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r <br />'(S` ! <br />ht �� C <br />m <br />, �_: <br />�+, <br />APPLICATIOC.�FOR CONSTRUCTI�N PERMIT �VefPcc <br />rnee�e�yreen TO BE COMPLETED IN INK—PLEASE PRINT � <br />CITV OF <br />everett HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />BUILDING DEPARTMENT <br />259-8810 <br />I DEMOLITION COMBINATION _ BUILDING ,�CrAECHANICAL I 1 PLUMBING SIGN <br />OVMER _ MAILADDRESS CIN IIP AMONE <br />IGrvnni MAILADDRE$$ <br />SGIT�e_ CLS nc�nn� <br />ARCHITELTOROESIGNER MAILADDRE55 <br />CIiV IIP <br />ZIP PHONE <br />MAIL A�ORESS , CITV ZIP PHONE . LICENSE � <br />MECHANILAI�ONTRACTOR � MFILADDRESS J CIN IIP PHONE LICENSEs (//I�I� <br />d'%� <br />PLUMBING CCNTRFCTOR MAIL ADDRESS GTY 21P PNONE LICENSE t <br />GUSS OF WOflN <br />'_� NEW � � ADDITION <br />CONTRRCT PRILE OF WORK "' <br />OESCRIBE WORK PND SOUARE FC <br />PROPOSED USE <br />TERATION .�. REPAIR .' DEMOLITION .�. WOODSTOVE/FqPL INSERT � i BUILDING RELOCATION <br />I CONTRCTPERSONANDPNONENO. <br />LEGRL DESCFIPTION OF PROPERTV �SNOWN BELOI <br />lOT BLOCH OF <br />PliOJEGT ADOR�SS <br />W <br />PLUMB G <br />NO. TYPE OF <br />WATER CLOSET <br />BATHTUB <br />LAVATORY�WASI <br />SHOWER <br />KITGHEN S�NK 8 DISP <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENT <br />SINK <br />FOR OFFICE USE ONLY: <br />FRONTSETBACN REAq; <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />coaiesi PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WIL� BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PqESUME TO GIVE <br />AUTHOflITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />?ERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORRED BY THE <br />OWNER OF THIS PROPEflTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br />SIGNr1TUREOFCONTRACTOPORAUTMORREDAGENT DATE <br />��.s� � ll r1�n /l^ / c/9� <br />A PLICANTS CITV BUSME55 LICENSE N0. ANO BUSINES AME <br />MECNANICAL <br />FEE NO. TYPE OF E�UIPMENT FFF <br />FORCED AIR SYSTEMS—B.T.U. M <br />UNIT HEATERS—B.T.U. M <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />PERMIT $ <br />TOTAL FEE 5 ' <br />SIOE SETBACK PLAN CNECK NIIMBER iEE <br />35�3 j_� <br />USEZOtJ[ � LOTAflEA I �ACANTSITE <br />IYoEOILON15.AllOWpBIC 'VPFOFCON51.PCiUA�. <br />SRE OF BIDG. IlO.Of STORIES <br />OCCUPANGY IOAD FIRE SPn9�l ca� qE0'D <br />REASON FOR SPRINKLERS <br />INiAK[OV � PLFNSAPPFOVEDBY <br />BUILDING <br />OCC�CI,NLY NO OfpW[LLIHGUN45 � <br />caour pLUMBING <br />sASEMENT MECHANICAL <br />MEIGHTLIMITATION ADDITIONPLPLANCHECK <br />_ OTHER <br />SiATE BUILDING SURCHARGG <br />CITY Of EVERETT pUBLIC WORKS <br />LOCALSALES <br />TAX CODE IS 310F TOTAL <br />SUB TOTAL g �f'p � <br />PERMIT 5 —�- <br />TOTAL FEE � � � <br />RECEIPT NO. <br />i <br />� <br />T <br />f� ; o a <br />•: <br />'� <br />� �� � �'r <br />�� <br />` ;l'C•: <br />� ..iri�� <br />�'' <br />+ <br />M i'r <br />{�" . <br />