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APPLICATII..� FOR CONSTRUC7 _ �N PERMIT <br />f�a E�erv�ra^ <br />CIiY OF <br />everett <br />1 <br />everett <br />e <br />BUILDING DEPARTMENT TO BE COMPLETED IN INK—PLEASE PRINT <br />259•8810 <br />i I DEMOLITION i'� COMBINATION BUILDING _'� MECHANICAL I I P!..UMBING I I SIGN <br />owrven �1 �_ n+naaovness cnr nr m�or+e <br />.��s u a�L�.1--- 29� �o�%li �I�Fr Lv;r1'F� `1810! ----zs�i�VY�q <br />IEN�NI MNL�DDfIFSS cnv 7m m�oNe <br />ARCNIIECT OR DES�ONE(1 AIML �CDRESS <br />arv zm mwr+e <br />GENER�LCON7A�CTOti MAILA�DRE55 CITY ZIP P110NE LICENSE� <br />MECIUNICALGONI{iAClOfi MAILAUORE55 CIIV DP PHONE LICENSE� <br />II•n'i L=. 17�at,.,e b�it..• ,. "�. `%�F20 .iS$-2�1N ,4'A7U/:4r V L <br />'� M� I � ! � � ' Z�p PMONE LICENSE � <br />PIUMBINGCON�R�C70 � ��AIIA�OfiE55 CITY <br />cuss or wonK <br />I I NEW I I ADDITION ! I AITERATION <br />TENMlT IMAROVEIAENi OR iME�iIOR PEMOUEI IXILV <br />M <br />CpNLRAf.T Pf110E OF WOPN: �rV O <br />DESCR�BE WORN AND SOUA�E fOULAOE INVq.VED <br />n 1 /!�. t0_, e_��/, �e-.��i., J <br />i � qFpq�q I I UFMOLI710N I I WOO�STOVE/FRPL INSERT I I BUILDING RELOCATION <br />1\F I Q 1 � —__— _—'_. _" <br />ieaei oese:mri �N or rnoren i r isuowN �r.i uw on ni incn roun curo-.si <br />�ot_. macK or -- <br />DRE55 <br />A�V �uef(F'�P. <br />TYPE OF FIXTURE Ofl <br />NATER CLOSET (TOILET) <br />3ATHTUB <br />_AVATORY (WASH BHSIN) <br />iHOW Efl <br />{ITCHEN SINK 8 DISP <br />DISHWASHER <br />LAUNDRY TRAY <br />CLOTHES WAShicR <br />URINAL <br />DRINK�NG FOUNTAIN _ <br />FLOOfi DRAIN _ <br />FRnNtSETB�CK <br />USE 2UNE <br />�rae or coxsr euownxi f <br />S2E OF PIOG <br />OCCUPANCVLOAD <br />OE�SON fOfl SPfUNNLEIIS <br />nrrur.?nor+ncc nv <br />CON1�C1 PEfi50N AND P110NE ND <br />I FIEREDY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNON THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AVD OHOINANCES GOVERNING THIS TYPE OF <br />WORK WILI. BE COMPI.EIED WI1H WHETHER SPECIFIcD HEREIN OR <br />NOT. 111F GRANTING OP A PERMIT DOES NOT PRESUME TO GNE <br />AU1tIOf71TY 10 VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTII[R STATE OR LOCAL LAW REGULATING CONSTflUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT 1 AM AUTHORIZED BY THE <br />OWNEF 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 296.200 WAC. <br />SICNnfUf1E` CONLf1�C10R011�U1110RIZED�GENT DR7E <br />x (l I �� . D � � �_g, <br />N�5 CItY BUSINESS LICENSE N0. AN09USirv W e na� <br />ANICAL <br />TYPE OF EQUIPMENT <br />NC—NHNDLG UNITS—H.P. <br />FORCED AIR SYSTEMS—B.T.U. M E.A, <br />UNIT HEATERS—B.T.U. M <br />CLOTHES DRYERS <br />VENTILATION fAN <br />RANGEHOOD <br />WATER HEATER _ <br />WOOD STOVE <br />METAL FIREPLACE & CHIMNEY <br />FIREPLIICE INSEFlT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN <br />SUB TOTAL S � <br />---r— — <br />PEFMIT $ '_ _ <br />10TALFEE $ <br />RE4RSEIO�CK SIDESEI114CR PL�NCNfCKNl1A1B[R <br />LO7 AOE� <br />im[ or consi. uma <br />NO M SIONf:S <br />FlnG SPliNnlEf15 RPOn <br />I I YES I'� NO <br />��inr.s nrrnovco nr <br />�FF. <br />V4C�NI SIIE ��c� <br />i i YES I I NO p���LDINC <br />fIfCIIfASfV NIIINIM�l11N�11N�it = <br />',"'"'" r�uMeu�c. _ <br />pASfMR�i A1[CIIANICAI <br />I I YES I I NO - -- - --�- - � -- - --- � <br />NE�c11r LIMnn71oN OIIIER __ __ <br />_ _________ SI�1FOl11U)W(;SURGI4RCE <br />STAiE F.NBRGY FURCIIARFf- <br />CITY OF EVERETT ruoi ic wonks <br />LOCAL SqLES <br />TAX CODE IS 3105 tom� _ <br />S� /3�� <br />$ � /�� � <br />RECEIP7 NO. <br />—.-.--�— <br />i <br />3�' <br />8 <br />