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t '' <br />� . APPLICATI�iil FOR CONSTRUC? �+bN PERMIT <br />fM EwryrNn <br />CITV OF <br />everett <br />BUILDING DEPARTMENT <br />259-8810 TO BE COMPLETED IP1 INK—PLEASE PRINT <br />❑ DEMOLITION ❑ COMBINATION I:.l BUILDING I_i MECHANICAL <br />OWNER ADDNESS CITV =Ip pf <br />M�IL <br />CIN ZIP <br />CITY ZIP <br />CITY 21P <br />CITV ZIP <br />QTY ZIP <br />PIIONE <br />PNONE <br />PFIONE LIGENSE / <br />PMONE LICENSE � <br />PHONE IICENSEI <br />everett <br />e <br />❑ SI(iN <br />� V� <br />❑ NEW ❑ ADDITION ❑ ALTERA710N ❑ REPAIR ❑ DEMOLITION ❑ WOl)DSTOVE/FRPL INSERT ❑ BUILDINO RELOCATION <br />TEINNT MPNOVEMEM OR NITENIOR REMOOEL ONIY <br />m <br />nvuvtu <br />� � w � � J � • <br />' PROPERTY (BIIONRJ BEIOW OR <br />e�oac oF <br />MIOIECf �DOIIE88 <br />' 3�07 �_ <br />PLlllllNlO <br />N0. TYPE OF FlXn <br />WATER CIOSET (TOIL <br />BATHTUB <br />' UVATORV (WASH BA; <br />SHOWER <br />KITCHEN SINK 8 DISP <br />DISnWASHER <br />LAUNDRYTRAV <br />FRONTSETBACK <br />USEIONE <br />IYiE Of LONSi.AILOWABIE <br />BREOFBLIX3. <br />OCCUPR:CYLO�D <br />� flEASON FOfl SPNINKLERS <br />APPLIG�TION ACC. BV <br />CONTACT PERSON AND I'NONE NO. <br />I HEREBY CERTlFY THAT I HAVE HEAD AND EXAMINEO THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECL /LLL <br />P^OVISIONS OF LAWS AND ORDINANCES 60VERNIN6 THIS TVPE OF <br />WOI1K WILL BE COMPLETED WITH WHETHEH SPECIFIED HEREIN OR <br />NOT. THE ORANTING OF A PERMIT DOES NOT PRE5UME TO 01'JE <br />AUTHURITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL lAW RE6ULATING CONSTRUCTION OR THE <br />PEHFOHMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPEHTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I CUMPLY WITH THE STATE <br />CONTRACTORS LAW 1827 RCW AND 296.200 WAC. <br />SICiNANflCOFCONtMCTOpOR�UTIqP EM O�TE <br />X �.W"�1� <br />•rv��wrscineusmess��Nsera.�wo ruu� <br />� <br />FORCED AIR SVSTEMS--B.LU. M E.A. <br />UNIT HEATERS--B.T.U. M <br />WATER HEATER ,*,JO .. <br />WOOD STOVE �� <br />METAL FIREPLYICE & CHIMNEY <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />TOTALFEE S ' <br />REMSETBIIGK SI�ESETBRCK PLANCHECKNUMBEfl FEE <br />LOTAqEA yACMlT51TE FEES <br />❑ YES ❑ NO BUILDING <br />TYPEOiCON5CFCIUAL a.cur,u1cr rpavncu��uxis ' <br />GRpIP <br />PLUMBING <br />NO.OFSTORIES BASEMENt MECHANICAL <br />❑ YES ❑ NO <br />fIRESf�NKLERSREO'D NEIGHTLIMITATION OTHER <br />Ll YES ❑ NO STATEBUILDINGSURCHARGE <br />STATEENERGYSURCHARGE <br />PlANSAPPROVED�V CITY OF EVEHETT PUBLIC WORKS <br />LOCALSALES <br />TAX CODEIS 3105 70TAL <br />i S /) i � <br />FEE S 30 � — <br />RECEIPTNp. ' <br />TION FEE <br />i <br />1 <br />�i � <br />i <br />3 � – <br />a� <br />� <br />i <br />i <br />i <br />� <br />i <br />� <br />� <br />.�5�_ <br />