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� <br />��� <br />C�J�H <br />9HC/� <br />rxa� <br />y zH <br />� H� <br />�+] H'� <br />y�C <br />� 0� <br />Hl7 <br />H C�7 O <br />� V �] <br />aH� <br />1 <br />r HH <br />g� <br />H <br />f] C7 C/� <br />� � [r�1 <br />Z H Cn <br />H O v� <br />po �, <br />.�o — <br />��'�� <br />��4 � <br />I '"'j <br />r "`� everett <br />APPLICATIO►_ FOR COl�ISTRUCTI�N PERMIY � <br />TO BE COMPLETED IN INK—PLEASE PRINT <br />tne Evergrcen <br />CITV OF <br />everett HEATING SYSTEM: f�1 GAS ❑ ELECTRIC ❑ <br />EPARTMENT <br />BUILDING D <br />`' 259-8810 <br />❑ DEMOLITION ❑ COMBINATION <br />OWNEP _ MAILAODPES� <br />GENERALCONTRAGium m�i�nuu..=�., <br />GYOJIJ �✓i•'sTi�(lc%J.� <br />�M HA!NI,CAL/CONTRACTOR MAILADLRESS j <br />v" ��1'� _5 U�� -scrc hl <br />Py I�MBINGGONTRAGTOR IMILADORESS <br />`/� C iv� � N� S �: I I S C a <br />CLASS OF WORH <br />❑ NEW ix.! ADDITION C ALTERATION <br />CONTRACTPRICEOFWORK ��Q�G �.f� <br />OESGHIBEWOFKpN�SOUAPEF00TA EINVOLVEO <br />LOT _ BLOCK <br />.� <br />BELOW <br />_ OF <br />FOR OFFICE USE ONLY: <br />FflONTSETBACN REARSETBAGK <br />— � . S� <br />USE201J� ` � LOTAPEA <br />� // <br />TY-P{E'jO'iLONiS.�A�LLpOWABIE -i(Y)P'EOFCONSiI.,ACNAI <br />-Y-� I Lll� Ji- ' � ii� <br />SIZEOFBL00. NO.OFSTOPIES <br />2?k6F TI. I <br />OGCUPANCYLOAD FINESPRYKLERSRE <br />_ <br />�. ?9.�'i0 l. <br />PUNS APPflOVED BY <br />?; BUILDING <br />. ,cin /'�r:l <br />��/L <br />CITY <br />�� . � <br />� CITY <br />f�!� �i <br />an <br />9 l.l�:�/E , <br />cin <br />�L _ ! �C: <br />CITY <br />❑ MEChIANICAL <br />L�;a � ,. PI <br />/';�.,�- i <br />ZIP <br />ZIP <br />z� <br />❑ PLUMBING i7 SIGN <br />./lf! �%G'i�9� ��A]�� <br />PHONE <br />!-��. �%�-G%� � -- <br />PNONE r ����ENSEM <br />��. y9•'r,f/�� �.rons�_ }��2i3s <br />PHONE /LICENSER , �/7 <br />o'�s�/y�'� l���M'1i}.cf/7��( <br />PMONE LICENSE M <br />G REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL INSERT C BUILDING RELOCATION <br />CONTACT PERSON AND PHONE NO. _, _,, � <br />s <br />� <br />SETBACN <br />I HEREBY CERTIFY THAT I HAVE RE�D AND EXAMINED 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 VIOLATE OR CANCEL THE PROVISIONS OF ANY ! <br />OTHER STATE OR LOCAL LAW FiEGULATING CONSTHUCTION OR THE '�. <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE I. <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 296.200 WAC. <br />516NFTUFEOFCONTFiACTOPORAU7HORIZEDAGENT �ATE <br />X / /�� /%�"ti� �/�/ ✓V�� <br />APPLICAN CIP(BUSINESSLICENSE .ANOBUSINESSNA E <br />OF <br />M <br />M <br />\TION FAN i � <br />HOOD ' <br />PIPIN6 <br />�1� BUILDING <br />O[CUCAHtv NO OfOW[LLIN411NiR <br />A P �' PLUMBIN� <br />eASEMENT MECHANICAL <br />HEIGHTLIMITATION ADDITIONALPLANCHECK <br />OTHER <br />STATE BUILDING SURCHARGE <br />CITY OF EVERETT PUBLIC WORKS <br />LOCAL SALES <br />TAX COUE IS 3105 TOTAL <br />s <br />