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y(7H <br />xr7 <br />�n <br />a �? <br />.ai x s <br />C. H <br />a�v <br />�>3 <br />Hz�. <br />K n <br />� '.si <br />Q �: 0 <br />� F � <br />U. H <br />� O t�1 <br />H t7 <br />� !'��y <br />H C�+�7 O <br />� Y (�] <br />9 H� <br />r z <br />r-i y <br />8 �' <br />H <br />C] t1 fA <br />� � Cil <br />x y cn <br />HOm <br />APPLICATIa►N FOR CONSYi;UC7oJN PERMIT <br />�,.. F,�,,;.,.-�� - <br />everett ' �� �� ` � ) <br />BUILDING DEPARTMENT � f_� <br />259-8810 TO BE COMPLETED IN INK—PLEASc PRINT <br />DEMOLlTION COMBINATION BUILDING MECHANICAL PLUMBING <br />ow;�[�� /� �rn�,�noor,�ss — n,r [ia r��on�= <br />_�i�-� !"r�:'i� Z7_ it — U/L /�r �ioR��, 9/r �E b'i SYl.��l 2 S L—L 3 <br />1N:4'i � IMRAOORE55 Citv ZIP PHONE <br />APC�aIECTONO[S�GNER MAiLADDR�55 <br />GF�LRAL CONTRRCTOR IANL RDOPE55 <br />qTY j�P <br />CITV <br />PIIONE �ILENSE / <br />evercll <br />� <br />SIGN <br />1.'�EGMAWCALCONTRACTOR M11P'LAOOFESS CITY ZIP PHONr. �ICBISEa <br />/!/. Lv. G✓c. �c,. �tc�� %t �%%i� � f�� f v7 �j�lo/ 2 S5 �3 S i �(/c,.'f� t,,l, /3� /� J <br />GWNJMGCONTRACIOq N�iIpDDRE.,S �ITV Z�P PI+�\[ �iLENSE♦ <br />CL4SS OF WORK <br />�NEW ADDITION ALTERATION REPAIR DEMOLITION WOODSTOVE/FRPL INSERT . BUILDIN3 RELOCATION <br />ENANT IMoqOV[INENT OH INT[RIOR REM1•,ODEL 01lLV I LONiRCT PERSON ANO PIIONE NO <br />-/ N s rin� <br />Fr�o�•nsF o use oF <br />s�n <br />�t Gn� DESCRiPiiO <br /><<,; <br />���oa�cinooAess <br />SCIIAR[ FppiqGE INVGLV[D <br />�h, Gwna� <br />BLOCN pF <br />7YPE OF FI%TUFlE OR ITEM <br />N'ATER CLOSE7- ITC�iLf Ti <br />BATHTUB ____ ___ . ______.. <br />SHON'ER <br />KITCHEN SINK B DISP <br />WASH[R <br />FLOOR DRAIN <br />BACKFLOW PREVFNTERS <br />ROOF DRAINS—R�INLEADERS <br />SINK (SEPVIGE—�Aq. ETC.1 <br />FW R CAPiES� <br />I HEREBV CEHTIFY ?HAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CCRRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVFRNING THIS iYPE OF <br />WORK WILL BL COMPLETED WITH WHETHEP ,',PECIFIED NEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NGT PRESU�AE TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIOIv. UF qNV <br />OTHER STATE OR LOCAL LAW qEGULA7WG CONSTRUCTION GR THE <br />PHRFORMANCE OF CONSTRUCTION. THAT I AM AUTH091ZED BY THE <br />O�YNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPIJCATION IS MADE AND I COIAPLV L'JITH ?HE STATE <br />CONTRACTO LAIN 18 2%RCK' AND 296.200 WAC. <br />n,.'.ttl�Rt. CGY �f,iORO�tAUiMUR12E0FGENi CAi[ <br />X � <br />i � -��/ - <br />e . .•��s ��r _'�Fs t•.�I �•�nu5 � :NnM1�t <br />MECHANICAL <br />_-__.. '-=I '_ <br />P[RMIi 5 <br />TOTAL FEE S <br />I qONi 5El0Af.K qEFf15[TOALK I SIUE S[TpACN <br />USEZONE I IOTARER <br />iv�fOfCONSi.ALIOWA&E � tV1'EOfCON51RC1UAl <br />size oF uioc. <br />OCCUP�NCVLOA� <br />9[450N�OfiSPqlNnlEPS <br />nraucnnorvncc.ov <br />NO OF STOFIES <br />FiRE SPRNKLERS REOD <br />YES NO <br />rinNsnvri��vtoov �' <br />7YPE OF EOUIPMENT <br />A C—A H4�LG UNtiS—H P. �� <br />FOFCED AIR SVSTEMS—B.T.U. td <br />U'�i7 HEATERS—B.T U. M <br />CLOTHES ORVEHS <br />VENTILATION FAN <br />RANGEHOOD <br />WOODSTOVE <br />METAL FIREPLACE & CNINNEY <br />FIREPLACE INSERT <br />HEATPUMP � <br />GAS PiPING ,Q_ �k t�—y R.� / <br />E%HAUSTfAN � Y <br />PERMIT <br />� TOIAL FEE $ � <br />PIANCHCCNNUAIOEq �EE HCGHPTNO <br />vncnNr�rt� FEES <br />YES NO �7UILOMG <br />acuo�nu rromt�wnur��y.+s _ <br />cwau^ <br />PLUM�ING <br />Bas[MENt MECHANICAL <br />YES NO <br />HEIf.11iLIMIiAIION OTHER <br />— STATE BUILOING SURCHARGE <br />STAiE ENE(iGV SUPCHARGE <br />CITY OF EVERETT rueuc woares <br />LOCALSALES <br />TAX COUE IS 3105 rorn� <br />FEE <br />