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f� , <br />_ .. � . . .. . .. . .... .. � . ... . � . � - .. . ...J..�. . y?1�a'�i� . : <br />� <br />� <br />APPLICATIO�! FOR CONSTRUC?.vN PERMIT <br />� EN��� everett <br />ciTv oF � <br />everett <br />BUILDING DEPARTMENT <br />259-8810 TO BE COMPLETED IN INK—PLEASE PRINT <br />❑ DEMOLITION rl COMBINATION V9 BUILDING ❑ MECHANICAL I-1 PLUMBING ❑ SIGN <br />ONTlER M�ILADORE55 CITY 21P PHONE <br />� ('le.�i_ Pe."Bax 7oa �.� � 9sa�s 8x�-rnb <br />w107R MAI��OOPESS CITV ZIP PMONE <br />ARCNITECTOflDE51�NER AUILAODRESS CITV ZIP PHONE <br />C_ t,��+�' �e�,w,. .�a.e. � Sa.... a.. aL.w.� S/- L E c� �//n k il/ <br />OENEfUL CONTRALTOR MAIL �DDflE55 LIN ZIP PHONE IIGENSE I <br />� <br />MEGNANILQCONTRACTOP M�ILAODRE55 CITY IIP PHONE ULENSE� <br />PLUMBM�CONTAACTOfl MAILMDRESS LITY 21P P110NE LICENSE/ <br />CUSS OF WOAK <br />L7 NEW li� ADDITION ❑ ALTERATION Cl flEPAIR ❑ DEMOLITION 17 WOODSTOVE/FRPL INSERT ❑ BUILDING RELOCATION <br />TEIUNTMPqOVEMENTORINTERqqREMODEIONLY I CONTACTPERSON�NUPNONENO <br />D�V � !'n.W.. r� � P27- <br />�y83 <br />PqOPOSED USE OF BURDIN(i 1 <br />S�_ ��..w�,. /�aV.i.+�n. <br />� LE6AL DE RIPT OF PROP RTY �SMONTI BELOW OR ATiACH` fO�UR COPIES� <br />� LOT 4S BIOLK OF �M1OK � �• <br />PRO.IECT ADDRESS <br />� � BATHTUB <br />� LAVATORY�WASH BA: <br />SHOWER <br />KITCHEN SINK 8 DISP <br />� i DISHWASHER <br />PREVENTERS <br />TOTAL FEE $ ' <br />FRON7 6ETB�CK RE�R SETB�CN SIOE SETBAGK <br />�+ �� 6� d- io' <br />USE E LOTAFEA VAC�NTSITE <br />�- I I 1 YES Cl NO <br />ttPEOiCONSTAtLOWABLE TYPEOiCONST.ACTUAL ot[Uwritt xodpv0.uNGUNrtS <br />GRqIP <br />-n/ ,L� 3 / <br />612EOFBLDCI. Jyts�a NO.OfSTORIES BASEMENT <br />SF� � 2 AT YES f 1 NO <br />OCCUPANCYLOAD FIRESPRNI(LEPSREOV NEIGNTIINITFTION <br />d/d LI YE3 };1 NO �� <br />RE�SON FOR SPPINKI.ERS <br />APPUC�TIONRCLBV PL�NS�PPROVEOBY CITYOFEVERETT <br />� � Q� LOCAL SALES <br />/ TAX CODE IS 3105 <br />I HEREBY CEflTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND OROINANCES GOVERNIN6 THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETNER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO OIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL lAW REOULATING CONSTRUCTION OR THE <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 />CONTRACTORS LAW 18.27 RCW ANO 296200 WAC. <br />SIGN�TUPEOFLONTRALTOPORAUTHOH2EDAGENT DATE <br />X `� �lf ['1.,�D <br />APPLIC�NTS CITV B INESS LILENSE NO. b BUSINE55 N�ME <br />MEGMIINIGIIL <br />RANGE <br />WATER <br />FIREPLACE <br />PLAN CMECK NUMBER <br />FE S � <br />BUILDING <br />PLUMBING <br />MECHFNICAL <br />OTHER <br />S7ATE B ILDING SURCHARGE <br />S7ATEENERGVSUPCHARGE <br />PUBLIC WORKS <br />TOT�L <br />SUB TOTAL <br />PERMIT <br />TOTAL FEE <br />Fee� �D...� � <br />REC,EIPT /NO.�C <br />� <br />