 296200 WAC. <br />SIGNATUREOFCONiRACTOpOpAUTVpq¢EDA6EM DATE <br />X�l��R=/����—�— /`�V <br />MP�/h�i5 C BUSINESS �ICEN9E Np, SINESS W1ME <br />CLOTHES DRYERS <br />VENTILATION FAN <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />PLMICHECKNUMBEfl <br />v�cu�t site FEES <br />❑ YES ❑ NO BUILDING <br />acuwxcr xa.aow¢uxouxns <br />BASEMENT <br />❑.VES ❑ NO <br />MEIONT UMITATION <br />CITY OF EVERETT <br />LOCALSALES <br />TAl( CODE IS 3105 <br />PLUMBING <br />MECHANICAL <br />OTHER <br />STATE BUILDING SURCHARGE <br />STATEENERGVSURCHARGE <br />PUBLIC WORKS <br />TOTAL <br />SUB <br />FEE I RECEIPTNO. <br />FEE <br />i <br />n <br />