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APPLICATIO�I�i FOR CONSTRUCT ON PERMIT everett <br />iM1eEvergreen TO BE COMPLETED IN INK—PLEASE PRINT � <br />GITV OF <br />everett HEATING SYSTEM� ❑ GAS ❑ ELECTRIC ❑ <br />BUILDING DEPARTMENT <br />259-8810 <br />r� DEMOUTION ❑ COMBINATION J BUILDING �' ECHANICAL ❑ PLUMBING ❑ SIGN <br />MAIL PO BE55 21P PHONE <br />oW�� 1 ._ %_ . � .,, . �'St�r�n, 2��%� � <br />CONTRACTOR <br />ADDRE55 <br />ciTv <br />CITV <br />CITV <br />1 ZIP <br />�ZIP <br />ZIP <br />ZIP <br />PHONE <br />PMONE <br />PHONE <br />LICENSE Y <br />LICENSE p <br />LICENSE P <br />S�S OF WORK <br />NEW ❑ ADDITION ❑ ALTERATION Ll REPAIR ❑ DEMOLITION I-! WOODSTOVEIFRPL INSERT �� BUILDING RELO A <br />I CONTACT PERSON AVD PNONE NO. <br />�ES`CRIB,F,. ^WURNq/� D: ]UAFE F�OOTA(�/7 E INVOLVED <br />�UIOr Jt(,(/�C C �c..i`� <br />PROPO�S'�QJ�U�SE OF UILDING <br />C/uD / A� <br />LEGAL�ES IPTIONO PROPERN�SHOWNBELOY <br />�pt BLOCK OF <br />PaaecT <br />OF FIXTURE <br />SHOWER <br />KITCHEN SINK 8 DISF <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DfiINKING FOUNTAIN <br />ROOF <br />SINK ( <br />FOR QFFICE USE ONLY: <br />FRONTSETBAGK REFR: <br />7VPE Of CON15. <br />SRE OF BLDG <br />OGCUPANCY <br />REASON FOfi <br />INTANE BV <br />LOT AREA <br />PLIOWABIE TVPEOFCONSi.ACTI <br />. NO.OF STORIES <br />.OAO FIRESPRNKlERS <br />PtANS APPROVEO BV <br />FEE <br />I HEREBY GERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />GOPIES) PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHEF SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF AIJY <br />OTHER STATE OR LOCAL LAW REGUTATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORN THE WORK FOR WHICH <br />ApPLICATI�N iS MADE AND I COMPLI' VlITH THE STATE <br />CONTRP�CTO S 18.27 RCW AND 2SC.20G WAC. <br />��r.uen�obnc oAT OROAAUTMOR¢EDAGENT OAiE <br />� <br />FEE <br />LICENSE NO. AND <br />OF E�UIPMEt <br />UNITS—H.P. <br />!STEMS—B.T.I <br />—B.T.U. M <br />RANGEHOOD <br />WATER HEATER <br />WOOD STOVE <br />METAL FIFEPI.ACE & <br />FIREPLACE INSERT <br />HEAT PUMP <br />SIDESETOACK PLANCHECKNUMBER F@E <br />VACANT SITE FEES <br />BUILDING <br />acuvnxcr xo.aowcuirvcuxns <br />eaour pLUMBING <br />BFSEMENT MECHANICAL <br />HEIGHTuh11TATION ADDITIONAL PLAN CHECK <br />OTHER <br />STATE BUILDING SURCHARGE <br />CITY OF EVERE7T PUBLIC WORKS <br />LOCALSALES � <br />TAX COUE IS 31U5 T�TA� <br />$ <br />$ <br />$ <br />NO. <br />a—• <br />a <br />