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APPLICATIOK—rOR CI�NST/,�UCT14-d+1 PERMIT <br />lhaEvd�green TO BE rOMPLETED IN 1NK—PLEASE PRINT <br />cin oF <br />everett HEATING SYSTEM: U GAS ELECTRIC ❑ <br />BUILDING DEPE:RTMENT <br />259-8810 <br />❑ DEMOLITION I I COMBINATION '' BUILDING !' MECHANICAL LI P�ilMBI1JG <br />�WYEP MRILA�ORE55 CITV ZIP PHONE <br />_ . _ �A %1 l. / fn � -. / f ,�7 /� /� n n /]c o� v '7C' 2 _ Q � / i'1 <br />TENANT M�IL �DDRESS CITY ZIP PMONE <br />Sa�.,.� u.., a-.G.,.r <br />AqCHiTECTOR0E51GNER MAILAppRE55 CIIY 21P PHONE <br />GENEfiAL CONTPFCTOR MRIL FDORE55 LITY 21P PHONE I.ICENSE � <br />MECNANICALCONTFAGIOR MAILAUDFESS QTY 21P PHONE LICENSEI <br />PLIIMBINGCONTPRCTOR M�ILFDORE55 CITY 21P PHONE LICENSE� <br />Il NEW I I ADDITION i I ALTcRATION . <br />� � <br />CONTRRCTPqICEOFWOHK /Q or — lL5 <br />OESCRI�EWOFNAN�SOUAf1EFOptAGEINVp1.VEq _ <br />PROPOSEO USE <br />IEWL DESCRIPTION OF PqOPI <br />LOT BLOCK <br />KITCHEN SINK 8 DISP <br />DISHWASIIEF <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />DpAIN <br />FOR OFFICE USE ONLY: <br />LOi <br />OF <br />everett <br />e <br />I SIGN <br />I qEPAIR i I DEMOLITION -� WOODSTOVE/FFPL INSERT I.I BUILDING RELOCATION <br />CONi�CT PEfi50N AND PNONE NG. <br />I HEREBV CERTIFV THAT I HAVE READ AND EXAM1SINEG THIS <br />APPLICATION AND KNOW THE STMt= TO BE TRUE AND CORRECT. ALL <br />Fo�,ncoa�es� PROVISIONS OF LAWS AND ORDWANCES GOVERNING THIS TYPE OF <br />WOHK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREII� OR <br />NOT. THE GRANTING OF A PERMIT DOES �OT PRESUME TO GIVE <br />HUTHORITY 70 'JIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTH[R STA'fE OR LOCAL LAW REGULATING CONSTRUCTION OR ThiE <br />PERFORMAIJCE CF CUNSTRUCTION. THAT I AM AUTH�RIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATIGN IS MA�E AND I COMPLY WITH THe STATE <br />CONTRACT LAW 1827 qCW AND C9620[t WAC. <br />SIGNAiURE -CO tqqCTORORPUfNORIZFDAGENT OATE <br />(,�, � a: �, 'f� Qi �'�n <br />q�P'.iCANTS GITV BUSINESS UCENSE N0. AND BUSINESS NRME <br />SU8 TOTAL $ <br />PERMIT $ <br />TOTAL FEE $ <br />SIOE SEiB�CK <br />Vr1CR.VT SRE <br />7YPEOfCONIS.AILOWABIE I 1Y�'EO�LUNSI.ACIUAL <br />SRE OF aLOG. <br />OGWPANGY LOAO <br />NEASONfORSPRI. <br />INiAHE BY <br />�i�ihii��i <br />NO.OFSIONES <br />flRE SPRNNIERS flB0'� <br />PLANSRPPPOVEDBY <br />i� <br />TYPE OF EOUIPMENT <br />NC—A/HNDLG UNITS—H.P. <br />F7RCED AIR SYSTE>dS—B.T.U. M E.: �,. <br />UI�11T HcATERS—B.T.U. M <br />W�TER HEATER <br />WOODSTOVE <br />METAL PIREPLACE 8 CHIMNEY <br />FAN <br />PLAN CMECK NUbI6ER <br />P'JILOING <br />acurevv nuunnuurcwurs <br />cno,m -- pWM01NG <br />BnSEMENi MECHANICAL <br />NEtGHiLIMIiAi1pN �D�ITIONALPLANCNECK <br />OTHER <br />STATE BUILOING SUi1CHARGE <br />i;TY OF EVERETT PUBLIG WORKS <br />LOCAL SALES <br />TAX CODEIS 3105 rorn� <br />SU8 TOTAL $ <br />PERMIT $ <br />TOTALFEE $ <br />a <br />a <br />�� <br />� <br />, .. . . , <br />e <br />