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APPLICATIO�. FOR �ONSTRUCTr.1N �ERMIT °`"`'" <br />TO BE COMPLETED IN INK—PLEASE PRINT � <br />nvor — — <br />everett HFATING SYSTEM: ❑ GAS �I ELECTRIC J _ __- - - -- � <br />BUILDiNG DEPARTMENT J <br />259-8810 <br />DEMOLITION COMBINATION <br />pWNER OSQ�1.�G NRILADDRE55 <br />,115�'r� 2��A o �� �� <br />1C11AM <br />BUILDING MECHANICAL <br />CITV IIP PHONE <br />it% E(/P.CIT T �J` �% � <br />arv ziv P�or+E <br />PLUMBING SIGN <br />5� � - �/f�2 � <br />F�O�rt[Ci OFDES�GNER MRit AUDPESS Clr ZiP PH���E <br />.ENERAICONtRRCTOR MAILAG:�RE55 CITV 2iP PMONE IICENSE• <br />��, 6,� i,� --���_� �%� ��,��r�-� Z,9���� »��.�s�� i�o�,� ��z�,�� <br />pM04[ IILENS • <br />1!1O14N1 ALCONLP�CTOR MAILGDDRL55 <br />GTY 21P PNON[ IICGNS[� <br />���.indplvGCONiRAGTOR MNLADD:tE55 <br />ClAS� -WORK <br />NEW ADDITION ALTERATION . REPAIR DEMOLITION WOODSTOJE'FRPL INSERT BUILDING RELOCATI N <br />n�inLT PEF WN AND PNONE NO <br />ic.�.."��� ��d i��/ /Rn<c %7�' ZS7Z — <br />o[scRiee wonK nr+o sou.��e.w�A�� ��......�� <br />�,� - fPaoF S D�' '� <br />OPOSED USE OF 9l1iL01NG <br />LEGAL DESfRIPTION OF PROVERTV �SHOWN HELOV <br />iGi BLOGN OF <br />� <br />TVPE OF <br />WATER CI.OSET <br />BATHTU� <br />[:3 <br />SINK <br />FY�I:] <br />FOR OFFICE USE ONLY: <br />FNONi SETBACN PERR SEiOALK <br />U56CONf LOTRPEA <br />IVP;piCOMSALLOWAtlI[ 1YFEOiCON57.ACiURI <br />S¢6 OF BLIX'i NO OF STORIES <br />OCCUPRNCY LOAD FIPE SPPNKLERS REL <br />H[q50NFOR5PRMNLERS <br />INiRKEBV PUNSRPPROY[DOY <br />I HEREBY Ce7TIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />coriesi PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS 7YPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIfIED HEREIN OR <br />NOT. THE GRANTING OF A PEAMIT DOES NOT PRESUME TO GIVE <br />AUTHORITV TO VIOI.ATE OR CANCEI THE PROVISIONS OF ANV <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR TFIE <br />PERFOFMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED 8V THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLI' WITH lHE STATE <br />CONTRAGTORS LAW 78.27 RCW AND 296200 WAC. <br />$IGNATOR[ OF f,ONT9ACTOR OR AUTHOHRED AGENT DATE <br />1�. � / / .�. <br />FEE <br />$ <br />PN[I O115�NE55NAM[ <br />'HNDLG UNITS-H.P <br />D AIR 5`.'STEMS-B <br />EATERS-B.TU. M <br />ES DRYERS <br />ATI�N FAN <br />WOODSTOVE <br />METAL FIREPLACE <br />FIREPLACEINSER' <br />HEAT PUMP <br />GAS PIPING <br />E%HAUSTFAN <br />SIDF:S[1IlAf.K PIANCNECNNUMO[R «< <br />vncnNrsrtE FEES <br />�UIL�ING <br />M[Ln�Np NO tl OWIl1iN911Ni15 <br />enav pLUM�ING <br />enSErnENT MECHANICAL <br />HEiGHiuMITnTron ADDITIONALPIANCHCCH <br />OTHEfi <br />STATE BUILDING SURCHARGE <br />CITY OF EVERETT PU9LIC WORKS <br />LOCAL SALES <br />TAX CODE IS 3705 TOTAL <br />� <br />PERMIT 5 <br />TOTAL FEE 5 <br />NO <br />