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f.�PP�LICATId�I FOR CONSTRUCT�ON PERMIT everett <br />tnr r.�.rqrsen TO BE COMPLETED IN INK—PLEASE PRINT � <br />CItY Oc <br />ev� rett HEATING SYSTEM: �,GAS ❑ ELECTRIC ❑ <br />BUiLDING DEPARTMENT <br />259•8810 <br />� i DEMOLITION � COMBINATION ' I BUILDING i i MECHANICAL ❑ PLUMBING �_] SIGN <br />OWNER MAIL�DDRESS CITV 21P ///P���HrONE <br />T IV G,ESk�/�/f �1,�D �iP�A0�0 QVE �vi�.ff QrZor /L/ r1,�-1/s'yj0 <br />TEN�NT M�IL �DDRE55 CITV ZIP PNONE <br />AHCHI7:CT OR DESIGNER MAIL pDDRE55 dfY ilP PHONE <br />�rt�-r�,� �� <br />PNONE LICENSE � <br />PHONE LICENSE / <br />�' NEW i I ADDITION '� ALTERATION �! REPAIR !-1 DEMOLITION ❑ WOODSTOVFJFRPL INSERT ❑ BUIIDING RELOCATION <br />�.�r..e.a_!Ow / Z ♦ � 3 '� CONTACTPERSONANDPlq.NE` f' ,r c <br />CONTMCTPRICEOFWORK �w G.��/�MT nI'+�� �{�/'O <br />����� � K`��Q� v <br />PROPOSED USE OF BUILDING <br />,��� � IPa/ai�'F <br />�EGAL DESCRIPT OF PROPEflTV �SHOWN BELOW OR ATTACM FOUR COPIES) <br />LOT BLOCN OF _ _ ___ __ <br />rnaecr <br />o z'"lYuK�r� �� <br />IeiN(i <br />TVPE OF FUfTURE OR ITEM <br />WATER CLOSET (TOILE�� <br />BATHTUB <br />LAVATORY(WASH eASIN)� <br />SHOWER <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />LAUNDRVTRAY <br />CLOTHES WASIIER <br />URINAI <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVEIJTERS <br />ROOF DRAINS—HAINLEADERS <br />SINK ISERVICE—BAR. ETCJ <br />TOTAL FEE $ <br />FOR OFFICE USE ONLY: <br />FRONTSETB�CK REARSETBACK <br />USE20NE LOTAREA <br />TVPEOFCONTS.ALIOWABIE TYPEOFCON51ACiURI <br />-N Tl-N <br />51't`O�FB'DCf+ NO.OFSTORIES <br />6 5 <br />S 7 Sf nR 2. <br />OCCUPANCY LOAD FIRE SPONN�C 73 REO'D <br />—dL�� N' <br />REASON FOR SPRINKLERS <br />MT�KEBY PLANSnPPROVEDBI <br />. n_i <br />FEE <br />1 HEREBV CERTIFY THAT 1 HAVE READ AND EXAMINED THIS <br />APPLICATIGN AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTI�VG OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGUUTING CONSTRUCTION OFi THE <br />PERFORMANCF OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF TH� iOPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION lo MADE AND I COMPLY WITH THE STATE <br />CONTRACTOHS LAW 1827 RCW AND 296.200 WAC. <br />SIGNATUREOFCONTMCTOROR�UTHOflIZF.DAOENT OATE <br />X �I 1 /i . /_ ��. _' '/✓ <br />NO. <br />A/�A/HNDLG UNITS—H.P. <br />FORCED AIR SYSTEMS—B.T.U. <br />UNIT HEATERS—B.T.U. M <br />CLOTHES DRYERS <br />VENTILATION FAN <br />RANGEHOOD <br />WATEH HEATER <br />WOOD STOVE <br />METAL FIREPLACC 8 CHIMNEY <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />SIDESETBFGK PUNCHECKNUMBEP FI <br />9/ 1G3�7 <br />VACANT $ITE FEES <br />BUILDING 730�5p �tjy,?.riZ <br />octtrwrvcr rroaoxtwecuxirs <br />6R�P I PLUMBING _ <br />Bn£EMENT MECHANICAL <br />v <br />NEIGHT LIMITATION ADOITIONAL PLAN CHECK <br />OTHER <br />STATE BUILDING SURCHARGE <br />CITY OF EVERETT PUBLIC WOtiKS <br />LOCALSALES <br />TAI! CODE IS 3105 ror�� <br />SUB TOTAL <br />a <br />�y <br />H <br />� <br />