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� {� <br />APPLICATIOi '' FOR CONSTRUCTIvN PERMIT everett <br />me E�e�preen TO BE COMPLETED IN INK—PLEASE PRINT � <br />CITV OF <br />everett HEATING SYSTEM: GAS Q ELECTRIC 0 <br />BUILDING DEPARTMENT <br />259-8810 <br />❑ DEMOLITION � ; COMBINATION <br />TEN�NT <br />GENERAL CONTMCTOR <br />AfAIL �DORESS <br />MAIL AODRESS <br />MAIL ADDRESS <br />RUMBINOCONTP�CTOR M�IL�DDRESS <br />CLASSOF WORK ,. -A <br />; BUILDING � <br />N TV A IP <br />K' �� �/i �� <br />CITY ZIP <br />CITY ZIP <br />dTY 21P <br />r�%`�u// !!/. � <br />,L �� PLUMBING 7 SIGN <br />PHONL <br />� i� �L%�-G � <br />PHONE <br />PHONE <br />PNONE �ICENSE f <br />�� <br />PHOHj� LICENSE• <br />C 7f�?.[9z���� <br />PHONE LICENSE s <br />❑ NEW ❑ ADDITION �_' ALTERATION L�. REPAIR .��'� DEMOLITION J WOODSTOVE/FRPLINSERT u BUILDINGRELOCATIO�i <br />CONTRCT PERSON AND PNONE NO. <br />CANTWICTPRICEOFWORK ��� •L ] <br />DESCRIBE WOHN AND $OU�9F F T�GE INVOLVEO . i <br />PROPOSED USE OF BU/ILDING <br />�/`� <br />LEG/�L DESCRIPTION OF PflOPERTV (SMOWN BEL01 <br />LOT BLOCK OF <br />� <br />COPIES) <br />�3 9�- C�Z�3-010- 6 <br />OF Fl7(TURE <br />UIVATORY (WASH BASIN) � <br />SHOWER <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />UUNDRV TRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />ROOF DRAINS-RAINLEADERS <br />SUB TOTAL $ <br />PERMIT $ <br />TOTALFEE S <br />FOR OFFICE USE ONLY: <br />FqONTSETBACK REARSETB�CK <br />USE 20NE LOT ANE� <br />lYPEOFCONTS.AILOWABLF ttPEOFCONST.�C111F1 <br />SIZE OF BLDG. NO. OF STORIES <br />OCGUPANCVLO�D FIRESPRNNLERSREO'D <br />REASON FOP SPRINNLERS <br />PIAN,"i RPPROVED BV <br />��0� i� ..� <br />I HEREBY CEiiTIFY 7HAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNUW THE SAME TO BE TRUE AND COHRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITli WHETHER SPECIFIED FiEREIN OP. <br />NOT. THE GRANTING OF A PERMIT DOES NOT PFiESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIOPlS OF ANY <br />OTHER STAT� OR LOCAL LAW REGULATING CONSTRUCTIU4 OF THE <br />PERFQRMANCE OF CONSTRUCTION. THAT I AM AUTHORIZEO BV THE <br />OWNER OF THIS PROPERTY TO PERFOflM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTfiACTORS LAW 18.27 RCW AND 296200 WAC. <br />SIGNATUREOFCONTR�CTOROP�UiMOR2EDAGEAT OAT? <br />X�o��9� �l�T��,sl �6-r� <br />APPLP..ANTS CITY BUSMESS LICENSE N0. ANO BUSI 5 N E T-- <br />UNIT HEATERS-B.T.U. M <br />CLOTHESDRYERS <br />WOOD STOVE <br />METAL FIREPI <br />GAS PIPING <br />EXHAUSTFAN <br />SIDE SETBRCH PUN CHECK NUMBER <br />�S26c <br />VACANT SITE FEES <br />Bl11LDING <br />ORLPIY[v MO MttNFLlM6tINi15 <br />GPWP PLUMBING <br />BASEMENT MECHANICAL <br />MEIGHTLIMITAfIJN AOOITIONALPLANCHECK <br />OTHER <br />STATE BUILDING SURCHARGE <br />CITY OF EVEflETT PUBLIC WORKS <br />LOCAL SALES <br />TAX CODE IS 3105 TOTAL <br />M E.A. <br />PERMIT $ <br />TOTALFEE $ <br />