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APPLICATII..�I FOR CONSTRUC7 :�N PERMIT everett <br />�AeEvorgroen TO BE COMPLETED IN INK—PLEASE PRINT � <br />CIT� OF <br />everett HEATING SYSTEM; ❑ GAS ❑ ELECTRIC ❑ <br />BUILDING DEPARTM�iVT <br />259-8810 <br />I J DEMOLITION I I COMBINATION i i BUILDING � MECHANICAL �PLUMBING i I SIGN <br />TENANT <br />o h S'. �- � <br />ARCHITECT OR DESIG <br />M\AILPDDRE\55 GI7Y ZIP PHONE ) G ) <br />.1�`l4�\+'\Y1 IH � �'1�1� �,�b,l <br />MRIL �DOP SS � CI Y ZIP PHONE / <br />��1oL �`�'-�i, �Je_ t{C C..,c,,.�n— �tcs �'—oK <br />1.�c: ,. �� <br />noon¢ss <br />zm <br />PHC4E <br />ALD�Rck��F(1�� <br />PNONE LICEqSE� <br />CLASS OF WORN <br />I I NEW I I ADDITION I I ALTERATION i I qEPAIR <br />CONTMCT PRICE OF WORK <br />DESCRIBE VIORK ANO SOU�RE FOOTAGE INVO�VEO <br />PROPOSED USE OF BUIlOING <br />LEGAL DESCRIPTION OF PROPERTV �SIIOWN BELOW OR ATTACII FOIIR GOPIES� <br />LOT . BLOCN Of <br />PflPIECT ADORESS <br />NO. 71 <br />� WATER CI <br />'y BATHTUB <br />KITCHEN SINK 8 <br />DISHWASHER <br />LAUNDRYTFAY <br />URINAL <br />DRINKING FOl <br />FLOOR DRAIN <br />BACKFIOW Pf <br />ROOF DRAINS <br />SINK ISERVICI <br />OR ITEM <br />FOR OFFICE USE ONLY: <br />FRONTSETBAGK REFRSETDACK <br />US[ ION[ <br />NPE 0( CON7S. Al lOWA31 E <br />SIZE Of BLOG. <br />OCCUPANCVLORO <br />flEA50N FOR SPRINKLEI <br />IMTAKE BY <br />1 <br />LICENSE � <br />I � DEMOLITION I I WOODSTOVE/FRPL INSERT I. i BUILDING RELOCATION <br />� CONTRCT PERSON ANO PIIONE NO <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND COR(iECL ALL <br />PROV�SIONS 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 GIVE ! <br />AUTHORITV TO VIOLATE OR CANGEL THE PROVISIONS OF ANY .I <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORI2ED BY THE ! <br />OWNER OF TIfIS PROP[RTY TO PERFORM THE WORK FOR WHICH <br />APPLICA ION IS MADE AND I COMPLY WITH THE STATE :i <br />CONTRA T RS LAW 18.27 qCW AND 296.200 WAC. � <br />SIfN�TUR OF 010R�CTORORAUTMONREO�GENT D�TE <br />X _ C9� �, � �._� <br />APPIICRNTS QTV BUSINE551 ICENSE NO AND BUSINE55 N�ME ' <br />NO. <br />A/C—A/HNDLG UNITS—H.P. <br />FORCED AIR SYSTEMS—B.T.U. <br />UNIT HEATERS—B.T.U. M <br />CLOTHESDRYERS <br />VENTILATION FAN <br />RANGEHOOD <br />WOODSTOVE <br />METAL FIREPLACE 8 <br />FIREPLACE INSERT <br />HEAT PUMP _ <br />GAS PIPING <br />EXHAUSTFAN <br />SUB TOTAL $ <br />PERMIT $ <br />TOTAL FEE $ <br />7YPE �f CONSi. ACl <br />NO.OF STORIES <br />FIPE <br />PUNS APPROVED �V <br />SIDE SETBACK I �� <br />VAC�NT SITL 1'CCJ <br />oui�oiNc <br />acur�xcr xoaowuuNcuxns <br />cnam PWMBING <br />OASEMENI h�ECHANICAL <br />HEIGIITUTAITATION �DOITIONALPLANCHFCK <br />OTHER <br />STATE BUILDING SURCHARGE <br />CITY OF EVERETT PUBLIC WOflKS <br />LOCALSALES <br />TAX CODE IS 3105 TOTAL <br />SUB TOTAL � <br />PERMIT $ <br />FEE � REGEIPT NO. <br />FEE <br />a <br />a <br />� <br />� <br />