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APPLICATIO:� FOR CONSTRUCTC�N PERMIT <br />rne E�aryree� TO BE COMPLETED IN INK—PLEASE PRINT <br />CITV OF <br />everett <br />BUILDING DEPARTMENT <br />259-8810 <br />� DEMOLITION f_; COMBINATION <br />MAIL <br />MAIL ADDRESS <br />MAIL ADDRE55 <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />�.7 BUILDING ❑ MECHANICAL ❑ PLUMBING <br />Z��� h-��k <br />ZIP PHpNE <br />GENERALCONTRACTOR MAILA�UHESS CITV ZIP PHONE LICENSEI <br />MECHANICAL GONTRACTOP MAIL ADDRE55 CITY ZIP PHONE LICENSE � <br />PLUMBINGCONTRACTOR MAIL�GDRESS CITY ZIP PHONE UCENSE• <br />CLASS OF WORK <br />❑ NEW ❑ ADDITION <br />everett <br />e <br />❑ SIGN <br />L REPAIR I.i DEMOLITION [ 1 WppDSTOVE/FRPL INSERT ❑ BUILDING RELOCATION <br />�^, � CONTACT PERSON AND f'HONE NO. <br />CONTRACT PP�CE OF WORK <br />DESCRIBEWORK�NDSOl1AREFOOT�GEINVOWED � <br />LEGAL DESCPIPTION OF PROPI <br />LOT BLOLK <br />aaaecr <br />, �_ <br />PLU <br />NO. <br />TYPE <br />LAVATORY(WAS <br />SHOWER <br />KITCHEN SINK R <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />ROOF ORAINS—RAINLEAC <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />C� APPLICATION AND KNOW THE SP.ME TO BE TRUE AND CORRECT. ALL <br />LOW OR ATTACN FOUR COPIES� , PROVISIONS OF LAWS AND OFDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />oF 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 IOCAL LAW REGULATING CONSTRUCTION OR THF <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFOHM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 1827 RCW AND 296.200 WAC. <br />SIGNATURE TPALTORORAUTNORIZEOAGENT DATE <br />X � � � <br />. <br />C^r ,� ,� � APPUC� CITYBUSINES$LICENSENOANDBUSMESSNAME <br />SUB TOTAL $ <br />PERMIT $ <br />TOTAL FEE $ <br />FOR OFFICE USE ONLY: <br />FRONTSETBr1CN REARSETBRCK <br />�' �. f ST! � <br />USE7.((ZNE _ LOTqNEA <br />iVPE Of CONiS. <br />NO. <br />INTANE BY <br />NS APPFOVED 9Y <br />� <br />SI=ESE�BRCK I PIAN <br />NO IX pNF1LIHG UNi15 <br />BASEMENT <br />� �� <br />1 <br />HEIGHT LIMITATION <br />CITY OF EVEREIT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />A/C—A/HNDLG UNITS—H.P. <br />FORCED AIR SYSTEMS—B. <br />CLOTHES DRYERS <br />VENTIUITION FAN <br />RANGEHOOD <br />METAL FIREPLACE 8 CHIMNEY <br />FIREPLACE INSERT <br />HEAT PUMP <br />EXHAUST FAN <br />BUILDING <br />rwMow� <br />MECHANICAL <br />ADDITIONAI PLAN CHECK <br />OTHER <br />STATE BUILDING SURCHARGE <br />PUBLIC WORKS <br />.OTAL <br />FEE <br />TOTAI. FEE $ � � <br />FEE RECEIPT NO. <br />VALUATION FEE <br />5 i <br />� <br />� <br />i <br />i <br />i <br />� <br />i <br />i <br />i <br />i <br />� <br />F <br />