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� �\� APPLICATI '� FOR CONSTRUC�N PERMIT <br />� tM Everyreen <br />� CITV OF <br />; everett <br />� BUILDING DEPARTMENT <br />� 259•8810 TO BE COMPLETED IN <br />i ❑ DEMOLITION ❑ COMBINATION ❑ BUILDING <br />� YMEfl <br />' J—L`�}.� <br />� <br />1 T�1C <br />; <br />ARCHITECT ( <br />' a�6dd�l <br />,� <br />MECNANIGN <br />PLUMBIN00. <br />W/!/�IJ' !,-X <br />, _V,� ^ MAILADDRE55 <br />VIK/ <br />DESIGNER MAILADDRE55 <br />4IIY <br />Pl/LEASE PRINT <br />�M�CHANICAL O PLUMBINr <br />� ��fl_l�`�NE a5a��1L <br />D? PHONE <br />ZIP <br />everett <br />e <br />❑ SIGN <br />1 � <br />� <br />� CUSSOFWORK <br />I ❑ NEW O AODITION <br />i <br />i TEIUNTIMPROVEMENTOHINTEi <br />i <br />� CONTRACTPRICEOFWORK; <br />�� D IBEW (AN�EF� <br />i <br />J <br />� <br />M�IL ADDRESS <br />LOT BIOLK OF <br />BACKFLOW PREVENTERS <br />ROOF DRAINS—RAINLEADERS <br />SINK fSERVICE—BAR. ETC.1 <br />FRONTSETBRCK <br />USE20NE <br />IYPE OF CONSi. ALLOWABIE <br />SRE OF Bl0(i. <br />. OCCUPANCYLOAO <br />i <br />' REASONFORSPRINKLEBS <br />' APPLICATIONACC.BV <br />...�. .,-. ... ..... _ ... �.. <br />cm <br />rHorve <br />❑ REPAIR ❑ DEMOLITIGN ❑ WOODSTOVE/FRPL INSERT ❑ BUILDING RELOCATION <br />COPIES) <br />CONTfCTPER50NANDPHONENO. <br />� HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUF AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORD�NANCES GOVEFNING 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 />AUTHORITV TC VIOLATE OF CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REuULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHOHIZED 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 1827 RCW AND 296200 WAC. <br />S�GNANREOFCONiRRCTORORAUTHON12EDpGENT J�7E <br />X�'��c�� � ��v <br />�P UCANTSCITVBU51 SSLICENSEN .�NDBUSINESSNAME <br />NEGHANICNL <br />O. TYPE OF EOUIPN <br />A/C--A/HNOLG UNITS—H.P. <br />FORCED AIR SYSTEMS—B. <br />UNIT HEATERS—B.T.U. M <br />CLOTHESORYERS <br />VENTILATION FAN <br />RANGEHOOD <br />FAN <br />TOTAL FEE $ <br />REAR SETBACK SIDE SETBPCK PLAN CHECK NUMBER <br />LOTAREA VqCANTSI7E FEES <br />❑ YES ❑ NO BUILDING <br />1YPEOFCONSi.RLTUAL OCCU>eNtr NOIXvnnuMcuNnS <br />Gntuv <br />PLUMBING <br />NO.OFSTOflIES BASEMENT MECHANICAL <br />❑ YES ❑ NO <br />FIPESPRNKLERSPEO'D HEIGNTLIMIfATiON OTHER <br />❑ YES ❑ NO STATE BUILDING SURCHARGE <br />STATEENERGVSURCHARGE <br />PUNSAPPROVEDUY CITYOFEYERETT PUBLICWORHS <br />LOCAL SALES <br />TAX CODE IS 3105 TOTAL <br />A.�. �.. . . i � _ . . _ .. . . .♦ �. ` ' • .� <br />E.A. <br />f'ERMIT $ <br />TOTAL FEE 5 <br />FEE RECEIPTNO, <br />i <br />i <br />� <br />