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APPLICATIOh FOR CONSTRUCTII�.N PERMIT everett <br />TO BE COMPLETED IN INK—PLEASE PRINT � <br />the EveiDree^ . <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />259 8810 <br />HEATING SYSTEM: U GAS U ELECTRIC 0 <br />I I DEMULITION IJ COMBINATION CI BUILDING f I MECHANICAL Iy�LUMBING CI SIGN <br />OWNER MAILADDRESS CITY 21P PHONE <br />�v�2��1—�crsi�,�c-f- I�vr Po9a(,�iL ru�` ��Zo( <br />1ENANT MAIL DRESS GITY 21P PNONE <br />APCHITECTOROESIGNER MAILPODRESS CITY ZIP PHONE <br />PDORESS CITV ZIP PHONE <br />'"_� <br />MECH�NIGILCONTR�CT M�ILA�DRESS CITY ZIP PHONE LIC / <br />PLUMOIN6 GON70�CTOR M�IL AODRE55 CITV ZIP PIIONE LICENSE 1 <br />���Z..S� :�3:'3•�/7iY� �..f�OH•.P% 3SWtc <br />'7D�` s �/�L!/�3l'nic r�vFSe��' //j7 �',E2`������..�, --�---------- z <br />cuss ov wonK %��� <br />I.�I NEW LI ADDITION Il.'ALTEHATION CI REPAIF I.] DEMOLITION I I WOODSTOVE/FRPLINSERT ❑ BUILDIMGRELOCATION <br />CONTACiPER50NANDPHONENO. <br />CONTN�CT PR�CE OF WORK <br />DESCRIBE W�R���pE FOOTAGE INVOLVED <br />7� • <br />PRpPOSED USE OF BU�LDING <br />� ��� <br />LEGAL DESLRIPTION OF PROPERTY (SHOWN BELOV <br />LOT BLOCK OF <br />„���� r� h i i R <br />iING <br />TYPE OF FIXTUHE OR ITEM FEE <br />W41 ER CLOSET (TOILET) � � ' <br />BATHTUB � <br />LAVATORY fSYASH BASIN) � <br />SHOWER ' <br />KITCHEN SINI. A DISP � <br />DISHWASHER ' <br />LAUNDRYTRAY � <br />CLOTHES WASHER ' <br />URINAL � <br />DRINKING FOUNTAIN � <br />FLOOR DRA�N ' <br />BACKFLOW PREVENTERS � <br />ROOF GAAINS—RAINLEADERS ' <br />SINK (SERVICE—BAR, ETC.) � <br />� <br />_ , <br />i <br />_ —� <br />� <br />SUB TOTAL $ � <br />PERMIT $ � <br />TOTAL F[E S , '; <br />FOR OFFI�E USE ONLY: <br />moNT SETBRCN AEAR SETBACK <br />2pry� � lOT <br />IVPEOFCONiS.MLOWABLE IYPEOfCUN57.FLil <br />SIZEOFBlO(i. NO.CFSTOBIES <br />OGCUPANCY LOAD FIRE SPRNNLEFS <br />INtAKE BV � PUNS APPROVED BY <br />SIDE SETBACN <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 GOVERNING 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 !�fOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR COCAI LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM TNE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br />SIGNATUREO ONTRACTORORAUTHORIZEDAGENT D�TE <br />X �� � 7�� %/ <br />APPLIC SCITVBUSINESSLICENSENO.ANDBUSINESSNAME <br />TYPE OF EOUIPMEN7 <br />A/�NHNDLO UNITS—H.P. <br />FORCED AIR SYSTEMS—B.T.U. M <br />UNIT HEATERS—B.T.U. M <br />CLOTHES DRYERS <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />W006 STOVE <br />METAL FIREPIACE 8 CHIMNEY <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUST FAN <br />NUMBER <br />VACANT SITE rCCD <br />BUILDINC, <br />acuvu¢r xoaownuxcuxns <br />cawr PLUMBING <br />BnSEMENT MECHANICAL <br />HEIGHr uMITA71oN ADOITIONAL PLAN CHECK <br />OTHER <br />STATE BUILDING SUFCHARGE <br />CITY OF EVERETT PUBLIG WORKS <br />LOCAL SALES <br />TAl( CODE IS 3105 TOTAL <br />PERMIT 3 <br />TOTALFEE $ <br />� <br />b <br />v <br />