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x C'H"-0 <br />i=! i*i <br />>H <br />,O�1x <br />'�' N <br />9 H [a <br />��� <br />'�J H'�] <br />(q H <br />� O [*1 <br />H C7 <br />��g <br />4� � C] <br />H <br />7H <br />9H <br />r z <br />HH <br />g�' <br />N <br />C� C7 N <br />� e� r <br />C�1 <br />Z H �n <br />H O [/� <br />APPLIC/�lTIvN FOR CONS'iRUC1.ON PEFiMIT <br />everett <br />tl�c 6�argrcen � <br />CITY OF <br />everett <br />BUILDING DEPARTMENT TO BE COMPLETED IN INK—PLEASE PRINT ' <br />259-8810 <br />DEMOLITION COMBINATION BUILDING MECHANICAL LUMBING I SIGN <br />OSnCo%i Tt-1 HhI,AAAODR^5�-/ 575� S�l� CI*G-V��{�� Z/6�05 PNONE �.JJ ��/�� <br />w� t <br />TENANT MAILA �FE55 GITY ZIP PHONE <br />�RCHITECTOPDESIGNEP MNLRDORE55 LITY 21P PHONE <br />GENERRLCONTPACTOF M�ILADORESS CITY Z�P PHONE LICENSEa <br />MECFANICALCONTRAGTOR MAILRD�RE55 GTY 21P PHOkE LICENSE• <br />czaa� <br />PLIJ\1BMGCONiRACTOR MRILpDDRE55 UTY ZIP PHONE LILENSEM��/./SP%'1 <br />E7�Rt�-�5! PC...�.w/3�...c,.,� E}G+�7...c,_ rsi�6 bo�"s% St�; c.�xio�...,s�3, 5�z5o7 6s ��7 r��a� <br />CLASS OF WORK �—`� <br />�. � NEW I ADDITION � ALTERATION �. . REPAIR �� DEMOUTION .. WOODSTOVBFRPL INSERT ��. � BUILDING RELOCATION <br />iENANT IAIPROVEMENT OR INTERIOR NEMO�EL ONLY CONiACi PERSON AND PHONE NO <br />CONiRACi PRICE OF 1YORN: <br />OESCRipE WORK AND SOUPRE FOOTAGF�INYOLVED <br />yai..�Et' <br />iecn� oescaianor+c: <br />�or <br />N�,o�E�r <br />_ e�ocK <br />BATHTUB <br />LAVATORV <br />KITCHEN SINK 8 <br />DISHWASHER <br />LAUNDRVTRAV <br />FLOOR DRAIN <br />BACKFLOW PI <br />PRO�lTSETBFCN <br />115E ZONE <br />IYF[ Of LONSf. RIIOWABIE <br />SILE OF 9LDG. <br />OCCIIPANGVl0A0 <br />R[RSON FOR SPRINKLEf15 <br />ra�rucnnor+ ncc. or <br />�ti�. � <br />�— I HEFiEBV CERTIFY THAT I HAVE READ AMD EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />BELOW GR4TTACMFOUR COPiE51 PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL c3E COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />oF NOT. THE GRANTING OF A PERMIT DOES NOT PFESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />� PERFORMANCE OF CONSTRUCTION. THAT I Aht AUTHORIZED BY THE <br />OWNER OF THIS P(iOPERTV TO PERFOFM THE WORK FOR WHICH <br />. APPLIGATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS L�W 1827 RCW AND 296200 WAC. <br />S�Gt�AtUf1E 0� CONiRAG10R OP AUTNOAiZED AGENt DATE <br />�'�,.+d7 p[,�.-.�?� �4 s° f k�7�.tr <br />,�. � a 2 i t's r <br />_, ,� „��, „ � AnPl1UN15OiVOtJSi•.i:SSUCENS[NOA��OBUSiNE55NP61E <br />—BAR,ETC.) <br />SUB TOTAL $ <br />PERMIT S <br />TOTALFEE 5 <br />R[APSETOACN I SIDLSETORCK <br />lOT RPEA <br />tVPEOfLONSf AG10Al <br />NOAF STORIES <br />FIRE SPRNKLERS RE00 <br />I-'. YES I ! NO <br />ptnr�s nrraoveo ov <br />VAG�NT SITE <br />i �� YES �. ' NO <br />OCCpP4XY p0 OiCNIIIiMuUXi15 <br />caao <br />BRSEMENT <br />i' YES I 1 NO <br />HEIGNT UMITATION <br />CITY OF EVEHETT <br />LOCALSALES <br />rax cooe is 3�os <br />NO. <br />lvC—A�HNDLG UNITS—H.P. <br />FORCE� AIR SYSiEMS—B.LU. <br />UNIT HEATERS-6.T.U. h1 <br />RANGEHOOD <br />WATFR HEATER <br />WOOD STOVE <br />METAL FiREPLACE & CHIMNEY <br />FIREPLACE INSERT <br />GAS <br />SUB TOTAL 5 <br />PERh11T 5 _� <br />TOTAL FEE 5 L <br />PIRN[NELNNIIMBER FEE I RECEIPiNO. <br />DUILUING <br />PLUMB�NG Z-Q i <br />MECHANICAL Z� � Sl.' <br />OTHER <br />STATE BUIL�ING SURCHARGE <br />STATEENERGVSURCHARGE <br />PUBUC WOfiK$ <br />TOTA� �i i �50 <br />- <br />