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'';'�,. _. <br />., <br />�� APPLICATI� FOR CONSTRUC� ON RIeR11A1T <br />•;:. <br />,,. <br />:,= <br />'�. Mr E�wprwn . <br />', CRV OF <br />everett <br />BUILDING DEPARTMENT <br />259•8810 TO BE COMPLETED IN INK—r�EASE PRINT <br />❑ DEMOLITION ❑ COMBINATION [J'BUILDING ❑ MECHANICAL ❑ PLUMBING <br />OWNER � MAIIM�RE55 CITV IIP PHONE <br />G�oK6c-� T'ici,rz �os..2!-.MH�.i,4�.,iAve-tve�f¢i'. 9��oy ��3—�� <br />TEWWL MAILADDRESS ! CIiY iiP PHONE <br />� <br />i <br />everett � <br />� ' <br />� <br />i <br />❑ SIGN i <br />� <br />� <br />� <br />� <br />i. <br />ARCHITECTOROESIGNER M�ILADDRESS CITY ZIP PMONE ., <br />OENEMLCONTMCTOfl GUIL�ODRESS qTY IIP PNONE LICEN3E� � <br />MED�� MAILADDRESS CITV ZIP PIIONE LICENSE! ' <br />PLUMBINUCONiMCTOR MAllA00RES5 CITV IIP PHONE LICENFEI �� <br />CU69 OF WORK <br />❑ NEW ❑ ADDITION ❑ ALTERATION W�REPAIR �7 DEMOLITION I.1 WOODSTOVElFRPI INSERT ❑ BUILDING RELOCATION • <br />TENMlTIMPROVEMENTORINTERIOflPEMOUELONLV �����rj CONTA/CT'PEHSONANDPHONENO. � r � <br />CONTMCTPRICEOFWORK• CG' FO ' �G` - u7 a� G�.� <br />DFB(',RIBE WOAK AND SOUARE FOOTAOE INVOLVED <br />/2 " '� o - O <br />pp.o.r.Cos USEOFBUILPNO I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS � <br />v� APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />LEOALOESCNIPTIONOFPNOPERTY�SlIOWNBELOWOR�TfACHFWPCOPIES) PROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTYPEOF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR • <br />�or _ e�ocK oF NOT. THE GFANTING OF A PERM�T DOES NOT PRESUME TO GIVE f <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY � <br />OTHER STATE OR LOCAL LAW FEGULATING 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 i� <br />CONTRAC fORS LAW 1827 RCW AND 296200 WAC. ' <br />SIGNATUREOFCONTMCTORORAUTHORREOAGENT DATE <br />PlIOJECTADDRESS /� �/�[.IY�"I�C- OV • ✓�r/'� y <br />�/'15 ) / � '/ � /^I1 b APPUCANTSCINCUS ESSLIGENSENO.ANOBUSINESSNMIE � <br />vv vv V`, <br />rrre oF <br />WATER CLOSET <br />SHOWER <br />KITCHEN SINK 6 DISP <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />FAON7SETBACK <br />USEZONE <br />1YPE OF CONSi. ALLOW�BIE <br />b¢E OF BlDO. <br />OCCUPANCYLOAD <br />REA&ON WF SPRWKLERS <br />APPLICATION ACC. BY <br />FEE <br />SUB TOTAL $ i <br />PERMIT 8 � <br />TOTAL FEE $ ' <br />PEAq SETBACK SIOE SETBACN <br />LOTAREA WICANTSITE <br />❑ YES ❑ NO <br />FORCED AIR SYSTEMS-8� <br />UNIT HEATERS—B.T.U. M <br />RANGEHOOD <br />WATER HEATER <br />WOOD STOVE <br />METAL FIREPLACE 8 CHIMNEY <br />E.A. <br />PERMIT S <br />TOTAL FEE S <br />PUNCMECNNUMBEi1 FEE RECEIPTNO. <br />BUILDING <br />lYPEOFtONSt.�C7U�l oc[uourcr rro.qvx[wncuxirs <br />GRWP p�UMBING <br />NO.OFSTONIES B�SEMENT MECHANICAL <br />❑ YES U NO <br />FIRESPRNKLERSREO'D MEICMTLIMITATION OTHER <br />❑ YES ❑ NO � STATE BUILDING SURCHARGE <br />STATEENEROYSURCHAFGE <br />PUNS �PPqOVEO BY 1 CITY OF EVERETT PC!BLIC WORKS <br />ILOCALSALES <br />TAX CODE IS 3105 TOTAL <br />FEE <br />N <br />x <br />