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/�PPLIC�4,TItrN FOR CONSTRUGI.AN PERMIT <br />!hr [�Ergreen <br />CITV OF <br />everett <br />BUILDING DEPP.RTMENT <br />259-8810 TO BE COMPLETED IN INK—Pl_EASE PRINT <br />DEMOUTION COMBINdTION Q��BUILDIPdG _M�CHANICAL <br />OW E`T f HqIIADDRESS CITV Z�p pF <br />�%_. �,- A��� �S 2(�2� i�,loe- I.�� Evr��r—r q�zo3 <br />TENqNT MAILAD�RESS CITV 21P pF <br />� giuif�iaµ�s �.,.._, ,� �' 1 I .--�,-- <br />mtGHANIGNLCONTRAGTOR MqILA00RE55 CIiY <br />PLUMBING CONTRACTOR MAIL Ap�FE55 CI�Y <br />CLASS OF WORN <br />_ ! NEW ❑ ADDITION �G <br />iENANT IMPROVEMENT OR INTERIOR �RJEI <br />CONTRACT PqICE OP W09H: ^ <br />DESCRIBE WORN AND SOUARE FOOTAGE <br />T�...- — ' - ^- <br />LOT <br />PROJECT <br />OLOCK <br />TYPE OF <br />WATERCLOSET <br />DATHTUB <br />LAVATORY(WA51 <br />SHOWER <br />KITCHEN SINI( & <br />��✓ PHONE <br />c1�,277 (0�5 <br />1�P �j�� PMONE <br />��� <br />T�P PHCN[ <br />ZIP PHONE <br />everett <br />� <br />SIGN <br />ALTER4TION ,.. REPAIR �� DEMOLITION C_ WOODSTOVFJFRPL INSERT �7 BUILDING RELOCATION <br />O�ELONLV I CONTACTPERSONANpFHONEHO. <br />OF <br />OR ITEM <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />ROOF DRAINS—RAINLEADERS <br />SINK ISERVICE—BAR. ETC.1 <br />FRONTSETDACN <br />USEZONE <br />��Z <br />tVFE Of f.ONSi PLLONABLE <br />REASON FOfl SFRINH�ERS <br />FPPUCFTION AGC BY <br />��_' ' \) <br />I HEREBV CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. A; L <br />FOIIR LOPIES� PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE UF <br />'NORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOeS NOT PRESUME TO GIVE <br />AUTHORiTY Tp VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHEn STATc OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFCRMANCE OF CONSTRUCTION. THAT I AM AUTHOP2ED BV THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WOPK FOR WHICH <br />APPLICATION IS MADE AND I COMPLV WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />SIGNATUREOFCONTPACTORORAUTHORI2EDAGENT �ATE <br />X �//./��� ,. /i�, /.�.. <br />SUB TOTAL S <br />PEFMIT 5 <br />TOTALFEE S <br />0E4R SETBACH � SI�E SETBACK <br />tOTAREA VqCANT5ITE <br />YES NO <br />iYPEOFCj�y.,fACiUAI OCGuveutr NO OWEwnGi <br />��'�' NOUP � <br />NOAf STORIES BASEMENT <br />I (' YES O <br />FIPESPRNKlER5RE0� NEIGNTLIMITATIO": <br />:_' YES �NO �S /�- <br />PIANSAPPRQVEDGV i ClTYOFEVERETT <br />�� I LOCAL SALES <br />7'i1X CODE IS 3105 <br />TVPE OF E�UIPMENT <br />A/C—A/HNDLG UNITS—H.P. <br />FORCED AIR SYSTEMS—B.T.U. M <br />UNIT HEATERS—B.T.U. M <br />CLOTHES DFYERS <br />VENTILATION FAN <br />RANGE HOOD <br />WATEfl HEA7ER <br />WOOD STOVE <br />METAL FIREPLACE 8 CHIMNEY <br />FIREPLACEINSERT <br />HEAfPUMP <br />GAS PIPING <br />EXHAUSTFAN <br />SUB TO'fAL <br />PERA4!T <br />TO'AIFEE <br />J `E��L L <br />� FEES VALUATION <br />BUILDING — <br />PLUMBING <br />MECHANICAL <br />OTHEfl <br />STATE BUILOING SURCHARGE <br />STA7E ENERGY SU(iCHARGE <br />PUBLIL WORKS <br />TOTAL <br />0 <br />-r— <br />