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��� <br />H <br />9HfHi� <br />�xy <br />Hz� <br />oxo <br />'�1 H �i1 <br />(q H <br />� 0 � <br />H C7 <br />O H <br />H�g <br />y� Y C] <br />t"y� <br />HH <br />g�' <br />H <br />C] t7 �+ <br />��� <br />zyv, <br />HOCn <br />, , ,,,,, <br />APPLICATIO�� FOR C6�NSTRl�CT1�N PERN9IT <br />Ne Everg.een <br />CITV OF <br />everett <br />BUILDING DEPARTMENT <br />259-8810 TO BE COMPLETED IN INK—PLEASE PRINT <br />QFMOLITION COMBINATION '- BUILDING I: i MECHANICAL <br />OWNER � AiLApDFESS .•,� � ^^ Zip ' I pi <br />n7hQ�.P lJA%1 '� >ih� ,,�,�� <br />� -�,2�Jd.L J�Ir-l:.L A <br />DES!GNER � I.IAIL <br />PHONE <br />PHONE <br />everett <br />� <br />PLUMBING _: SIGN <br />�� JJ J`l� <br />PWM9INGCONTRACTOR MAIL�DOqESS <br />. ��. NEW r! ADDITION <br />TENANT IAIPpOV[MENT OP INtEP <br />CONTRACTPRIGEOFWORN: C <br />PROPOSE� USE OF OLlIL01NG <br />LEGAL �ESCRIPTION OF PROPE <br />LOT BIOCK <br />PROJECTFOOPE��� � I I) <br />'�� <br />PLUMBING <br />NO. TVPE OF FIXTURE <br />WATER CLOSET(TOILET) <br />BATHTUB <br />LAVATORV�WASH BASIN) <br />SHOWEF <br />KITCHEN SINK 8 DISP <br />FRONTSETOFCK <br />USEZONE <br />iYPE Of LONST. ALLOWABIE <br />SIZE OF BLDG. <br />OCCUGANCYLOAD <br />REASON FpR SPRINNLERS <br />4PPLICATION �CC.9Y <br />u�cr�ac� <br />._1 RcPAIR '._. DEMOLITIO�� ' i WOODSTOVE/FRPLINSERT :-] BUILDINGRELOCATION <br />I G�NTACT PEflSON AND PHON� N0. <br />J 1 I HEREBV CEFTIFV THAT I HAVE READ AND EXAMRJED THIS <br />�_ APPUCATION AND KNOIN THE SAME TO BE TRUE AND COqRECT. ALL <br />LOWOflFTfACHFOUqLOPIES� PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIPIED HEREIN Ofl ' <br />°F NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE , <br />AUTHORITV TO VIOLATE OR CANCEL THE PROVISIONS OF ANV I <br />OTHER STATE OF LOCAL LAW REGULATING CONSTRUCTION OH THE <br />PERfORMANCE OF CONSTRUCTION. THAT I AM AUTHORI2ED BY TH[ i <br />OWNER OF THIS PROPERTY TO PERFORM THE VJOflK FOR WHICH ', <br />APPLICATION IS h1ADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />SiGNATU EOFCONiRACTO/ RAl1THOF2EDAGENi pAtE � <br />X �y� � <br />� � ��� AP iSGITVBU SSLICENSENO.Af:OBl15iNES5NAME <br />TYPE OF EOUIPMENT <br />NC—A/HNDLG UNITS—H.P. <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />UNIT HEATERS—B.T.U. M <br />CLOTHES DRYERS <br />VENTILATION FAN <br />RANGEHGOD <br />WA'ER HEATER <br />WOOD STOVE <br />METAL FIREPLACE 8 CHIMNEY <br />FIREPLACEINSERT <br />HEAT PUMP <br />GAS PIPING <br />REAqSLtBACH SIOESETBRCN PIANCNECKNUMBER FEE <br />LOTAFFA VACANTSITE FEES <br />CI YES �! NO BUIL�ING <br />TYPEOFCONSi.ACiOAL IXCUPANLY NOOipWR4NG�NIiS <br />LNWP <br />PLUMBING <br />NO.OFSTOflIES BASEMENT MECHANICAL <br />❑ YES D NO <br />FIRESPPNKLERSREO'D HEIGHTlIM111TATION OTHER <br />❑ VES ❑ NO STATE BUILDING SURCHARGE <br />STATEENERGVSURCHARG[ <br />r�.nr�snranoveouv CITYOFEVERETT PUBUCwOaKs <br />LOCAL SALES <br />TAX COOEIS 3105 TOTA� <br />SUB TOTAL <br />PERMIT <br />TOTALFEE <br />FELEIPi N0. <br />30 �— <br />QL I <br />