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APPLICATItyN FOR C�R�lSTRUCti .ON PERiV11T <br />Ihe Eveigreon TO BE COMPLETED IN INK—•PLEASE PRINT <br />CI7Y OF <br />everett <br />BUILDING DEPARTMEN i <br />259-8810 <br />❑ DEMOLITION C COMBINATION <br />OWNER . MRILAOORFGS <br />AOORE55 <br />AP.CHITECT Oq <br />HC:ATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />❑ BUILDING <br />GITV <br />Si�D6 Lo.x <br />CITY <br />CITY <br />❑ MECHANICAL <br />Z�P PHONE <br />` <br />Zi^ PHONE <br />Z�7 PHONE <br />❑ PLUMBING <br />everett <br />e <br />❑ SIGN <br />- eHALGo TRACTOri MAILAODRESS CITY 21P PHONE iICENSEY <br />- .vs�rio.✓ /,�iZ- �¢�,l�./�l�,I! u�u..E �yl.,�o Gs� •6ir� .�G �Ci�w,��w <br />MECHANICFLCONTRACTOR MAILADDRESS CIN ZIP PNONE LICENSEN <br />PLUMDINGCONTfiACTOR IdMLADDRESS CITV ZIP PNONF. LICEHSER <br />CLA55 OF WORN <br />❑ NEW ❑ ADDITION �ft[TERATION ❑ REPAIR Cl DEMOLITION ❑ WOODSTOVE/FRPL INSERT ❑ BUILDMG RELOCATION <br />I CONTAGT PERSON AND PHONE NO. <br />CONTRRCT PRICF OF W[1n¢ G�i� O� � � <br />ANDSOUFflE <br />LEGAL DESCRIPTION OF PROPEflTV (SHOWN BELOW Ofl <br />�OT �� 6LOCK �L_ OF G <br />v.��, .O ��. �-� � <br />PROJEGiAD�RESS <br />,s�aL �a,� <br />P :UMBING <br />— NO. TYPE OF <br />WATER CLOSET <br />I BATH7U8 <br />KITCHEN SINK 8 <br />WASHER <br />DRINKING FOf <br />FLOOR DRAIN <br />B�CKFLOW PF <br />FOR OFFICE USE ONLY: <br />FRONTSETOACK REARSETBACK <br />USE20NE LOTAPEA <br />ttPEOFCONiS.ALLOWA04 TYPEOiCONST.PCTUAL <br />SIZE OF BLDG. NO.OF STORIES <br />�ono <br />ItItAKE BY I PLANS APPROVED BY <br />��" 8/� <br />FEE <br />SIOE SETBACK <br />VACRHT SiTE <br />I HEREBY CERTIFY THAT I HA':E READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAML TO BE TRUE AND CORRECT. ALL <br />PqOVISIONS OF LA1NS AND ORDINANCES GOVERNING THIS TYPE OF <br />VlO;iK INILL BE COMPLETED WITH WHETHEfl SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERNIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR C/�NCE:. THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULA'i �fJG CONSTRUCTION Ofl THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFC'iRM THE WORK FOR WHICH <br />A°PLICATION IS MA�E AND I COMPL� WITH THE STATE <br />CONTfiACTORS LAW 1827 RCW AND 2962pp yJAC. <br />SIGNATUFEOFCONTRACTORORAUTHOf11ZE AGENT DATE <br />X <br />APPIIC NTS CITY BUSIN SS ULE E I10. AND BU$INE55 NAME <br />TYPE OP <br />FOFiGED AIR SYSTEMS—B.T.U. M E.A. <br />UNIT HEATERS—B.T.U. M � <br />CLOTHES DHYERS —T— <br />VENTILATION FAN � <br />RANGE HOOD �— <br />METAL FIREPLACE 8 CHIMNEY <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />SUB TOTAL <br />PERMIT <br />TOTAL FFE <br />CHECKNUMOEfl � FEE � RECEIVTNO. <br />BUILDING <br />OCLUPANCY NOAfp11'[LLIIIGUNIfS <br />cnour p�UMOiNG <br />BASEIAEHT MECHANIC�L <br />� <br />HEIGHTLIMITATION ADDITIONAL PLAN CHECK <br />CTHER <br />STA7E 9UILDING SURCHARGE <br />CITY Of EVERETT PU�LIC WORKS <br />LOCAL SALES <br />TAX COOEIS 3105 rora� <br />0X <br />A <br />