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r` <br />APPLICATI �'� FOR CONSTRUCT'.�N PERMIT <br />m. c,rem�� <br />TO BE COMPLETED IN INK—PLEASE PRINT <br />CITV OF <br />everett � <br />BUILOING DEPARTMENT <br />259•8810 <br />❑ DEMOLITION L! COMBINATION <br />OW�ER MAILADURESS <br />A�DPE55 <br />Tvs►�i5 �l1YAM � <br />ARCHRECTpROESIGNER MAII <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />I1 BUILDING <br />an <br />c,n <br />�CMECHANICAL <br />Z�p PNONE <br />Z�p PHONE <br />SPpC� � Ib Tae.�F� <br />an z�v <br />everett <br />e <br />❑ PLUMBING f7 SIGN <br />��n. Z�p PHJNE IICENSEI <br />OENERALCONTMCIDR MAILAOORE55 <br />MECNMIIC�LCOHTR�CTOR M�ILADURE55 QTY ZIP PNOHE LICENSE� <br />�"Sw• �,yaawnon qFp36 ?'ls-3��7 Er�•Ic•�:I+�ziz�7 <br />�„� Mw C.n 552t-2O� - ���ENSE. <br />eiuunwnr.nuiPACTOfl MMIADOPESS CITY ZiP PNONE <br />GU1850F M/ORK <br />❑ NEW ❑ ADDITION l� ALTERATION I I REPAIR I� I DEMOLITION I I WOODSTOVE/FfiPL INSERT ❑ BUILDING flE�OCATION <br />�— � LONTAGT PERSON AND PHONE NO. <br />i� /�(`�° na�.y�- M. Ea�cxsoa <br />CONTMCTPRICEOfWURN �.J��+"" <br />[+E6CRIBE WOAK AND iOU�RE FOOTAGE II:VOlVEO �^ � ^�ry ..� <br />LOT BLOCK _ �F <br />ADDRE55 <br />E1�6R MAu- Wnti S.C. S�Acr- � <br />MBINO <br />TYPF OF flXTURE OR ITEM F <br />WATER CLOSET (TOILET) . <br />BATHTUB <br />LAVAfORY�WASH BASIN)� <br />SHOWER <br />KITC!'.EN SINK & DISP <br />DISHWASHER <br />LAUNDRYTRAY <br />� SUB TO <br />j PEFiMIT <br />� TOTALF <br />? FOR OFFICE USE ONLY: <br />� <br />.' FRONTSETBACK NEARSETB�CK <br />i <br />�� USEZONE LOTAREA <br />1 <br />� lYPEOFCON15.AU0WAelE iYPEOF(ONSi.AC10Al <br />t <br />! 61ZE OF 91D0. NO.OF 5'fOAlES <br />i <br />y OCGUPMICY lOAO FIRE SI'RNKLERS REO'0 <br />L, qEA50NFOR5�RINKLE.15 <br />INTAKE BY <br />�5 APPROVED BY <br />�C.-�� <br />SIDE SETBRCN <br />_J IJ '�� -1 I <br />I HEREBY CERTIFY THAT I HAVE READ AND E.CAti11NED THIS <br />AVPUCATION AND KNOW 1'HE SAME TO BE TRUE ANC CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINAI'CES �iOVERNING THIS TYPE OF <br />WORN WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME 10 GIVE <br />AUTHORITY TO VIOLATE OA CANCEL THE PROVISIONS OF ANY <br />OTF;ER STATE OR LOCAL LAW REGULAT�NG CO�ISTRUCTION OR THE <br />PERFURMANCE OF CONSTRUCTION. THAT i AM AUTHCRIZED BY THE <br />OWNER OF THIS PROPER7Y TO PERFORM THE WORK FOR WHICH <br />i.PPLICATION IS MADE AND I COMPIY WITH THE STATE <br />CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br />SKiNATUREOFCONTRACTORORAUTHORIZEDAGENT ORTE <br />` �iV 11\' •M'v" �Y��/%� <br />APPLICRNTSCITY SINESSIICENSENO.ANOBJS!NESSNAME <br />NO. I TYPE OF <br />FORCED AIR SYSTEMS—B.T.U. <br />UNIT HEATERS—O.T.U. M <br />FAN <br />8 <br />HEAT PUMP <br />GA� PIPING <br />EXH,.JST FAN <br />SUB TOTAL $ I �C � <br />PLANCHECKNUMBEN FEE I flECEIPTNO. <br />i <br />BUIIDING ' <br />ocwr�ucr twavnnuvouxns ' <br />�AWP PLUMBING � <br />uASEMEN7 MECHANICAL S � �0 <br />i <br />HEIGNT LIMITA710N ADDITIOtJAL PLAN CHECK � <br />� <br />OTHER � <br />i <br />STATE BUILDING SURCHARGE � <br />CITY OF EYERETT PUBLIC WORNS � <br />LOCAL SALES <br />TAX CODE IS 3105 TOTAL %;l�L� <br />