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�APPLICAT11yN FOR CONSTRUC'►-�ON PERMIT everett <br />TO BE COMPLETED IN INK—PLEASE PRINT � <br />fhe Eveigreen <br />CITY OF <br />eve rett HEATING SYSTEM: U GAS ❑ ELECTRIC ❑ <br />BUILDING DEPARTMENT <br />259-8810 <br />� I DEMOLITION I COMBINATION i I BUILDING i I MECHANICAL I! PLUMBING � I SIGN <br />OWNER MAILAD�RESS CITY ZIP PHONE <br />�d�',�k �w�ks l 5 �� LaK-I;w ,c �>,ae ti rys/ zo3 � 55 - 5 7!� / <br />TENRNT IAAILAODRESS CIiY ZIP PHCNE <br />MAILM1DORE55 CITY ZIP PHONE <br />GENERALCONTRAGTOF MAILAD�NE55 CITY ZIP PIIONE LIGENSEM <br />�MECNAN%ICA\�CONiRRCTOR MMLFDORE55 CITY ZIP PNONE LICENSEa <br />% 1 /._1 .. P1C_ �O'�'�4� __ _ <br />M�IL AD�RE55 CIIY 21P PIIONE 4CENFE s <br />LUSS OF WORK <br />I�I NEW I I ADDITION �• qLTERATION I I REPAIR I I DEMOUTION I I WOODSTOVE/FRPL INSER'f I i BWLDING RELOCATION <br />GONf�CT PE1R�SON( ��NO PIIONE NO. <br />/CONTRALTPRICEOFWORN�) 1��� I���K ".+C��G 365-5761 <br />DESCflIBE WORN ANU SOUARE F W'�AGE iM1 <br />i- z��oo 5 <br />PROPO$Ep USE OF BUII OING (� ( <br />/ Si K S � e �Ch��-t <br />LOT_ OLOCK _ OF <br />Pfl0.1ECT ADORE55 <br />� 25 � S L.u,� (;« D 2 <br />PLUMBING <br />NO. TYPE OF FIXTURE OR ITEI <br />WATER CLOSET (TOILET) <br />6ATHTU6 <br />LAVATORY(WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 �ISP <br />DISHWASHER <br />LAUNDRYTflAY <br />CLOTHES WASHER <br />URINAL <br />�RINKING FOUNTAIN <br />I HEREBY CERTIFY THAT I HAVE FEAD AND EXAMINED THIS <br />L I � v� APPLICATION AND KNOW THE SAA7E TO BE TRUE AND CORR�CT. ALL <br />qrraCNFounCOri_ � PROVISIONS OF LAWS AND ORDIP:ANCES GOVERNING THIS TVPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OF <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANV <br />OTHEFl ST1TE OR LOCAL LAW REGULATING CONoTRUCTION OR THE <br />PERFOFiMANCE OF CONSTRUCTION. THAT I AM AUTHORI2ED BY THE <br />iJWNER OF THIS PROPERTY TO PEflFORM THE WORK FOF VJriICH <br />— APPLICATION IS MADE AND I COMPLY WITH THE :iTATE <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />SIGNAiUREOFCONTP�CTOIiORAUTMOR2E0AGENT OATE <br />i <br />X 1���� / /��1� <br />APPIIC�NTS QTV BUS W E55 l ICENSE N0. ANU BOSINE55 Nl ME <br />TYPE OF E�UIPMENT <br />A/C—A/HNDLG UNITS—H.P. <br />FORCED AIR SYSTEMS—B.T.U. <br />UNIT HEATERS—B.T.U. M <br />METAL FIREPLACE 8 CHIMNEY <br />FIREPLACEINSERT <br />HEAT PUMP <br />GAS PIPING <br />E%HAUSTFAN <br />SUB <br />FOR OFFICE USE ONLY: <br />FRONTSE7UACK AE�RSE;OAGK <br />USE20NE <br />IYPE Of W NiS. <br />SIZE OF BLOG <br />OGGUPANCYI <br />PEASONiORI <br />INiAKE AY <br />IOTAREA <br />2I�1 <br />aarcncr xaaownuxcuxns <br />cnair <br />9nSEMENi <br />11EIGNt UMIiAiION <br />CITY OF EVERETT <br />LOCAL SALES <br />TAR CODE IS 3105 <br />N111A0ER � FEE <br />BUILDI�G <br />PLUMBING <br />MECHANICAL <br />A�DI710NAL PLAN CHECK <br />O1HEFi <br />STATE BUILDING SURCHAflGE <br />PUBUC WORKS <br />TO7AL <br />.,.._z ....-_;�. ._.-.._ -......._... . .. � . .__" <br />�,r>. . .. .. � . . . - _ _ .. <br />FEE <br />