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9 <br />APPLICA�`�aN FOR CONSTRU�ION PERMIT <br />fM E�erpreen <br />cm oF <br />everett <br />BUILDING DEPARTMENT <br />259-BB10 TO BE COMPLETED IN INK—PLEASE PRINT <br />❑ DEMOLITION ❑ COMBINATION 17 BUILDING ❑ MECHANICAL <br />OWNER n MMLADDNESS CIiV ZIP PIIONE <br />lK:lis.o 771/7 JJ J' <br />CITY ZiP PNONE <br />everett <br />e <br />17 SI(iN <br />AflCH1fECTOflDESIONER M�ILAUURESS CITY ZIP PHONE ', <br />OENEMLCONIMCTOP IMLMDRE55 CITY ZIP PIIONE LICENSE/ � <br />�-t/)q-'G.�-_ ' <br />�CWWICALCONTMCTOiI AUILAUDRESS CITY 21P PIIONE LICENSE/ � <br />i <br />PLlIMBMqCplTRACTOR WN.ADDPESS GITY ZIP PHONE LICENSEI � <br />CU1SS OF WOqK I <br />❑ NEW ❑ ADDITION ❑ ALTERATION � REPAIR ❑ DE�AOLITION ❑ WOODSTOVEIFRP� INSERT ❑ BUILDIN6 RELOCATION <br />REMOOEL ONLY <br />USEOFBU0.DHq <br />wr�_ e�ceK %�.i oF <br />Vo i. �l �. PI �, <br />TYPE OF FlXTUHE <br />KRCHEN SINK 8 DISP <br />BACKFLOW PREVENTERS <br />ROOF DRAINS—RAINLEAC <br />SINK (SERVICE—BAR. ETC <br />FiqNTSETBACK � pEAqSETBACN I SIDESETBACK <br />USE ZONE LOT �PEA <br />meacaur.uiaw�eie Trreaw�sr.�cru�� <br />BIZE OF BLDO. <br />OCCUPANCV LOM <br />flEASON FOR SPRINKLERS <br />AP^LICAiION ACC. BV <br />NO.OF STORIES <br />FIRE SPflNNLERS REO'D <br />❑ YES ❑ NO <br />PL/1N5 APPROVED BY <br />FEE <br />VAGINT SITE <br />❑ YES ❑ NO <br />OLWfMCV NOIXOW[llIN01M115 <br />wan <br />BASEMENT <br />❑.YES ❑ NO <br />HEIGHT LIMItATION <br />CITY OF EVENETT <br />LOCALSALES <br />TAX CODE IS 3105 <br />GONT�CTPEflSIXJANJPNONENO. <br />_ l+o,"„� 3r3- � �t <br />I HEREBY CERTIFV 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 60VERNINO THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR � <br />NOT. THE 6RANTINO OF A PERMIT DOES NOT PRESUME TO 61VE �� <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION3 OF ANY '� <br />OTHER STATE OR LOCAL UW HEOULATIN(i CONSTRUCTION Op THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BV THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLV WITH THE STATE �, <br />CONTRACTORS LAW 1827 RCW AND 296.200 WA0. i <br />BpNANflEOFCONTRACTOpqiAUT1y�RIZEDAOENT DI1TE <br />//�'� � �% %% ' I <br />X l /'+�:�./(/f • � A"`te �'bL`�,�. <br />�rr��uwrs cm eus�ss i�cErrse ra. sx�ss ru� <br />YCf`Y�NIf��1 <br />NO. <br />UNIT HEATERS--B.T.U. M <br />CLOTHES DRYERS <br />METAL PIREPLACE 8 <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />SUB TOTAL S <br />PERMIT S <br />TOTALFEE S <br />PLANCHECNNUMBEp 1 FEE I NECEIPTNO. <br />BUILDINO <br />PLUMBINO <br />MECHANICAL <br />OTHER <br />STATE BUILDING SURCHPRGE <br />STATEENF.RGYSURCHARGE <br />PUBLIC WORNS <br />TOTAL <br />V i � <br />