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APPL1�^.AT11�►N FOFi C�NSTRUCI`�iON PERMIT <br />ma e�o,g,aa� everett <br />cm c� � <br />everett <br />[3UILDING DEPARTMENT <br />259-8810 TO BE COMPLETED IN INK—PLEASE PRINT <br />❑ DEMOLITION O COMBINATION ❑ BUI�DING �MECHANICAL ❑ PLUMBING ❑ SIGN <br />OW4ER MAILA�ORESS CIiY ZIP PMDNE <br />fENANT MRILADDflE55 � ��ry Z�p <br />��,� -Y;r u ,�,�-�L��� � ��- qB��R <br />ARCHITECT�RDESIGNEfl MUL/DDRE55 qTY 21P PMONE <br />GENEMLCONTRACTOR MAILAD�RESS LITY ZIP PNONE LICENSEI <br />MAllA0DRE55 CIN (� 21P PMONE LICENSEe <br />1G��_ �� 14F�'�I�V'�'�'� �� 9fCtrJ� X$3�Z2Q-��E�2�TM116?tM <br />MRILRDDRE55 CITY ZIP pNONE LICENSEa � � <br />O NEW ❑ ADDITION J�ALTERATION <br />''UPf10VEMENT OR INTERIOR REMO�tL ONLY . <br />� PRn.LO°WORK: I SQUD <br />.. : WOFF AN� SOUPHE: C^TAGE INVOLVED <br />��-'��Au�i� ��S �t�°� <br />PPOP�SEU USE OF BUIL�INO <br />ATTRCH <br />LOT <br />BLIX:K <br />OF <br />PqOJECTAODRESS Ql_ ��� <br />� �C�� `l � � YY (' <br />LUMDING <br />N0. TYPE OF FIXTURE OR Il <br />WATER CLOSET(TOILET) <br />_ BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 LqSP <br />DISHWASHER <br />LAUN�RY TRAV <br />CLOTH[S WASHEIi <br />UqINAL <br />D;iINI(ING FOUN i�AIN <br />FLOOR DP.AIN <br />BACNFLOW PF� !ENTERS <br />ROOF DRAINS—RAINLEADERS <br />SINK (SERVICE—BAR, ETC.) <br />SUB <br />❑ REPAIR ❑ DEMOLITION ❑ WOODST04E/FRPL INSERT ❑ BUILDING RELOCATION <br />TOTAL FEE $ <br />FRONTSETBACK pEARSETBAUK SIOESETBRCH <br />USEZONE I �OTAREA <br />lYPEOFL@lSTAIIOWABLE I lYPEOFCON57.ALiUAL <br />SIZE OP BLDG. <br />aCCUPANCYLO�D <br />FEASON FOR SPRINKLEflS <br />APPLICRT�C. BY <br />NO. OF STOHIES <br />FIflE SPPNNLERS flE0'O <br />❑ YES ❑ NO <br />PlANS APPROVEO BY <br />� <br />PEq50NANDPHONENO. <br />_ � ^ <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AN� KNOW THE SAME TO BE TRUE AND CORFiECT. O,LL <br />PROVISION3 OF LAWS AND ORCINANCES GOVEFNING THIS TYPE OF <br />WORK WILL BE COMPLFTED 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 REGULATING CONSTRUCTION OR THE <br />PEFFORIAANCE OF CONSTRUCTION. THAT I AM AUTHOFI[ED BY THE <br />OWNER OF THIS PI;OPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION �S MADE AND I COMFLY WITH THE STAT'e <br />CONTRA��f�S L4W 18.27 RCW AND 296.200 WAC. � <br />SIGNA7UR C�rlTRACTOROflAU7NORIZEOAGENT DATE <br />� ANTSC O1151N SSLICENSEN� <br />MECHANICAL <br />FEE NO. TYPE OF E�UIPMENT <br />FORCED AIR <br />UNIT HEATEF <br />CLOTHES DF <br />RANGE HOi <br />WATER HEi <br />WOOD STO <br />METAL FIRE <br />FIREPLACE <br />HEAT PUMF <br />GAS PIPING <br />�B.T.iI. M E.A. <br />M <br />CHIMNEY <br />PLAN CNECN NUMBER I FEE <br />VRCANT SITE FEES <br />❑ YES ❑ NO <br />BUILDING <br />OCCuvM1VLY xp.p{pMLL�xGUNitS � _ <br />GRWP <br />PLUMBI4G <br />BaSEMEN7 MECHANICAL <br />❑ YES ❑ NO <br />HEIGHTLIMITATION OTHER � � <br />STATE B ILDING SURCHARGE <br />S7ATE ENER3V Sl1RCHARGE <br />CITY OF EVERETT PUBUC WORKS <br />LUCAL SALES <br />TAX CODEIS 3105 TOTAL <br />flECEIPT <br />C <br />