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APPLICATION FOR CONSTRUCTIG _ J PERMIT <br />� E�re�� TO BE COMPLETED IN INK—PLEASE PRINT <br />cin oF <br />everett HEATING SYSTEM: �GAS ❑ ELECTRIC U <br />BUILDING DEPARTMENT <br />259-8810 <br />�] DEMOLITION I i COMBINATION � i BUILDING b�MECHANICAL I I PLUMBING <br />everett <br />e <br />i I SIGN <br />q �� " M�IL��UPE55 GIIY ZIP P110NE <br />�GacET2EN 873 l'IYi�Pi� 8/�0. �vr �f'.?v� 3 S�- 2 r� 8� <br />TEN�NT MML ADDRE55 CITY 21P PNONE <br />ARCHITEGiORDE5IGNEP MAILADUNESS GITY ZIP PIIONE <br />GENERALLONTRACTOR M�IL�DDRfSS CITY ZIP PIIONE ULENSE• <br />�a/ l.�Nf�� l�re� 3//0 /�i�.c.. sT �✓�' 9C� Zs9�s�3� �/u•tr,t�Nu�o��e �— <br />MECH�NICQCONTMCTOR MAILAD�flE55 CITV ZIP PHONE LIGENSEt <br />PLUMBING CONTR�CTOR MAIL ADDRESS CITY Z/IP PHONE LICENSE • <br />�.v577K.1. 6.f?5 ^�v1�'�.0 — U/�4/��t �7L�4��.'7` <br />cuss oF wonK <br />❑ NEW ❑ ADDITION f 1 ALTERATION I. I REPAIR I I DEMOLITION f J WOODSTOVE/FRPL INSERT ❑ BUILDING RELOCATION <br />�J M� CONTACT PERSON �NO PIIONE NO. <br />CdJTRACTPPICEOFWORK IC.+��� <br />LOT BIOCK <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINEU THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />lOW OR ATT�CHFOUR COPIES) PROVISIONS OF LAWS AND ORDINANCES GOVERNINO THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />oF NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANV <br />OTHER STATE OR LOCAL UW REGULATING CONSTRUCTION OR THE <br />— PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BV 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 AND 296.200 WAC. <br />SIGNATUREOF�CTOHO� THORIZEpAGENT D�TE <br />X v// <br />� � $ U(yrNPrC <br />PLUMBIN6 <br />NO. TYPE OF fl%TURE OR I <br />WATER CLOSET (TOILETI <br />DISHWASHER <br />LAUNDRVTRAY <br />CLOTHES WASHER <br />URINAL <br />ORINKING FOUNTAIN <br />FOR OFFICE USE ONLY: <br />FPONT SETBACK RE�R SETBRCK <br />USE ZONE LOT ARE� <br />fYPEOFCONTSALLOWABIF TYP[OiCONSiAC� <br />SIZEOFBIDG. NOOFSTORIES <br />RE�SONFORSPflINKlERS <br />INT�NEBV I Pl�NSAPPROVEDBY <br />a <br />$ <br />SIDE SETOACN <br />WGRNT SITE <br />r� <br />BUSINESS NI1ME <br />A/C—A/HNDLG UNITS—H.P. <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />UNIT HEATERS—B.T.U. M <br />METAL FIREPLACE 8 CHIMNEV <br />FIREPLACE INSEFT <br />HEAT PUMP <br />GAS PIPING <br />ExHAUSTFAN <br />PLAN CHECN NUMBER <br />BUILDING <br />nccwnxn xoaowtwxrurns <br />�A�"�P PLUMBING <br />BeSEMEN7 MECHqNICAL <br />nElaliUMlTenoN ADOITIONALPLANCHECK <br />O7HEfi <br />STATE BUILDING SURCHARGE <br />CITY OF EVERETT Pl1BLIC WORKS <br />LOCALSALES <br />TAX COOE IS 3105 ror�� <br />SUB TOTAL $ <br />PERMIT S <br />TOTAL FEE S <br />FEE <br />,�r,� <br />� <br />A <br />r' <br />I� <br />p" <br />