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M1r <br />APPLICATIO � FOR CONSTRUCTI�N PERMIT <br />1M Eroryreen <br />CITV OF <br />everett <br />BUILDING DEPARTMENT <br />259-8810 TO BE COMPLETED IN INK—P1.L�'�EASE PRINT <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING yw�ECHANICAL ❑ PLUMBING <br />�p�u�d t�°°u � -4�-�� �-1 ��T.��,ti (�%iP - <br />� T MAILADORE59 GITY Z�P <br />1 \ /1 ^^n n <br />4_�...f 1' Y I �"'C% <br />Ai.�L=— <br />�ACHITECTORLE516NER M�IADDRE55 CITY 21P <br />OENERAI <br />269•6492 — 355.7730 _ <br />GITV <br />21P PNUNE <br />�53 <br />LwrNf, Wphln�n fL�+i <br />PLUMBMOCONTR�CTOR MAILADDRE55 CITY 21P PNONE LICENSE� <br />n ue... n enninnu <br />TENANTIMPRO�EMENTON <br />LEp/y pE$�RIPTION OF PROPERIi �anunn ut��� <br />LOT BLOCN � <br />SINK 8 <br />everett <br />e <br />❑ SIGN <br />f I REPAIR f� I DEMOUTION f I WOODSTOVEIFPPL IN::ERT ❑ BUILDINQ RELOCATION <br />SUB TOTAL S <br />PERMIT S <br />� TOTAL FEE $ <br />F110NTSETBACK REARSETBACK SIDESETBACN <br />USE 20NE I LOT �REA <br />TYPE OF CON51. ALIOWABIE <br />SRE OF BLU(7. <br />OCCUPANCVLO�D <br />REASON FOR SPRINKLEHS <br />APPLIC�TION ACC. BY <br />TYPE Oi CONST. ACIO�L <br />NO. OF STORIES <br />FlRE SPRNKlERS REOD <br />C) YES CI NO <br />V�CANT SITE <br />I I YES I I NO <br />acun,xcr rroaovrtwhcuvns <br />BASEMENT <br />IJ YES ❑ NO <br />NEIGHT LIMITATION <br />PUNSAPPROVEDBV CITYOFEYEREIT <br />LOCALSALES <br />TAl( COOE IS 3105 <br />CONTACT PEFSON ANO PHONE NO. <br />I HEREDV CERTIFY THAT I HAVE READ AND E%AMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS UF LAWS ANf) ORDINANCES GOVERNINO THIS TYPE OF <br />WORK WILL BE COMPLETFD WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO 61VE <br />AUTHORITY TO VIOLATE OR CANCEL THE PRQVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CnNSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTPACTORS LAW 1827 RCW AND 296200 WAC. <br />SIGN�TUREOFCONTMCTORORAUTHORIZEO�OENT D�TE �� / <br />X �1 I/t� <br />'�-�! �71. / �%� �: <br />A PLIC�NTSCITVBU51 SSL�CENS O.ANDBUSINESSNAME <br />CLOTHES DRYERS <br />VENTILATICN FAN <br />RANGEHOOD <br />WATER HEATER <br />WOODSTOVE <br />METAL FIREPLACE 8 <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />ExHAUSTFAN <br />PL�N CMELK NUMBER <br />PUILDING <br />PLUMBING <br />�IECHANICAL <br />OTfiER <br />STA1 E BUILDING SURCNARGE <br />STATEENERGVSUHCHARGE <br />PUBLIC WORKS <br />TOTAL <br />E.A. <br />SUB TOTAL S O 'Ub <br />PERMIT S S �O <br />TOTAL FEE S ' <br />FEE AECEiPTNO. <br />VALUATION FEE <br />i <br />i <br />i <br />--�— <br />�Os ' � <br />i <br />i <br />i <br />i <br />i <br />� <br />i <br />i <br />S � a� <br />