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APPLICA��`iON FOR CONSTR��TION PERMIT <br />the Evc�gmen <br />CITV OF <br />everett <br />BUILDING DEPARTMENT <br />259-8810 <br />I1 DEMOLITION � <br />OWNEIi ���� <br />everett <br />e <br />TO BE COMPLETED IN INK—PLEASE PRINT <br />CC!.1BINATION I I BUILDING f_] MECHANICAL ❑ PLUMBING ❑ 51GN <br />. nooness crtr zm r�wr+e <br />nncHIIECTOR�E5IGNEN MRI��OORESS <br />CITY <br />PHONE <br />PLUMBINGCONTRACTOR MAILAOURE55 CI7Y 21P PIIONE UCENSE� <br />CL�SS OF WORK <br />I I NEW Ll ADDITION � ALTERATION L I REPAIR I.I DEMOLITION I. 1 WOODSTOVE/FRPL INSERT ❑ BUILDING RELOCATION <br />tENANTIMPAOVEMENTOAINTERIOAflEMODELONLY <br />cor�Tnnctvn�ceorwonK: .q (pbtlb •_ <br />OESGRIBE WORN AND SOURRE FOOTAGE INVOIVEU <br />`f ' 1° �Ib�vn �Z�e� !� �.;'w .i..* <br />PROPOSED USE OF BUIIDING� �4�1 <br />LOT <br />� <br />raaecr <br />' PR�PERri (SHOWN BELOW OR RTTAGN <br />BLOCK OF <br />�-y�,w�a <br />BINO <br />?VPE OF <br />WATEH CLOSET <br />BATHTUB <br />LAVATORY(WAS <br />SHOWER <br />KITCHEN SINK 6 <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASH <br />URINAL <br />ORINKING FOU� <br />FLOOR DRAIN <br />BACKFLOW PRE <br />ROOF DRAINS— <br />fRONTSEIpACN ' <br />USE7.ONE�• �• <br />� f R; eiQ�'1i�� <br />IYPE Ot 40NSi. ALLOWABLE <br />� <br />SIZE OF BLDG. <br />t] �`j ��' <br />. OCCUPANCYLOAD <br />4'' : <br />� REASONFOfiSPRINNLE115 <br />1 <br />fi"�: �. nrrucnnor�ncc.ev <br />SUB TOTAL S � <br />PERMIT $ --r <br />TOTALFEE $ ; <br />PEAfl SETB�CK � SIDE SElO�CK � <br />—i p c•— r 5-f � <br />LOTAREA 37 VAC�NTSII[ <br />[ 1 YES NO <br />AND PNONE NO. <br />�"` : 1 � �G �%'n �a lJ. - <br />I� EBY6CERTIFY �AT 1 H�'E RE D A�� MIN�.!S <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OH <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHEfl STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PE-RFORMANCE 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 STATE. <br />CONTRACTORS lAW 18.27 RCW AND 296.200 WAC. <br />SIGN�TUREOFCONTRACTORORAUTHORIZEDAGENT DATE <br />x .� :o�-„�:r �►- �; ro , `�'°1Q. <br />APPLICANiSCITYBU51NE55LICENSENO.AND�BU51NE55NAME '� ' <br />NO. <br />A/C—A/HNOLG UNITS—H.P. <br />FORCED AIR SYSTEMS—B. <br />UNIT HEATERS—B.T.U. M <br />CLOTHES DRYERS <br />VENTILATION FAN <br />RANGEHOOD <br />WOOD STOVE <br />METAL FIREPLACE 8 <br />FIREPLACE INSERT <br />HEAT PUMP <br />EXHAUST <br />�v�%�J - �• BUILDING _ <br />...��.� acuru¢r HOO�IMTR�xGUNiR <br />NO.OF STOIiIES <br />FIfiE SPRNNLEIiS R[OD <br />[J YES fyt NO <br />ruws nrrnoveo nr <br />�� <br />r.nmm pLUM01NG <br />�'1 <br />onSeAlcNr MECHANICAL <br />IJ YES i NO <br />HEIGHTLIMIiA710N � OTHER <br />�i O fi �,� STATE BUILDING SURCHAPGE <br />STATE ENERGY SUf1CHARGE <br />CITY OF EVERETT ruouc wor�Ks <br />LDCAL SALES <br />TAX CODE IS 3105 TOTAL <br />TOTAL <br />FEEf ^ <br />�� <br />FEE <br />S ' <br />$ i <br />$ � <br />RELEIPTNO. � r � <br />3�_ <br />