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"�t�; pppLICAT'��'rN FOR CONSTRUC�ON PERMIT <br />.;�Y,- . <br />: Mr ENrrVrwn <br />CITY OF <br />everett . <br />BUILDING �EPARTMENT TO BE COMPLETED IN INK—PLEASE PRINT <br />259-8810 <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL or+E <br />� M�IL ADDPESS ��TM <br />°r"+E" �.Fa�l"r 9 82oi <br />R/ n A .ti .�. �./ 9 O/I I!/. �i/1 ii/i I/l/� �/IwV.%�.6' / <br />21P <br />MAIL <br />O PLUMBING <br />G <br />everett <br />e <br />❑ SIGN <br />� `, <br />.. CITY ZIP PHONE ' <br />MCMITEGi Oii DESIONER MAIL �DDRESS <br />�'ry Z�P p�pryE LICENSE� <br />� OENERALCONTMCiOp MAILADDRESS O C �� <br />v � _„�ro.�rheN 2/C�l��RCZ/�.�/� or�.c�2,9�'�39 _�Q'�5., „�.'t'�� <br />CUSS OF WORK <br />fl NFW O ADDITION � ALTERATION , <br />7ENANTIMPROVEMENTON VTERIORFEMODELONLY <br />Y <br />, aT e�oac <br />� <br />� <br />' FROMTSETBACK <br />i U6EZONE <br />� ryPEOFCONSL�LIOWI�BIE <br />1 <br />� 612E OF BLDO. <br />� OGCUPANCYIOAD <br />OF <br />OR <br />REARSETBACK <br />LOT AREA <br />TYPEOFLONST.�CTOAi <br />NO.OF STORIES <br />FIRE SPRNKLERS REO'D <br />❑ YES ❑ NO <br />� REASONFORSPRINKLERS <br />f <br />� `PPLIC�TION �CC. BY PUNS �PPROVED BY <br />i <br />PHONE LICENSEI <br />REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FR:'LINSERT ❑ BUILDINGRELOCATION <br />FOUF COPIES) <br />_� <br />$ <br />$ ' <br />SIDE SETBAGK <br />VACANT SITE <br />G YES ❑ NO <br />occuvn�' xo.aow[ureci <br />4RWV <br />BASEMENT <br />❑ YES ❑ NO <br />HEIGN7 LIMITATION <br />CITY OF EVERETT <br />LOCALSALES <br />TAX CODE IS 3705 <br />CONTACTPERSONANDPHONENO. <br />I HEREBV CERTIFY THAT I HAVE READ AND ExAmirvtu in�a <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HF.REIN OR <br />NOT. THt GRANTING OF A PERMIT OOES NOT PRESUME TO 61VE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF� ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION Ofl THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BV THE <br />OWNER OF THIS PROPERTV TO PEHfORM THE 1YORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br />SIGNATUREOPCONTR�G70ROR�U7NORIZEDA�ENT D�TE <br />X ,�1�+'� 1W!`�7�1.-f� <br />AP ICRNiSCITYBU5INESSUCENSENO.ANUBUSINESSNf�ME <br />FORCED AIR SYSTEMS—B.T.U. M <br />UNIT HEATERS—B.T.U. M <br />CLOTHESDRYERS <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />WOOD STOVE <br />McTAL FIREPLACE 8 CHIMNEY <br />FIHEFLACE INSERT <br />HEATPUMP <br />GAS PIPING <br />pIANGNECNNUMBER FEE I PECEIPTNO. <br />BUILDING <br />PLUMBING <br />MECHANICAL <br />OTHER <br />STATE BUILDING SURCHARGE <br />SIATEENERGYSURCHARGE <br />PUBLIC WORKS <br />TOTAL <br />i <br />N <br />