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APPLICAT( �N FOR CONSTRUC . ION PERMIT e�e��tt <br />TO BE COMPLETED IN INK—PLEASE PRINT � <br />Ihe Eve•9�een <br />CITY OF <br />everett HEATING SYSTEM: p9 GAS Q ELECTRIC ❑ I <br />BUILDING DEPARTMENT <br />259-8610 <br />DEMOLITIUN COMBINATION BUILDING MECHANICAL ?tPLUM8ING SIGN <br />OWNER MAILA�DPE55 GTV ZIP PHONE <br />G�i✓tan,��ir.� R�sr .,u <br />TENANT MAILADDRE55 GITY ZIP PHONE <br />r/�.ti Q,ci�c G=,�n�i�3ssr ��,3/ s,� �Fvn:Rr�r �na«- w�/ d.�o".� <br />FRCNIIECTORpE51GNEF MAILAODRE55 GTV ZIP PHONE <br />GENERALCONTRACTOR MAILFDDRESS CITV ZIP PHOIIE LICENSEY <br />/�LC vCm�y( ��ensi — <br />MECHANICALCONTRACTOR MNLA�ORESS LITY ZIP PHONE LICENSEa <br />PWMAINGCONTFACTOF MAILA��FESS CITV 21P PHONE (J�l�'J-Y��LICENSEp <br />'- R io�c PLE3 d A1z��c �v�/ ��a �.�� ` �1/t "risa .4�iKK/.niio/��A LAKC•AP/9 l.a�oF <br />CLASS OF WOFK <br />/� NEVJ - � ADDITION �. � ALTERATION �. � REPAIR . �. DEMOLITION �. '�. WOODSTOVE/FRPL INSERT .- I BUILDING RELOCATION <br />� CONTACT PEFSON NND PHUNE NO. <br />CONTRAGi PFICE OF WORN <br />DESCRIBE WOPK� A�ND SOUAIR,E fOOTAGE <br />l^- QlA�' �.. V.��YV`:�.Jll1'\_O- <br />PRO USEOFB LDING <br />LEGAL DESCRIPTION OF PROPERTV (SNO <br />�p7 OLOCH _ <br />PROJECTAOJRE55 <br />II HEREBY CEfiTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />fiELOW OR ATTACH FOUR COPIES) PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />_ oF NOT. THE GRANTING OF A PEFMIT DOES NO7 PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHEA 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 FOH WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 1827 RCW AND 296.200 WAC. <br />SIGNATUPEOFCONTRACTORORAUTNORIZEDAGENT DATE <br />TYPE OF FIXTURE OR ITEM <br />CLOSET (TOILET) <br />LAVATORY�WASH BA: <br />SHOWER <br />KITCHEN SINK 8 DISP <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />ROOF DRAINS—RAINLEAC <br />SINK (SERVICE—BAR, ETC <br />FOR OFFICE USE ONLY: <br />FRONTSET�ACH REARSETBACN <br />USEZONE <br />' iVPtOiCONiS.ALL01 <br />SREOFBLDG. <br />OCCl1PANCV IOAD <br />fl[�SON FOR SPRII <br />INi�K[ BY <br />LOT ANEA <br />7YPE OF CONSi AGIIIAI <br />NO. OF STORIES <br />FIRE SPRNKLERS REC <br />PL�NS�PPqOVED�Y <br />FEE <br />$ .�3C� � �O <br />5 /D �O (7 <br />5 <br />SIDE SETBACK <br />VACANT SITE <br />o�cwa+cv uoo�owewxcuxns <br />GFOUP <br />DASEMENT <br />HEIGMT LIMIT�TION <br />CITY OF EVERETT <br />LOCALSALES <br />TAX CODE IS 3105 <br />OJ��oXFLhCI� an� t J' <br />APPUCANTS CITY BUSINESS LICENSE N0. AND BUSINESS NAME <br />NO. <br />OF E�UIPMENT <br />FORCED AIR S`.'STEMS—B.T.U. M E.A. <br />UNIT HEATERS—B.T.U. M <br />CLOTHES DRYERS <br />VENTILATION FAN <br />WATER HEATER <br />WOOD STOVE <br />METAL FIREPLACE & CHIMNEY <br />FIREFLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUST FAN <br />P�AN CNECK NUM�EF <br />BUILDING <br />PLUMBWG <br />MECHANICAL <br />ADDITIONAL PLAN CHECK <br />OTHER <br />STA7E BUILDING SURCHAFGE <br />PUBLIC WOFiKS <br />TOTAL <br />SUB TOTAL 5 <br />PERMIT 5 <br />TOTALFEE 5 <br />FEE <br />0 <br />4Yy <br />MN <br />Op <br />X <br />� <br />�-� ;�D <br />