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APPLICATId�M FOR CONSTP�UC'ii-'r�DN <br />(�e Evoryruen <br />cin oF <br />everett <br />BUILDItvG DEPARTMENT <br />259-6810 TO BE COMPLETED IN INK—PLEASE PRINT <br />f�DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL <br />OWNER MAI�AODNE55 CITV 21P PHONE <br />D _ i. i� ... .. ..,... . ._ f4ilr//7 <br />PERMIT <br />everett <br />� <br />❑ PLUMBING ❑ SIGN <br />- - .crv-lYr-py(�s <br />TENWT MAILA�DHE55 CITY ZIP PHONE <br />i��,/. E�,.7kN Sf3�'k' �}ODitFrsf' <br />FRCHITECTORDESIGHEfl MRILADDRESS CITY 21P PMONE <br />SHMG�' <br />GENERILCONTflACTOR MAILAODRESS CIN 21P PHONE LICENSEI <br />MEC�R� ONTRA�a��' M�ADOfl �5 N �iJSf'l: � /S�e� �h� �fj'YD 20�-i.�72 TrP/ �//�!/I76 �,?/�� <br />C'Y ZIP PHONE LICENSE Y <br />PlUM01NGGONTRRCTOR MAILpODRE55 dTV ZIP PHONE LICENSE/ I <br />CLASS OF WOflK - �� <br />❑ NEW ❑ ADDITION ❑ ALTERATION ❑ fiEPAIR Lrl DEMOLITION ❑ WOODSTOV6'FRPL INSERT ❑ BUILDIRG RELOCATION <br />TEN�NTIMPAOVEMENTORINT IOppEM00ELONLY , GONTFFTPEFSONRNOPHON�HO. <br />CONTRRCTPRICEOFWOflN•���0�� TfT KA3Ea/.ER <br />DESCRIBE 1VOflN ANO SOURRE FOOTAGE INVOLVEO <br />7?u_�_�� � _ . ._ � <br />"'_"_..._ (/ � <br />I%Ch� �dlr�4�T�t.-H %� T <br />IECALDESLRIPTIONOFPflO EPtt�SMOWN6ELOWORATTACH <br />LOT BLOCK OF <br />ADORESS <br />NBING <br />TYPE Of <br />WATER CLOSET <br />DATHTUB <br />LAVATORY�WAS <br />SHOWEfi <br />KITCHEN SINK 8 <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASH <br />UflINAL <br />DRINKING FOUN <br />FLOOR DRA�N <br />BACKFLOW PRE' <br />ROOF ORAINS—; <br />FRONTSETBAGK <br />USEIONE <br />TYPEOFCONSL�IIOWAtlIE <br />SIZE OF BLOG. <br />OCCUPANCYLOAD <br />REASON F095PRINKLERS <br />APPLICATION ACC. BY <br />SUB TOTAL $ <br />PERMIT $ <br />TOTAL FEE $ <br />REAflSETBRCK SIDESETAACK <br />LOTRREA <br />TYPE Of COHST. ACNAL <br />NO. OF STORIES <br />FIRE SPHNKLEflS flEQD <br />❑ YES ❑ NO <br />PUNS APPROVED 9Y <br />VACANTSITE <br />❑ YES ❑ NO <br />O[CJPANLY NO.OfDW[LLINGI <br />cxauv <br />BASE.'AENT <br />❑ YES ❑ NO <br />HEIGHT LIMITATION <br />CITY Of EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />I HEREBY CERTIFY THAT I'riAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANC'cS GOVERNING THIS TYPE OF <br />WORK N'ILL BE COMPLETED WITH WHETHEH SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A FERMIT DOES NOT PRESUME 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 CONSTRUCTIG4. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND 1 COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC, <br />SIGNAID�iE�FCONTRRCTORORqUTHOflIZEDAGENT OATE <br />UCENSE N0. <br />EMS—B.T.U. M <br />SU. M <br />METAL FIREPLACE & <br />FIREPIACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUST FFN <br />PLAN CHELK NUM1IBER <br />FEES <br />BUILOING <br />PLUMBING <br />MECHANICFL <br />OTH[R <br />SiAT[ Ul1;l.DING SURCHARGE <br />STATEENERGYSURCHARGE <br />PU9LIC WORKS <br />70TAL <br />FEE <br />TOTAL $ <br />dIT $ <br />_L FEE $ <br />NECEIPT NO. <br />FEE <br />T <br />� I <br />: <br />� ' <br />i <br />—r— <br />� <br />� <br />i , <br />� <br />�i <br />i ' <br />� <br />i <br />� I <br />� � <br />