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r;�. <br />,�,'.";.:_.. ... <br />� <br />r�n:., <br />a <br />u'::..,,. x,.. } r . r�.. ,{. �.. _ ,. . _ . . . . <br />i a. . <br />,.t . ... . . . . . . . . .. _ . .. . . <br />APPLICATI� FOR CONSTRUCTi'ON PERMIT <br />TO BE COMPLETED IN BLACK INK—FLEASE PRIWT � <br />I HEATING SYSTEM: �{GAS ❑ ELECTRIC ❑ � <br />BUILDING DEPARTMENT <br />259•8810 ; <br />I I DEMOLITION I_1 COMBINATION I i BUIIDING I J MECHANICAL Cl PLUMBINQ ❑ SKiN <br />OYMER MAILiWDRE55 � CITY ZIf� PIqNE ..�_. i+._ <br />MAIL �WIIESS <br />an <br />�RCXffECTOflDESqNER W0.�UIN1E55 GTY <br />MDNE55 <br />M�IL <br />cm <br />ZIP PFIONE <br />[v!l ��20/ o'C <br />ZIP PHd1E <br />21P PNONE <br />STATE LICEN$E I <br />PIUNBINOfANiPAGT011 IM0.AUDfi[55 CItV 21P PIItHJf: ST�TELICEN9E/ <br />I.1 NEW C1 ADDITION I.-I ALTERATION <br />� a ono. oov <br />DESCflIBE VIOfM( <br />LEML DESCRIPiION OF PPOPEflTY ISIqNT! BELOV <br />l0T BLOCK OF <br />8 DISP <br />CLOTHES <br />SINK <br />FOR OFFICE USE ONLY: <br />FRONTSETBACK , REAfl; <br />IYPE 0� <br />- �SyIIE�OFB`!;/ " <br />}, /r✓ _1 <br />«����AN�Y �ORD <br />�: I�U � <br />'� �����"''-' n REASONFORSPPINNLERS <br />� . 1NT�KE BY <br />� <br />NO.OF STOPIES <br />FIRE S�PRNNK�LEflS REQ'D <br />/1.1/ <br />PUNS PPPNOVEO BY <br />REPAIR I_1 DEMOLITION I I WOODSTOVE/FRPLINSERT CI BUILDINGRELOCATION <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND K�OW THE SAME TO BE TRUE AND CORRECT. ALL <br />FWRCOPIES� PROVISIONS OF LAWS AND ORDINANCES GOVERNIN6 THIS 7YPE OF <br />WORK WILL BE COMPLETED WiTH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATINO CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTHUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />qPPI�ION IS MADE AND I COMPLY WITH THE STATE <br />CO A ORS LAW .27 RCW AND 296200 WAC. <br />x /,�ii..A ��� /- 3 • Fy <br />SIGN�iWF WtE <br />�/Ci ST• M1iYNIVIFCCIKfNSEiq <br />a <br />s <br />S�DE SETOACN <br />BO�lLiMOUXlf6 <br />TNU T�oN <br />CiTY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />FORCEO AIR SYSTEMS—B.LU. M <br />UNIT HEATEHS—B.T.U. M <br />CLOTHES DRYEHS <br />VENTILATION FAN _ <br />RANGEHOOD <br />WATER HEATER <br />WOODSTOVE <br />METAL FIREPLACE 8 CHIMNEY <br />BUILDING <br />PLUMBING <br />MECHANICAL <br />ADDITIONAL PLAi� CHECK <br />SPRINNLER <br />STATE BUIL�ING SUPCIIARGE <br />PUBLIC WORKS <br />TOTAL <br />)TAL $ ' <br />r a ' <br />FEE a � <br />PECEIPTNO. <br />710N FEE <br />0 <br />