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APPLICw►T10N FOR CONSTRi��TION <br />. PERMIT <br />Ihe Everyreen . everett <br />CITY OF � <br />everett <br />BUILDING DEPARTMENT <br />259•8810 TO BE COMPLETED IN INK— PLEASE PRINT <br />OWNER AInILApORESS LIiY ZIP PHONE <br />Mo,�Trirtf /Sd3 M�x��� �.�i�✓c MvK�c�7' 9�.�7s �53-"73�-.5 <br />TENANT RIAILADOfVE55 CItY IIP PMONE <br />SNyO��"� <br />pRCNITEGTORDE5IGNER M�ILAOORE55 C�iY 21P PNONE <br />PLUMBINOLONTPACTOR h1AILR�DRE55 CIiY 21P PIION[ 4CENSE• <br />❑ NEW ❑ ADDITION ❑ ALTERATION � REPAIR ❑ OEMOLITION ❑ WOODSTOVE/FRPLINSERT ❑ BUILDINGRELOCATION <br />TEN�NTIMPROVEMENTOpINTERIORREM00ElONlY CONTRGTPERSONANpPHONENO <br />CANT CTPNICEOFWONK � �' ���� ���'QL� �0� a�""�y��� <br />•NySjg�af �9�: � � � ,'t'�R— i . .- � I �J � l.t�'1%tq en�J� f /T 0 <br />_ . <br />PROPOSED USE OF BUILDING 1 HEREBV C[RTIFY TIIAT I HAVE PEAD AND EXAA�INcD 7HI5 APPLICATION AND <br />� E�� KNOW THE SAME TO BE TRUE AND COHRECT. ALL PROVISIONS OF LAWS AND <br />LEOA� pESCFIPTION OF PROPERTY ISNOWN pELOW OR ATTAGH FOl1R COPIE51 ORDINANCES GOVERN W G THIS NPE OF WORK W ILL BE COMPLETED W ITH <br />WHETHER SPECIFIED HEREINOR NOT.THEGRANTINGOFA PERMITDOES NOT <br />Se.S�OFLOi S1C, PRESUMETOGIVEAUTHORITYTOVIOLATEORCANCELTHEPROVISIONSOF <br />icLloT_�_ B�ocK� oF E/ rEII�LAKD Go,NMMfc qNYOTHERSTATEORLOCALLAWREGULA7INGCONS7RUCTIONORTHEPER• <br />FORMANCE OF CONSTRUCTION. TNAT I AM AUTHORIZED BY THE OWNER OF <br />THIS PROPERN TO PERFORM THE WOPK FOR WHICH APPLICATION IS MADE <br />/ST Anb �v Eve� � ✓J�- 7 �l L� AN� I COMPLY WITH THE STATE CONTRACTORS LAW 18�7 RCVj� AND <br />^ zse.zouwno. 3/Z � % �G <br />0 - - -- C� /9U� [�� Si''/i-DMiSF+ �� SIGNALUFEOFCONiRACTOROFnlI1110RRE0FGENT ORTE / <br />,. X ,�,_� -, <br />, <br />PRQIECTAUORE55 �' IfPLICANiSCIlYBU5WE5 �ENSENO�NDBUSin[SSNn1E <br />,� $/) ,Cd G K E eC'EL L E7"e.. <br />PLUMBIN4 MECHANICAL <br />TYPE OF FII <br />WATER CLOSET (TOIL <br />BATHTUB <br />LAVATORYIWASH BA` <br />SHOWEti <br />KITCHEN SINK6 DISF <br />DISHWASHER <br />LAUNDRT pY <br />CLOTHES WASHER <br />URINAL <br />ORINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENI <br />ROOF ORAINS— RAII <br />SINK ISERVICE — BAI <br />OR ITEM I FEE <br />SUB70TAL s <br />PERMIT $ <br />TOiAI. FEE S <br />FRONTSETBRCH REAq5ET9ACN SIDESETBACN <br />USEZONE LDTANEA WCr1NT51iE <br />❑ YES ❑ NO <br />iVPEOFCANST. OCCUP�NGYGROl1P NO.OFDWEIUI <br />�LLOW�BLE/ACiUAL <br />SiZEOFBIDG. NO.OFSTORiE9 BSMT. OCGLOAO <br />❑Y <br />O N <br />HEIGNT IIMITRT <br />FINESPRINNLERSREOUIREO ❑ YE9 ❑ NO <br />TYPE OF E�UIPMENT <br />iNDLG UNITS— H.P. <br />AIR SYSTEMS— B.T.U. <br />1TER5—B.T.U. A1 <br />RANGEHOOD <br />WATER HEATER _ <br />WOODSTOVE <br />METAL FIREPLA(:E 8 <br />FIREPLACEINSERT <br />GAS <br />SUB <br />FEES <br />BUILDING <br />PLUMBING <br />MECHANICAL <br />OiHER <br />STATE BUILDING SURCHARGE <br />STATE ENERGY SURCHARGE <br />PUBLIC WORKS <br />TOTAL <br />M [0. <br />S <br />FEE <br />