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APPLICATI4� FOR CONSTRUC?.dN PERMIT <br />everett <br />Ihe ftrer�renn � <br />CIN OF <br />everett <br />BUILDING DEPARTMENT TO BE COMPLETED IN INK—PLEASE PRINT <br />259-8810 <br />�( DEMOLITION I 1 COMBINATION }�BUILDING � MECHANICAL PLUMBING SIGN <br />OIVN MRR q00FF 5 CITY PMONB <br />�r� o���a�c.� �o �x s.3g �verer� tN,4 982c�o 25g_ s/lo¢ <br />- ._._ ..... .....�«< rirv nn PIIONE <br />FODRESS <br />CRV <br />_,�eiC!' ��a �ef�! /rrc Pd Sox �t'o:�lJ �. hr/wr�' �v/.1 �/„YJ.�'o -v�_ <br />GENERALCONfRACtOR MA A 55 dtt � 2 VNONE UCENSE• <br />� hC ���� <br />NECHANICALCONTRACtOfl MAILr1�ORESS LITV ZIP PHONE UCENSE� <br />PLUMtlMGCONTPRGiOR MAILA��RE55 CIN ZIP PHONE LICENSE� . <br />�NEW L� A�DITION . 1 ALTERATION CJ <br />TENr1NT IMPROVEMENT OR INtERIOR R MOO/EL ONLY <br />CONTRACi PqILc Of WDRN: �3[�'O, OOO <br />� <br />PROPUSE� USE OF BUILDING <br />�i r <br />LEGAL DESCRIPTION OF PROPERTV �SHOWN BELOW <br />LOT BIOGK OF <br />�6�� ls�g� <br />!o'a.� I,� Mar�ne. V i <br />TVPE OF FI7 <br />WATER CLOSET (TC <br />BATHTUB <br />LAVATORY�WASH2 <br />SHOWER <br />KITCHEN SINK 8 01: <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAI <br />FLOOR DRAIN <br />BACKFLOW PREVE <br />ROOF DRAINS—RA <br />FHO`1TSETBFCK <br />IISE20HE <br />lYCEOFCONST PLLOWRBLE <br />SRE Of B�OG � <br />�(Ox2¢ <br />OCCl1PA ' LOFU <br />flEA50 ORSPFINKLERS <br />APPLIGATION ACC. NY <br />REAR SETBACN <br />LOTAREA <br />NO.OF � RIES <br />FIpE SPRNNL"cR5 REO D <br />I i YES � NO <br />BY <br />FEE <br />C1 WOODSTOV6FRPL INSERT G BUILDING RELOCATION <br />SO.�%v,�E� . � �5 -.3¢34 <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. AlL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS T�'PE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />P[RFORMANCE OF CONSTP.UCTION. THAT I AM AUTHORI'LED BY THE <br />OWNER OF THIS PflOPERTY 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 />SIGNAIDREOFCJ111PPCTOROHAl1THOfiREDRGENT DATE <br />" �-O. /,�.�GG�_`� �i/� �/e9 , <br />APPI i NTS CIiV B ESS UCENSE NO. AND BUSMESS NRME '�, <br />TYPE OF EQUIPMENT <br />NC—A/HNDLG UNITS—H.P. <br />FORCED AIR SVSTEMS—B.T.U. M E.A. <br />UNIT HEATERS—B.T.U. M <br />CI.OTHES DRYERS <br />VENT��.ATION FAN <br />RANGEHOOD <br />WATEF HEATER <br />WOOD STOVE <br />METAL FIREPLACE 8 CHIMNEY <br />FIREPLACEINSEFT <br />HEATPUMP <br />GAS PIPING <br />EXHAUSTFAN <br />SUB TOTAL $ <br />FEE 5 <br />SI�ESETBRCK PL�NCII KNUMOEN � FEE <br />L <br />VACANT SITE FEES <br />!-I YES �.-i NO BUi�oirvc <br />acureva xo orowcw cuvns <br />�p`�'P PLUMBING <br />0.5E E MECHANICAL <br />��. '�. YES NO <br />H[IGNTLIMIiAT10N OTNER <br />STAiE BUILDWG SURCHARGE <br />STATEENERGVSURCHAR�E <br />CITY OF EVERETT PUBLIC WORNS <br />LOCALSALES <br />TAX COOEIS 31U5 T�Tp� <br />PERMIT <br />TOTAL FEE <br />\i'\'"-1 � / <br />