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APPLICATIOh FOR CONSTRUCTION PERMIT <br />llre EvenJreen <br />CIN OF <br />everett <br />BUILDING DEPARTMENT TO BE COMPLETED IN INK—PLEA!'- PRINT <br />259-8810 <br />! � DEMOLITION COMBINATION BUILDING MECHANICAL PLUMBING <br />OWNER MAILADDRESS CIiY ZIP PHONE <br />� i�e/nn� 216-0� w��'�c �vc �-Ji i�l.�/ ?-S"Z-�9/7 <br />_ __ ...�� .nnvccc CITV 21P PMONE <br />OR DESIGNER <br />GONTRACTOH <br />M�IL ADDRESS <br />MAIL A�DRE55 <br />�NcW !-i ADDITION !J ALTERATION �... REPAIR <br />iENANT IMPROVEMENT OR INTEPIOR REMO�EL ONLY <br />,/ <y <br />CONTRACTPRICEOFWORK• "J�O <br />DESCRIBE WOPK AND SOI�ARE FOOTRGE INVOLVED � <br />LEGAL DESCRIPTION OF PROPEFTY ISMOVm etiu� <br />LOT BLOGK OF <br />PPQIECT ADDRE55 <br />��� _hiHN��I �,�.�n <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASFiER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFIOW PREVENI <br />ROOF DRAINS—RAIN <br />SINK (SERVICE—BAR <br />FRONTSETBAGN <br />USE ZONE <br />iVPE OF CONSi. RIIOWABIE <br />SRE OF BLDG <br />OCCUPANGYLOA� <br />REASON fOR SPRINKLEPS <br />APPIILATION RCC. BV <br />everett <br />e <br />SIGN <br />CITY 21P PHONE LILENSE • <br />vr 9gzol 2s�-53�� �1�rfhW1, Iv3 QL <br />��TY Z�p PMONE LIGENSEI <br />��T, Z�p PHONE LICENSEt <br />', DEMOLITION �- WOODSTOVEIFRPL ItdSERT _. BUILDING RELOCATION <br />I CONTRCT PERSON AND PNONE NO <br />I HEREBY CERTIFY THAT I HAVE READ AND E%AMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />FOURCOPIE51 PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WIIL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZEO BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY VJITH THE STATE <br />CONTRACTORS LAW 1827 RCW AND 296.200 WAC. <br />SIGNATUREOFCONTRACTORORAl1TNOHIZEUR3ENT DATE <br />X I� �«�N � �,� S 3�� � � <br />APPLILANTSC- �TY9�S�NES'�GENSENO.ANDBUSMESSNAME <br />FORCED AIR S�STEMS—B.T.U. <br />UNIT HEATERS—B.T.U. M <br />CLOTHESDRYERS <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />WOOD STOVE <br />METAL FIREPLACE 8 CHIMNEY <br />FIREPLACE INSERT <br />HEAT PUMP <br />"GAS PIPING <br />EXNAlJST FAN <br />TO�AL $ � <br />NIT $ ' <br />\l FEE $ ' <br />PLAN CMECN NUMBER FEE <br />RE�R SETBACK SI�E SETBFCR <br />IOTAREA VACANTSITE FEES <br />-- VES �. � NO BUILDING <br />iYPEoiCONSi.Atluat acu>nNcr xo atmEuixcuvr.s <br />�P00o pLUMBING <br />NOOFSTORIES BASEMENT MECHANICAL <br />YES NO <br />FIRE SPPNKlERS FEO'D HEIGNT LIMITATION OTHER <br />-. �� YES � NO STA7E BUILDING SURCHARGE <br />STATEENERGYSUFCHARGE <br />PLANS APPROVED BY CITY OF EVERETT PUBLIC WORKS <br />LOCAL SIILES <br />TAX CODEIS 3105 TOTAL <br />TOTAL S <br />NIT S d <br />\LFEE $ '� <br />REGEIPT NO. <br />UATION FEE <br />i <br />1 <br />��I <br />i <br />i <br />i <br />—i <br />i <br />