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APPLICATI�r�I FOF� CONSTRUCT'�'ON PERMIT <br />nwEreroreeo everett � <br />cm oF <br />ever�tt e � <br />BUILDING DEPARTMENT <br />259-8810 TO BE COMPLETED IN INK—PLEASE P6iINT ' <br />❑ DEMOLITION ❑ COMBINATION CI BUILDING �QMECHANICAL I.l PLUMBING � SIGN <br />�(' NEF MAILADDHESS LITV 21P PHONE <br />X 11�LIIo �A�� �-�O�IXS GtiJ1�e�Ul.�� }�._ c-� 1`7— �'k;��i 5�� I?R�� <br />TEN�NT M�ILADDPES� CITY ZIP PHGNE <br />ARCHRECTOHOESIGNER MAILAOORE55 CITV 21P PHONE ' <br />GENEflALCOFlTRACTOR MAILADDRESS CITV 21P PHONE LICENSEI <br />X <br />PI.UM9INGCONTRRCTOR MAILADDRESS <br />CLASS OF WOpK <br />❑ NEW ❑ ADDITION ❑ ALTERATION <br />TENANTIMPROVEMENTORINTEq10RRcM0�ELONLY <br />CONiRACT PRICE OF WORN: <br />DESCRIBE WOflK AND SOUAflE FOOTAf.E INVOLVE� <br />K i.l)OOQ-ST� � IUS'f�jt / % /%''1 <br />PflOPO5E0115E OF 9UILDING <br />X <br />j <br />l0T BLOCK OF <br />SGk <br />LAVATORY (WASH BA; <br />SHOWER <br />KI7CHEN SINK 8 �ISP <br />DISHWASHER <br />FPONTSETBRCK <br />USE 20NE <br />SIZE OF BLOG. <br />OGCUPANCYLO�D <br />REASON FOR SPRINKLEFlS <br />r1PPLICATION ACC. 6V <br />CITV <br />❑ FiEPAIR ❑ DEMOLITION <br />ZIP PHONE LICENSE � <br />ZIP PHONC LICENSE I <br />L�f WOODSTOVE/FRPL INSERT ❑ BUILDIIJG RELOCATIOh <br />CONTACT PERSON AND PHONE NO. <br />i <br />I HEREBY CERT�FY THAT 1 HAVE READ AND F.XAM�NED ?HIS j <br />APPLIC.>TION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL !; <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNIDIG THIS TYPE OF k, <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN Ofl f <br />NOT. THE GRANT�NG OF A PERMIT DOES NOT PRESUME 70 GIVE i; <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR'fHE ) <br />PERPORMANCE OF CONSTRUCTION. THAT I AM AUTIIORIZED BY THE !� <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH i <br />APPLICATION IS MADE AND 1 COMP�Y WITH THE STATE � <br />CONTRACTORS LAW 18.27 RCW AND 236200 WAC. . <br />SIGNATUREOF NTRALTOfl AUTHOR2EDAGENT UATE � <br />� <br />X � <br />1 <br />�PPLICA 1 ENS[ NO. AND BUSINESS NAME , <br />1. <br />MECHANICAL ; <br />10. TYPE CP EOUIPMENT FEE � <br />A/C—AIHNDLG UNITS—H.P. � � <br />FORCED AIR SYSTEMS—B.T.U. M E.0. �� � � <br />UNIT HE'ATERS—B.T.U. M ; ' <br />CLOTHES DRYEFS � ; <br />VENTILATION FAN ; <br />RANGEHOOD � <br />WATER HEATER ' , <br />WOOD STOVE � E�'J�O ; <br />METAL FlREPLACE 8 CHIMNEY � <br />FIREPLACE INSERT ; � <br />HEAT PUMP � �. <br />GAS PIPING ; �. <br />TOTALFEE $ ' <br />REARSETBACN SIDESETB'CK PLANCHECNNUMBER FEE <br />LOTAREA VFCANTSRE FEES <br />❑ YES ❑ NO BUILOING . <br />7VPEOFCONSLALiIIAL MCUPANm NOAfOwRUxGUNtls <br />�pWv pLUMBING <br />NO.OFSTORIEE BASEMENT MECHAN�CAL <br />❑ YES ❑ NO <br />FIRESPRNKLERSREOD NEIGHTUMITATION OTHER <br />❑ YES ❑ NO STATE BUILDING SURCHARGE <br />STATEENERGYSURCHARGE <br />PlANSAPPROVEDBY CITY OF EVERETf PU9LIC WORHS <br />LOCALSALES <br />TAX CODE IS 3105 TOTA� <br />RECEIPT NO. <br />a <br />