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(::�:;: ;'.:.1 <br />APPLICATIOiN FOR CONSTRUCT��ON PERMIT <br />me e�e�yreen TO BE COMPLETED IN INK—PLEASE PRINT <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />259•8810 <br />i I DEMOLITION ❑ COMBINATION <br />ONMEF MAILAODRESS <br />�encu�Ra G�CUP 1�4la(X7 t�f'2oCil <br />MAIL AUDRESS <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />CI BUILDING <br />CITY <br />� <br />cirv <br />, <br />❑ MECHANICAL <br />ZIP Pf <br />ZIP <br />❑ PLUMBING <br />GLI ��OfO <br />—� 8fj0 S <br />everett <br />� <br />❑ SIGN <br />ENEfiAICONT1iACTOR AIAILAD�RE55 dTY ZIP P410NE LICF.NSEI <br />�j'oY� G� uS i �io ��o u� C�utic�l� �'iCt,� (uh R8 l o S 525� •� I to l ToBgc.i*2Z3kL <br />IAECH�NILAICONTR�CTOfl � MAILADORESS CITV ZIP PHONE LICENSEI <br />Nv.� <br />PWMBINGCONTRACTOfl MAILAD�AE55 GITY ZIP PIIONE LICENSE� <br />�� i?. <br />CLASSOFWORK T(�h�JC {�{P' ��`UA� <br />f I NEW ❑ ADDITION IXl ALTERATION I_7 REPAIR ❑ DEMOLITION ❑ WOODSTOVFJFRPLINSERT ❑ BWLDINGRELOCATION <br />CONTRACT PRICE OF WORK <br />DESCRI�E WORN ANO S�UARE FOC <br />�ncr,e1s11w e� <br />PROP�- OSE'D USE OF BUIIDING <br />�'fM 1� Sl�1oP - <br />LEGM DESCPIPTION OF PPOPERTY <br />LOT__ OLOCK _ <br />So5' <br />aaaecT <br />TYPE OF <br />CLOSETi <br />SHOWER <br />KITCHcN SINK 8 DISP <br />CLOTHES WASHEF <br />URiNAL <br />DR�NKING FOUNTAIN <br />ROOF <br />SINK I <br />� <br />BELOW Ofl ATTACN <br />_ OF <br />�w w�'� <br />W� <br />TOTAL FEE <br />FOR OFFICE USE ONLY: <br />FFl@1TSETGACK REARSETOFCK <br />x �5�� <br />USEZONE � LOTAREA <br />C -_1 <br />iYPEOFCONiS.RILON:ABIE TYPEOFC@ISi.ACT AL <br />V - i✓ ✓- �✓' <br />SI2E OF BLDG. NO.OF STORIES <br />� � SQ'� � <br />OLCUPP:JCY LOAD FIRE SPRNKLERS REO'D <br />s R Y�S <br />RE�SON FOR SPRIN <br />�J/j C <br />INiAKE UV <br />FEE <br />sioe seToncK <br />GONTACi PERSON AND PHONE NO. <br />TaunBo�n,�r21-m�r3cousT�� 52S'-flol <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND OflDINANCES GOVERNING THIS TYPE OF i <br />WORK WILL BE COMPLETED WITH WHETHER SPEC�FIED HEREIN OR I <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 />PERFORMANCE OF CONSTRUCTION. THAT 1 AM AUTHORIZED BV THE <br />OWNER OF THIS PROPERTY TO PERFOflM THE WORK FOR WHICN . <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br />SIGNATURE FCONTRACTOqORAUTNOflIZEDAGENT UATE �/ �y !Q' <br />T.�t l2�-��r�tis) rv,�: <br />X kEvtu STOLTiE. <br />CbbtAPu PwS # p2oSolo <br />APPLICANTS CITY BUSINE55 LICENSE NO. AND BUSINESS NAME <br />FORCED AIR SYSTEMS—B.T.U. M E.A. ' � <br />UNIT HEATERS--B.T.U. M � � <br />r <br />CLOTHES DRYERS ' : <br />VENTILATION FAN � �' <br />RANGEHOOD � �� <br />WATER HEATER ; . <br />8 CHIMNEY <br />FIREPLACE INSERT i '� <br />HEAT PUMP � ! '�. <br />•v" BUILDING <br />OLWCNkY NO.OfRNFIIINGUN115 <br />LflOVv PLUMBING <br />�-z <br />3ASEMEN7 MECHANICAL <br />N� <br />HEIGH7 LIMIiA7loN ADDITIONAL PLAN CHECK <br />OTHER <br />STATE BUILDING SURCHARGE <br />CITY OF EVERETT PUBLIC WORKS <br />LOCAL SALES <br />TAX COUElS 3105 TOTAL <br />SUB TOTAL $ ' '� <br />PERMIT $ � <br />.�_ <br />TOTAL FEE $ ! <br />FEE � FEGEIYi Nu. . <br />2s ' .53.32A ' <br />VALUATION FEE <br />�7 000 'CJ� � <br />! <br />