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\�"�I A�PL,ICATIO.� FOR rONSTRUCTi�N PERMIT <br />1 the Everpreen <br />{ cirv oF <br />' �verett <br />: BUILDING DEPARTMENT <br />� 259-8810 TO BE COMPLETED !N INK—PLEASE PRINT <br />'� ❑ DEMOLITION ❑ COMBINATION Ci BUILDING �ECHANICA <br />M�ILADDHESS dTY 21P /'� <br />'i ��J�PR �,-► 'P�� ' � `� l�-�<<' LLVI!'� �l7' <br />��� f7Eq MAILPDORESS QTY Z�P <br />�,� �ecuiT4cTnRnFCIANEfl� MFILADDHE55 CITY ZIP <br />uervcn��c�...�..�..�259�5�T97��3'554730-7422944 -... <br />� <br />��os eeonoue.n �/Q <br />MECMANIC�LGONTRAC70R ��i�p���hlfl��Ofl 9BZOI 1 /_J��T� <br />V � •� <br />oiuuNwnCaNTRAr,TOR MAILAD�AESS dTY <br />C(ASSCFWORK \ <br />Cl NEW ❑ ADDITION � <br />TENANTIMPROVEMENTOR <br />CONTRACT PFICE OF WORI <br />DESCRIBE WORK �NQ¢Qlji <br />LOi <br />PROJECT <br />HON� <br />21P PNONE <br />�� <br />I 1 PLUMBING <br />J JJ � � <br />UCENSEI <br />LICENSE <br />— I� ' <br />LICENSE f <br />everett <br />e <br />❑ SIGN <br />❑ REPAIR I 1 DEMOLITION L.I WOODSTOVE/FRPL INSERT f l BUILDING RELOCATION <br />CONTACT PERSON AND PIIONE NO. <br />PROPERTY �SHOWN BELOW OR ATTACH FOUR <br />BLOCK OF <br />SHOWER <br />KITCHEN SINK & DI; <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />ROOF <br />SINK ( <br />FRONTSETOACN <br />USE20NE <br />TYPE OF CONSi. ALIOW�BLE <br />SIZE OF BLDG. <br />OCCUPANCVLOAD <br />REASON FOfl SPRINKLEPS <br />APPUCATION ACC. Bv <br />I HEREBY CERTIFY THAT I HAVE READ AND E%AMINED THIC <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVEflNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITFI WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PP.ESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE Ofl LOCAL La'N REGULATING CONSTRUCTION OH THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BV THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE 5T TE <br />CONTRACTORS LAW 1B.27 RCW AND 296200 WAC. <br />SICNAIUNEOFGONTRACTORORAUTHORIZEOAGENT OA7E <br />X .�� , � � � <br />pPPLICANTSQiY00 IN iSLICE O.ANOBUSINESSN�ME <br />ucnuwu�nw� . <br />UNIT HEATERS—B.T <br />CLOTHES DRYERS <br />VFNTILATION fAN <br />GAS <br />SUB TOTAL $ <br />PERMIT $ � <br />TOTAL FEE $ ' <br />BEARSETBACN SI�ESETBRCN PlANC11ECNNUM6ER <br />LOiAREA VACANTSITE FEES <br />IJ YES I�1 NO BUILDING <br />iVPEOfCONSf.ACIUAL ���r �a�tluHGUNnS <br />Cp�P PLUMBING <br />NO.OFSTORIES BASEMENT MECHANICAI <br />I-I YES f_1 NO <br />FIRESPRNKlER5RE0'D IIEIGHTLIMITATION OTHER <br />❑ YES ❑ NO STA7E BUILDING SURCHAFGE <br />STATEENERGVSURCHARGE <br />PUNSAPPflOVEDBV CITY OF EYERETT PUBLIC WORKS <br />LOCAL SALES <br />Tax cooe is 3�os TOTA� <br />8 <br />M E.A. <br />SUB TOTAL <br />PERMIT <br />TOTAL FEE <br />FEE <br />9ECEIPT NO. <br />OJ <br />vv <br />