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APPLICATION FOR CONSTRUCT�a�N P�RMIT <br />everett <br />fM Evergreen � <br />CI7V OF <br />everett �� <br />BUILDING DEPARTMENT <br />259-8810 70 BE COMPLETED IN INK—PLEASE PRINT ; <br />❑ DEMOLITION L 1 COMBINATIOM I I BUILDING I I MECHANICAL ��pLUMBING ❑ SIGN <br />pWNER MAILA�DRESS CI7Y ZIP PNONE <br />�TRt''plv'f)Peszr /�! .o z� <br />TENANi MAILAODRESS � CITY ZIP PHONE <br />('rlu.ltrYv,� /e via�v P•D•ae?�' 'L/Sir L`l�ttllaTG' `t1��3 3� / 6�'j' <br />MAIL AUDREuS <br />21P <br />GENER�L CONTRACTOB MAII. 4DDRESS CITV 21F PMONE LICENSE � <br />MECNANICAL CIXJTflACTOR MAIL ADOFE55 CIN ZIP P110YC UCENSE a <br />PLUMBIN6CONTR�GTOR M�IL�DDRE55 GItY ZIP PMONC LICENSE� , * <br />/ <br />'ClAS50FWOflK - <br />I�}'�JEW ❑ ADDITION CI ALTEFATION CI REPAIR ❑ DEMOLITION I 7 WOODSTOV6'FRPL INSERT f 1 BUILDING PELOCATION <br />TENANT IMPPOVEMENTOR IN� <br />CONTMCT PRIGE OF WORN: <br />DESCRIBE WORK AND SWAPE <br />REMODELONLY <br />ree. n10 <br />LEW�bESCRIPTION OF PpOPERTV (SHOWN BELOW OR <br />LOT BIOGK OF _ <br />i <br />��. f <br />" � <br />� �vserPP� „ <br />�PROIECTADDRE55 <br />,,3D1; S•C. �Y�Ac� <br />� PLUMBING <br />+ NO. TYPE OF flXTI <br />�. WATER CLOSET (TOILI <br />BATHTUB <br />LAVATORY(WASH BAS <br />SHOWER <br />KITCHEN SINK 8 DISP <br />�. DISHWASHER <br />- LAUNDRYTRAY <br />Cl OTHES WASHER <br />UfiINAL <br />DRINKING FOUNTAIN <br />ROOF <br />SINK ( <br />FRONTSETBACN <br />USEZONE <br />TYPE OF WhST. �LIOWABIE <br />S2EOFBlDO. <br />OCCUPANCYLOAD <br />flEA$ON FOR SPPINNLEHS <br />APPLICATION ACC. BV <br />$ <br />TOTAL FEE S <br />REAR 5[TB�CK SIDE SETBACK <br />LOT AREA VACANT SITE <br />I I YES I 1 NO <br />TYPEOit01lSi.ALiO�L OC[uPAHtv NOo�Mv[IUNGi <br />LPWP <br />NO.OFSTORIES BASEMENT <br />LI YES I I NO <br />FIRE SPRNKLERS REO'D IIEIGIIT LIMITATION <br />I.:I YES ❑ NO <br />PiANSAPPRCVEOflY <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />GONTACT PERSON AND PMONE NO. <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMIRED 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 PRESUME TO GIVE <br />AUTHORITY TO VIOI.ATE OR CANCEL THE PROVISIONS OF ANV '� <br />OTHER STATE OR LOCAL LAW FEGULATING CONSTRUCTION OR THE � <br />PERFORMANCE OF CONSTRUCTION. THAT 1 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 1827 RCW AND 296200 WAC. <br />SIGNRTUREOFCONTRACTORORAUTHOPREUAGENT OATE <br />X �����._r�/ # : <br />s/uc / �n0/:351�.� ' <br />APPUC�NTS LITY BUSINE55 UCENSE NO / VO BUSWESS N�ME <br />NO. <br />FOFCED AIR SYSTEMS—B, <br />UNIT HEATERS—B.T.U. M <br />CLOTHES DRVERS <br />RANGEHOOD <br />WATER HEATER <br />WOOD STOVE <br />METAL FIREPLACE 8 CHIMNEY <br />FIREPLACE INSEflT <br />HEATPUMP <br />GAS PIPING <br />EXHAUSTFAN <br />� TOTAL <br />PLAN GHECK NUMBER FEE <br />BUIIDING <br />PLUMBING <br />MECHANICAL <br />OTHER <br />STATE BUILOING SURCHARGE <br />STATE ENERGY SUFiCHARGE <br />PU�LIC WORHS <br />TOTAL <br />� <br />$ <br />$ <br />RECEIPT NO. <br />i <br />H <br />