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�. <br />APPLICATIOrI FOR CONSTRUCT. JN PERMIT <br />tl�e Everpreen <br />CITV OF <br />everett <br />BUILDING DEPARTMENT <br />259-8810 TO BE COMPLETED IN INK—PLEASE PRINT <br />f_' DEMOLITION ❑ COMBINATION ❑ BUILDING_�ECHANICA <br />everett <br />e <br />�.�� PLUMBING � SIGN <br />OWNER MAILADDRESS CITV 21A PHONE <br />Dn�e �'iq„sr., �oSH AI� Pcrk 4r L-"vrre'H 9k�o7 2c-9 �qsn <br />TENFNT MqI�ADDRE55 CITV ZI.� PHONE <br />�RCHITECTORDESIGNER MAILADORE55 CITY 21P PMONE <br />ornenw�cuniq�GTOR MAI�ADDRE55 dTY 21P PHONE LILENSEt <br />MECHANIC�LCONTRACTOR MAILADDREQSS GITY I 21P PHONE LICENSEI <br />�vtr�RCn ���t S�h. 4� �J[ ISO$_ �v1rt�'� la1o� 1cZ.31��( [V-��2 CS SIJI%(� <br />PLUMB GCONTflACTOR MAILAO�RESS CITV ZIP PHONE UCENSFI <br />CUSS OF WOpK <br />❑ NEW ❑ ADD�TION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL INSERT ❑ BUILDING RELOCAT�ON <br />TENANT IMPROVEI.IENT OR IN�E�IOq REMODEI ONLY CONTPCT PEPSON �ND oMONE NO. <br />DESCRiBE <br />OF <br />LEGAL <br />LOT <br />PRQIECTADDRE55 <br />I 0 SN <br />PROPERTV (SHOWN BELOI <br />BIOCK OF <br />TVPE <br />WATER CLOS <br />KITCHEN SINK 8 <br />Ll�UNDRY TRAY <br />CLOTHES NASHER <br />URINAL <br />DR�NKING FOUNTAIN <br />FLOOR DRAIN <br />P.00F <br />SINK ( <br />FPONTSETBACK <br />USE ZONE <br />fYPE Oi CONSi ALtOWABLE <br />SIZE OF BLIX'i. <br />OCCUPANCYLOAD <br />REASON FOR SPRINKLERS <br />APPPGATION ACC. BY <br />I HEREBY CERTIFY THAT I HAVE READ AND EX.4MINED THIS <br />APPLICATION AND KNOJV THE SAME TO BE Tr7UE AND CORRECT. ALL <br />COPIES) PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEI. THF PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING 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 pCW AND 296200 WAC. <br />SIGNANREOFCONTRACTORORAUTHORIZEDAGENT DRTE <br />X � � ��.. <br />�/G /5i <br />APPLIC TS CITV BUSINESS LICENSE NO. AND BUSINE55 NAME <br />SUB TOTAL $ <br />PERMIT $ <br />TOTAL FEE $ <br />RI 4R SETBRCN I SIDE SETBACN <br />LOT AREA <br />7VPE OF CONST AC7UAL <br />NO. OF STOP,iES <br />FIRESPRNHIEP' �EOD <br />I..! YES ❑ NO <br />PLANS APPROVEO BY <br />VAC�NTSITE <br />❑ VES ❑ NO <br />OLWPAYCY NOOfDWFLIINGI <br />GND�P <br />BASEMENT <br />❑ YES ❑ NO <br />HEIGHT LIMITqTION <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />NO. � TYPE OF <br />FORCED AIR SYSTEMS—B.T.U. M <br />UNIT HEATERS--B.T.U. M <br />CLOTHES DRYERS <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATEfi <br />� <br />METAL FIREPLACE S CHIMNEY — � <br />FIREPLACE INSERT � <br />HEATPUMP '— <br />E%HAUSTFAN <br />PLAN CNECK NUMBCP <br />BU�LOING <br />PLUMBING <br />MEChANICAL <br />OTHER <br />5T4TE BUILDING SURCHARGE <br />STATE ENERGV SURf.HARGE <br />PUBLIC WORNS <br />TOTAL <br />SUB <br />TOTAL FEE� <br />FEE RECEIPTNO. <br />: � <br />