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� �, <br />APPLICATIG.� FOR CONSTl�UC?.JN PERMIT <br />7n aF cAMPI ETE� IN INK—PLEASE PRINT <br />mecvwprwn <br />CITV OF <br />everett � <br />BUILDING DEPARTMENT <br />259-8810 <br />❑ DEMOLITION ❑ COMBINATION <br />ARCHITECT <br />PLUMBING CONTflACTOR <br />MAIL A�DRESS <br />G /20 <br />MAIL RDDRESS <br />HEATING SYSTEM: � GAS ❑ ELECTRIC U <br />❑ BUILDING <br />� cin <br />n ve ra <br />CITY <br />CITY <br />cin <br />G MECHANICAL <br />ZIP PHONE <br />9$�3 <br />ZIP PHONE <br />ZIP PHONE <br />ZIP PHONE <br />9g�o3 <br />ZIP PMONE <br />ZIP PHONE <br />everett <br />e <br />❑ PLUMBING ❑ SIGN <br />�S�J�� O <br />LICENSE � <br />LICENSE • <br />LICENSE t <br />CLA55 OF WORN <br />❑ NEW �ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVFJFRPL INSERT G BUILDING RELOCATION <br />�a � Q e] p/�• CONTACT PEfl50N AND PHIXJE NO. <br />INVOLVED <br />PROPOSEDUSEOFBUIIDING "1 <br />� mn�^S�Oln ' �/�/I/ic� ofNeO� <br />LEML DEp RIPTION OF PROPERTY (SHC`YN BELOW O/R �AT�TACH F <br />LOT �l I BLOCK !� OF /✓�✓{� <br />H. <br />WATER CLOSET <br />BATHTUB <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />ROOF DRAINS—RAINLEADERS <br />SINK (SERVICE—BAR. ETC.1 <br />TOTALFEE $ <br />FOR OFFICE USE ONLY: <br />FRONTSETBACN REARSETBACK <br />� 20� <br />USE20NE LOTAPEA <br />� z v sa� <br />IYPEOFCONTS.ALLOWABLE TYPEOFCONST.RCTUAL <br />$1/56 5f A��t NO.OFSTORIES <br />S �L <br />OLCUPANCY LO/D FIHE SPRNKLENS REO'0 <br />ll�A 1�� <br />REASON fOF SPRINKLERS <br />INTANE BY PLANS APPROVED BY <br />�l� iM11 I �''� F/Y <br />1 <br />FEE <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 PFiESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 HCW AND 296200 ::AC. <br />SIGNATUREOFCONTRACTONORAUTNOP2EDAGENT DATE <br />�X i� .�� 6 �s-2 i <br />qrLICANTSCITYBIISINE L ENSEN .ANDBUSINESSNAME <br />O <br />� <br />� <br />A/C—A/HNDLG UNITS—H.P. <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />UNIT HEATERS—B.T.U. M <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />WOOD STOVE <br />METAL FIREPLACE & CHIMNEY <br />FIREPLACEINSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN <br />SIDESETBACK PLANGHECN IUMBER <br />s' a <br />VACANT SITE FEES <br />� BUILDING <br />OCCUPAN[r NO.Of� EIIMGYM115 <br />�eouv PWMBING <br />BASEMEN7 MECHANICAL <br />� ADDITIONAL PLAN CHECK <br />HEIGHT LIMITQATION <br />2' �+ , OTHER <br />STATE BUILOING SURCHARGE <br />CITY OF EYERETT PUBLIC WORKS <br />LOCAL SALES <br />TAX CODE IS 3105 TOTA� <br />FEE <br />SUB TOTAL $ 6 0 '-- <br />PERMIT $ � <br />TOTAL FEE $ 6i ;r <br />qECEIPT NO. <br />3/G -- <br />VALUATION FEE <br />6 h` � 7 � .�o <br />1 <br />� 1 �0 <br />� /) ! Q G <br />�00 v <br />