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APPLICATIOK�`FUF� COM�TRUCTif�l <br />PERMIT � <br />evereU <br />fhn Evergmon . � <br />CITV OF <br />everett <br />BUILDING DEPARTMENT TO BE COMPLETED IN INK—PLEASE PRINT <br />259•8810 <br />f7 DEMOUTION I I COMBINATION I X BUILDING I I MECHANICAL I I PLUMBING Cl iIGN <br />owr+�n Mna nnnness cnr ZIP . PHONE <br />1'verett Ilousing Authority 1hOl Poplar tiveret� WA 98201 258-9222 <br />IENIINT <br />�uanunness cnr zm ruur�e <br />Same as Owner <br />encwtecronoesior+en M�i�nooness cnv zm r"°NE <br />'Che llykeman Architects 1G02 Rewitcrrn�le. livor•ett WA 9�8E01 259110E561 NO1]577 <br />GENEMLCONTMC700 M�ILA�OflESS <br />Not yet SClected �,� -C.�� reonE LICENSEI <br />MECIINIICALCONIO�LTOR M�ILPDDRESS ���Y Z�C <br />Not yet selected _ - -- <br />PIUMBINOCONIDACTON MMLAOOIIESS CI7Y ZIP PIIONE LICENSEI <br />Not et selected <br />tuss oF wonn <br />O NEW I I ADDITION IXI ALTERATION �I REPAIR I 1 DEMOUTION I. I WOODSTOVE/FRPL INSERT' O BUILDING RELOCATION <br />7[NANT IMPROVEMENT OFl INTEfiIOR RE�MO/DEL ON[L�V <br />cnuiBACT PRICE OF WORN: /�• /� 6 <br />181 <br />� y6, �o-� - <br />�ew� oescnirnou oF rnorenrv IsnowN oeiow on nT rnc <br />LOI BLOCK OF <br />I�Ltf1C�lC(1 _ <br />Pf10JECTADORE55 <br />1216 Poular St., tt <br />CIOSET <br />CLOTHES <br />JG FOUN <br />ORAIN <br />_I SINK <br />�ASIN) <br />SUB TOTAL 3 <br />'-- PEHMIT 3 _ <br />— 70�IA1 FEE E <br />rnaasnnncK nennsemncK -r510E5E79ACN <br />use ta+c <br />nr� nr toxsr nu a.v�m e <br />5�7E Of ALW <br />33 80 <br />or.cur�n�e��c�riuno <br />_—'�-- <br />nenson i on srnwK�rns <br />erriicnurn+ncc nr <br />iornnen <br />rvrc o� cm+s� ecmni <br />T <br />--"IL'- N — <br />NO OF SIOIVCS <br />� <br />r inr srnuKi F ns nco 0 <br />I.I YE-S 'k NO <br />PL�115 APPIIDVF.� DY <br />1 HEREBY CERTIFY THAT I HA�READ ANb EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIOIJS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETEO WITN WHETHER SPECIFIED HEH[IN OFi <br />NOT. THF GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHO(IITY TO VIOIATE OR CANCEL THE PROVISIONS OF ANY <br />O�NER SfATE OR LOCAL LAW REGULATING CONSTHUC710N OR TH[. <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 />CONI'R�C(ORS LAW 1827 RCW AND 29G.200WAC.OG%Y� /CJ�%li <br />nG�con� nCt nauTNOR�IED ENr oelE Gn���9{j' <br />The Dykeman <br />Architects <br />APPLICAN S CIIY BUSINE LI ENSE NO. ANO OUS E55 N�ME � <br />FORCEU AIR <br />UNIT HENEf <br />CLO(IIES DF <br />VENTILATIO� <br />RANGEHOU <br />WAlERI1EA1 <br />WOOD S �UV <br />'— — <br />; GAS PIPID <br />� EXIi�UST <br />vncnr+T sire <br />I I YES NO <br />rcrur�xcr wa m�uuxei <br />i�j- 1 I �..f_ <br />O�SEMEN� <br />I �I YES 1`i�NO <br />❑EIGNf LIMII�IION <br />Cx�aiG <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />EMS—B.T.U. M E.A. <br />T.U. M <br />INSCRf <br />PLAN GI IF.CN �lUMOf:fl <br />`!v .23 s <br />FEES <br />DUILDING <br />r�un+oiNc <br />MGCI IANICAL <br />omen <br />SIAi[ UUILl71NG SUIICIIAfIGf: <br />SIAIE ENf:f1GY SUf1CIlAf1GE <br />runuc wonrcs <br />TOTAL <br />F[E <br />sue ioin� <br />5' <br />FEE <br />0 <br />� � <br />_ �—. <br />� <br />S ' <br />neceirrrx�. <br />yiPYS <br />—:— <br />i <br />� <br />H <br />� <br />