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'� '' �' <br />APPLICATI�i'iil FOR CONSTRUCT �+bN PERMIT <br />m. Everpresn <br />CIiV OF <br />everett <br />BUILDING DEPARTMENT <br />259-8810 TO BE COMPLETED IN INK—PLEASE PRINT <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL <br />OVMER ADORESS CITV ilP PHONE <br />Cial./kt /4-. I�v�Ce.r'Z.ew�If�[.: Aa 3otc P?.� w1wk. i�u <br />TEIUNT MAILADDRESS CITV 21P PlpNE <br />everett <br />e <br />❑ SIGN <br />=a Y? <br />CU�95 OF YY�RK <br />❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL INSERT ❑ BUIIDING RELOCATION <br />7ENANT WVROVEMENT OR INTEAIOR REMODEL ONLY <br />CONTRACT PflICE OF WORI(: <br />pE8CpIBE WORK AND SOUARE FOOTAOE MVOLVED <br />wr _ e�ocK oF <br />WATER <br />CLOTHES <br />I <br />Fnorrt sEte�cK <br />�USE20NE <br />rne a caar. u�owu�c <br />eicc �+r xw. <br />OCCUPANCYLOAD <br />flEA11 SETBACK <br />LOTARFA <br />irve a coxsc �ciwi <br />NO.OF STOflIES <br />FIRE SPPNI(LERS flE0'D <br />❑ YES ❑ NO <br />'; REASONFORSPRINNLERS <br />MPLIG�TIONACC.BV PLANSAPPROVEOBY <br />n <br />FEE S ' <br />SIDE SETBACK <br />VACNNf SITE <br />O YES ❑ NO <br />CONTACT PERSON AND PHONE NO. <br />�o, •�ya y v <br />1 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 GOVERNINa THIu TYPE OF <br />WOHK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO 61VE <br />AUTHORITY TO VIOLATE OR CANCEI THE PROVISIONS OF ANV <br />OTHER STATE OR LOCAL lAW REDULATIN6 CONSTRUCTION OR THE �' <br />PF.RFORMANCE OP CONSTRUCTION. THAT I AM AUTHORI2ED BV THE i <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WIiH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />BNiNANflEOFCONTMCTOi10RAU7110R1 ENT O�TE <br />�i��'v�+ V � �� <br />MPLICNiTSCITVBU&NESSLICENSENO.ANDBU&N NMIE <br />AIC—MHNDL6 UNRS—H.P. <br />FORCED AIR SYSTEMS--B.T.U. M E.A. <br />UNIT HEATERS—B.T.U. M <br />RANGE HOOD ' <br />WATER HEATER <br />WOOD STOVE <br />METAL FIREPLXi <br />PUN CHECK NUMBER <br />BUILDING <br />pCCUMXLY NJ.OID'MllIM0U11116 <br />�a� PLUMBING <br />BASEMEN7 MECHANICAL <br />❑ YES ❑ NO <br />NEIGHTIIMITATION OTHER <br />STATE BUILDINa SURCHARGE <br />SiATEENERGVSURCHARGE <br />CITY OF EVERETT PUBLIC WORKS <br />LOCALSALES <br />TAX CODEIS 3105 ror�� <br />8 CHIMNEY <br />SUB TOTAL S .f ' <br />PERMIT S ) i � <br />TOTAL FEE S 3D � — <br />FEE RECEIPTNO. ' <br />VALUATION FEE <br />i <br />� <br />s� ~ <br />�_ ! ' <br />S � <br />