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APPLICAZ`�aN FOR CONSTRU � ION PERMIT <br />fM Evxpnen <br />everett <br />BUILDING DEPARTMENT <br />259•8810 TO BE COMPLETED IN INK—PLEASE PRINT <br />❑ DEMOLITION ❑ COMBINATION I I BUILDING L'I MECHANICAL <br />rwuucw � M�ILAUORE55 GITV ZIP PIqNE <br />M/�IL /�ODRESS <br />CIIY 21P <br />ARCMITECTq10ESqNER M�ILADORESS CITY 21P PHONE <br />everett <br />e <br />qQPLUMBING l"J SION <br />({ENEp11LCpNTMCTOfl IML�ODRESS CITY 21P PNONE LICENSE� <br />� <br />IE�NµICAICONTMCTOR AUILADDRE55 GITY 21P PMONE LICENSE� <br />qUl,lNqCpITMCTOq IMIL�UDflESS CITY 21P VNONE IICEN5E1 <br />❑ NEW ❑ ADDITION O ALTERATION IjQ REPAIp ❑ DEMOLITION ❑ WOODSTOVElFHPL �NSERT O BUILDIN6 RELOCATION <br />TEWWf MPIIDVEMENT di MTERKKi HEMODEL ONLV <br />oF sutiorio <br />IEMI OEBCflAT10f1 OF PIIOPEHTV IS/AYYH 6ELOW VX 111I�u:n <br />wr�_ e�ocu %8s oF �I w�' <br />CLOSET <br />KITCHEN SINK 8 DISP <br />BACKFLOW PREVENTERS <br />ROOF DRAIN�RAINLFADERS <br />FRONT SETB/�CK <br />SUB TOTAL $ <br />PERMIT $ <br />TOTALFEE $ <br />REAP SETBRCK SIDE SETBACK <br />USEZONE IOTAREA VACANTSITE <br />_ ❑ YES ❑ NO <br />7YPfOFCONSLALLOWABIE � TYPEOifAN57.At7U�L <br />6¢E OF BLD(3. <br />Y <br />OCCUPMICYLOAO <br />� REASONFORSPflINNLERS <br />i; <br />� <br />t APPLICATION ACC. BY <br />i <br />NO.OF STORIES <br />FIRE SPRNNLERS REO'D <br />❑ YES ❑ NO <br />PLANSAPPROVEDBY <br />BASEMENT <br />❑ YES ❑ NO <br />HEIGHT LIMITATION <br />CITY OF EVERETT <br />LOCALSALES <br />TAX CODE IS 3105 <br />CONUCT PERSON �ND P1qNE NO. <br />Q%r,,,,t. -warl� 61Y-oof< <br />_ Ho,�..n- 9Y3-'+o `�8 <br />1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED TFi15 <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES QOVERNINO THIS TVPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIEO HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO 61VE <br />AUTHORITY TO VIOLATE OR CANCEI THE PROVISIONS OF ANY <br />OTHER STATE OH LOCAL LAW REGULATINO CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT 1 AM AUTHORIZED BY THE <br />OWNER Of THIS PROPEHTV TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTOflS LAW 1827 RCW AND 296.200 WAC. <br />SqN�7UREOFGWlTMCTOPORAUT IZED/WENT DATE <br />X �� � <br />APPLN'.ANiSGITVBUSME55LICENSENO.AN SINESSNMIE <br />NO. TYPE OF EOUIPMENT FEE <br />AI�AIFINDLG UNITS-H.P. <br />FORCED AIR SYSTEMS-B.T.U. M E.A. <br />UNIT HEATERS-B.T.U. M <br />CLOTHES DRYERS <br />VENTILATION FAN <br />RANGEHOOD <br />WATEFiHEATER <br />WOOD STOVE <br />METAL FIREPLACE 8 CH�MNEY <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUST FAN <br />SUB TOTAL $ <br />PERMIT S <br />TOTAL FEE S <br />PLANCHECKNUMBER � FEE � RECEIPTNO. <br />BUIIDING <br />PLUMBINO <br />MECHANICAL <br />OTHER <br />STATE BUILDING SURCH�RGE <br />STATEENERGYSURCHAPGE <br />PUBLIC WORKS <br />TOTAL <br />n <br />