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\�� <br />APPLICATI( .� FOR CONSTRUC�.� DN PERMIT <br />1M Ereqrosn <br />CITV OF <br />everett <br />BUILDING DEPARTMENT <br />259-8810 TO BE COMPLETED IN INK—PLEASE PRINT <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING �ECHANICAL <br />�E� l l� rL�1 �IAAI�ADDRECJ� �l 1 I L/ y`J`l.c- I�lV� Z� �� <br />TENANT _ _ „ MAIL AUDRE55 CITV 21P PMONE <br />M�IL �OOHti� <br />ZIP YRUnC <br />❑ PLUMBING <br />everett � <br />e: <br />❑ SIGN <br />�� 259�5492 — 355J730 — 742•2944 v��`�Jr �,� � �(�� `�'���,����� <br />MEGHANICQGONTR�CTOR 1.�1 IlBBII CITV ZIP PHONE LIC I ' <br />[WrM4 WUhIn�tOrl YBZOl <br />PIUMBIN(3 CONTflACTOR MAIL �DDRE55 CITV ZIP PMONE LICENSE I <br />CUSS OF WONN \�/ � <br />fl NFW f1 AODITION �G ALTERATION I.] REPAIR Il DEMOUTION ( I WOODSTOVEIFRPL INSERT ❑ BUILD�NG RELOCATION <br />TENANT M%10VEM'NT OR IP <br />CONTMCT PRICE OF WORK: <br />lOi BIOGK � <br />SHOWER <br />KITCHEN SINK 8 DII <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />FRONTSETB�CK <br />USE ZONE <br />ME Of LONSi AIIOWABtE <br />SRE OF BLUG. <br />OGCUPANCYLO�O <br />REASON f-0R 6PRINKlERS <br />APPLICATION �CG BV <br />nTTACN FOUR COPIES� <br />FEE <br />CONT�CT PERSON AND PHONE NO. <br />I HEREBY CERTIFV THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TVPE OF �; <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TJ OIVE <br />AUTHORITV TO VIOLATE OR CANCEL THE PROVISIONS OF ANY y' <br />OTHER STATE OR LOCAI LAW REGULATING CONSTRUCTION OR THE �:, <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE }� <br />OWNER OF THIS PROPERTY TO PERFORM THE WOPK FOR WHICH � <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE ' <br />CONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br />SIGN�TUflEOFGONTRACTORORAUTHORIZEOAGENT DATE <br />X � � �vlc�a�' 1 " ,�. <br />�PPUC�NTS L'TY BUSINESS ICENSE N. ANO BUSINESS N�ME <br />UNIT HEATERS—B.0 <br />CLOTHES DRYERS <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />WOOD STOVE <br />METAL FIREPLACE 8 <br />FIREPLACE INSERT <br />SUB TOTAL S <br />PERMIT $ <br />TOTAL FEE $ ' <br />FEARSET��CK SIDESETBACK PI�NCNECNNUMBER FEE <br />LOTAREA WGANTSITE FEES <br />I� I YES ❑ NO BUILDING <br />TVPEOfCONSi.ACTIIAL attuvu1cr xoaowuuNGubn6 <br />cxwv pLUM81NG <br />NO.OF�TORIES BASEMENT MECHANICAL <br />i � ves ❑ No <br />fIRESPRNRLER5RE0'U NEIGNTIIMITATION OTHER <br />Ll YES ❑ NO STATE BUILDING SURCHARGE <br />STATE ENER(iV SURGHARGc <br />PUNS �PPROVE� BV CITY OF EVERETT PUOLIC WORHS <br />LOCALSALES <br />TAX CODE IS 3105 TaTAL <br />T <br />E.A. <br />RECEIPT NO. <br />FEE <br />�T <br />i <br />i <br />--'—T— <br />�� <br />S i <br />� <br />i <br />�— <br />i <br />i <br />� <br />�T <br />� <br />« � <br />