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� � <br />APPLIC,C�lT10N FOR CONSTRUCTIt�N �ERMIT <br />the Everyreen <br />CITv OF <br />everett <br />. BUILDWG DEPAFTM'cni <br />259-8810 TO BE COMPLETED IN !NK—PLEASE PRINT � � <br />DEMOLITION „ COMBINATION ✓BUILDING MECHANICAL vPLUMBING <br />U\YNER �IAILADORESS ;;ITV 21P PNONE <br />w o n�r�s; /�4�I. 10� A/it.�s ��y' �i g?pi �zc'� <br />TENANT MRILADDRE55 (:iTY ZiP PH011E <br />ARCNIiECTOFDE5IGNER MA�LAODPE55 CITV ZIP PMONE <br />GENENAICONTtiACT03 MAILApOlIE55 CITY ZIP PNONE <br />CONiRACiOR <br />rluMnlrvli W GTO9 Mqlt A�bJE55 <br />��i6-`J' 4+r��i ri:5'.3� - %% I� <br />CLASS OF WOqK � � <br />i I NEW i.' ADDITI N �+�ALTEFiATION '_I REPAIR <br />TENRNTIMPROVEMENTOR WTERIOHREMOOELONLY M <br />I'"7"'��'� <br />CONTRRCT PqICE OF tVORN: <br />DESCRIBE WORK AND SOOARE FOOiqGE INVOIVED <br />an <br />IICENSE � <br />PMONE UCENSE� <br />everett <br />e <br />SIGN <br />21P PHONE �ICENSE t <br />__._S'"r�e, 1��9p SE'J'-36/S j,'e,v,��r-�+or <br />DEMOLITION � WOODSTOV6FRPL INSERT I-1 BUILDING RELOCATION <br />��CONiACTPER50NAN PIIONENO. <br />�er��_L�-�� — '�3�f 262J <br />��� � ' p----� --�"""� I HEREBY CERTIFY THAT I HAVE flEAD AN� EXAMINED THIS <br />�� 1[J APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECL ALL <br />L[GALOESCRIPiIONOF PqOP[Rtt �SHOWN�ELOW ORATTAGNFOIIRCOPIE51 PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS NPE OF <br />�or._Li_ a�aK _L� oc ��.�c�'< ( «1' k WORK WILL BE COMPLETED N 'HETHER SPEGFIED HEREIN OR <br />NOT. THE GRANTING OF A PERiv� � DOGS NOT PRESU1dE TO GIVE <br />AUTHORITY TO VIOLATE OR CANCE� THE PROVISIONS OF ANV <br />� ar� �+ion � I' � Ei, <(' c(-i '7�� OTHER STATE OR iOCAL LAW REGULATING CONSTRUCTION OR THE <br />q PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BV THE <br />�I ZG � i- c+ F U acc��ccY �-( �$ OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MA�E AND I COMPLY WITH THE STATE <br />CONTFA.^•TORS W 1827 RCW AND 296200 WAC. <br />SIGNATl1RE0fC F 'TORCRAUTNOR�DAGFNI OAiE <br />x , �vv��_-_ <br />PflQIECT ADDfiE55 <br />�J/hI NIucC APP� iS�iV�USME55LiCENSENOnNOpUSME NA��[ <br />BATHTUB <br />iINK 8 <br />1ER <br />TRAY <br />DRINKING <br />FRONi5ET8ACN <br />USE ZONE <br />IVPEOiLONSC AllpWpBlE <br />SRE OFBLDG. <br />OCC4PRNCYlORO <br />REASON FOR $PRINKIERS <br />�PPUCATION RCC. BV <br />PERMIT <br />TOTALF <br />R[RRSETBALK <br />LOtAREA <br />iYPEOiLONSi.ACiUAI <br />NO.OF STORiES <br />FIpE SPPNKLERS REO'0 <br />f 1 YES f I NO <br />PLANSAPPROVEOBV <br />� — �. <br />5 <br />S�DE SETBACR <br />VACANT SITE <br />i '� YES i-'� NO <br />� !cC—NHNDLG UNITS—H.P. <br />— FORCED AIR SYSTEMS—B: <br />— UNITHEATERS—B.T.U. M <br />— CLOTHES DRVERS <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEAiER <br />WOODSTOVE <br />METAL FIREPLACE 8 CHIM� <br />FIREPLACE INSEFT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN <br />PLRN CHECK NL'MOEB <br />Bl11LDING <br />OCLUPAHfv �.0 O�NYIIlMGI1M1it5 <br />4PWo <br />PLUMBING <br />BASEMENT ti�ECHANICAL <br />�-' YES : ' NO <br />MEIGHiLIMIiAT10N OTHER <br />STATE BUILDING SURCIIARGE <br />STATEENERGVSURCHARGE <br />CITY OF EVERETT PU�LIC WORKS <br />LOCAL SALES <br />TAX CODEIS 3105 70TAL <br />M <br />SUBTOTAL S � <br />PERMIT S <br />TOTALFEE $ <br />F[E R[LEIPTNO. <br />