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l __ <br />APPLICA7.ON FOR CONSTRUCTION R�:RMIT everett <br />TO BE COMPLETED IN INK—PLEASE PRINT � <br />Ilre E�ergreen <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC U <br />259•8810 <br />I I DEMOLITION I i COMBINATION i i BUILDING I I MECHANICAL I i P:UMBING I I SIGN <br />OWNEH n pMAIL�DDRE/SS ��T1' 4 ZIP PMONE <br />D.L�S lLP�lIMy /�7�n(/��rp [ li�✓/% �z � /�Z.O� �5�2-/YI�' — <br />TEN�NT <br />MAILAD�RE 5 C17Y 21P P��ONE <br />ARCNITEGTORDESIGNER MAII�D�RE55 <br />GIiY ZIP PIIONE <br />GENERAL CONTRACTOR MAIL �DDRESS <br />CIiY ZIP FMONE LICENSE � <br />MECHAN�C,A�LI�C�fQ�� THACTOIR MAII/�DORESS LIIY (� 21P 7 PHONE � LICENSEI <br />N.W. W4'IC„��i" 3r � �r� ' �Jjc�� i�r�/'i)�f� ��1.�i/ .�V�. �Ui �Z <br />r��.( C ✓� <br />��iq Z�p PMONE LILENSEI <br />e�u.mwr.c�wiPAGTOR MhIL��ORE55 <br />C1A550F WORK <br />J�t�Eyy LI ADDITION I I AITERATION <br />� nU <br />�SIP�I- bP) /4YRG <br />ppppOSED USE OF B ILOING � <br />S � li ' <br />LEWI.OE RIPTION OF PROP TY ISH( <br />LOT BLOCK _ <br />� �l\//4/1l�' <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />LAUNDRYTHAV <br />C�OTHES WASHEF <br />FOR OFFICE USE ONL!': <br />FRONTSETBRCN AEPRSETBAC <br />USE ZONE LOT ARER <br />IYPE Of LON75 AIIOWABI[ TVPE Of CONST. <br />S2EOFBlD6. NO.OFSTORI <br />OCCUPANGYLOAD FIflESPRNNI <br />PL�NS <br />oF <br />%7 <br />REO'0 <br />I I REPAIR '� I DEMOLITION I i N:OODSTOVEIFRPL INSERT I.i BUILDING RF.LOCATION <br />I CONTACTPERSONAlIDP110NEN0 <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPI ICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />coriesi PROVISIONS OF LAWS AND ORDINANCES 60VERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERcIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO 61VE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANV <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT i AM AUTHORIZED BY THE <br />OWNER OF THIS PRO� �-aTV TO PERFORM THE WORK FOR WHICH <br />A�'PLICATION IS h�.ADE AND I COMPLY WITH TfIE STATE <br />CONTRACTORS LAW 18.2i RCW AIJD 296200 WAC. <br />SIGN�TUREOFCONTR�CTORORnUTHONIZEDR4ENT DATE <br />/! , (rN h � � <br />__ F— <br />APPLICANTS CITY BU INE55 LICENSE NO �ND 9115iNE55 NAME <br />$ <br />$ <br />SIOE SET�AGN <br />VACRNT SITE <br />UNIT HEATERS—B.T.U. M <br />HOOD <br />WOOD STOVE <br />METAL FIREPLACE 8 <br />FIFEPLACE INSERT <br />HEATPUMP <br />M E.A. <br />SUBTOTAL $ <br />PERMIT $ <br />TnTAL FEE $ <br />NUMBER fEE I RELEIPTNO <br />BUILDING <br />aav.xa r�uaownuxcuw.is <br />�^a° PLUMBING <br />BnSEMENT MECHANICAL <br />11[IGNT IIMITATior� ADDITIONAL PLAN CHECK <br />OTHER <br />S1ATE BUILDING SURGNARGE <br />CITY OF EVEflETf PUBLIC WOFKS <br />LOCALSALES <br />TAX CODE IS 3105 ror�� <br />i <br />N <br />�u <br />C <br />H <br />