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APPLICATIV�I FOR C�DNSTRUCI �ON PERMIT <br />the Eve�B�een <br />CITV OF <br />everett <br />BUILDING DEPARTMEPlT <br />259•8810 TO BE COMPLETED IN INK—PLEASE PRINT <br />❑ DEMOLITION ❑ COMBINATION f I BUILDING I I l:1ECHANICAL I I PLUMBING <br />OWNcq MAILA�OHESS ,��J CI�1' ZIP PHONE <br />o,,,t /yleJ.�r.,� /s7�o D�� I�3'�.tF ��;n�illc 4eo>,2 h4�'�-��kso2 <br />T� NAN�j ^� MAIIADOPE55 CITV 21P �'NONE <br />///�1I10nP�"aW1 ( iJS — 5c� 4110✓� — <br />ARLHITECTORDESIGNEfl MAILADDRESS <br />CITV <br />VMONt <br />everett <br />� <br />C �IGN <br />�NERALJpO."lTflA[�T�R�fJC$�AO�3��'���(�'��'/��r. Cj�4�cJ�1P 4�J�`�O .Y"`f`G�`�`�� LILENSEDJ/�I%NT:-�^ <br />J/V1��+11�'� �\1s <br />MECHANICFLCONTflACiOR MAIL ROORE55 CIN ZIP PHONE IICEYSE Y <br />PLUMBIN6 CONTflACTOR MAIL r100RE5S CIN 21P PHONE UCENSE � <br />CUSEOFWOflK T��12✓l. /m V���'�PK <br />❑ NEW ❑ ADDIT�ON E�-IttTERATION ❑ REPAIR LI DEIdOLITION L1 WOODSTOVE/FRPL INSERT ❑ BUIIDMG RELOCATION <br />TEMANT IMPqOVEMENT OR INiEflIOR fiEMWCL ONIV I COfJTAC�� �'SON A�ND P;lp� NO_�� .. `` 33 �{-�1,2_s <br />-��� .�.,.� � W l't� f K 1 <br />ItESCRIBE WORK FND SOUARE FOOTAGE INVO�VE[ <br />��� r� r5 lt �F/��k�' S' <br />P�OPOSED USE GF BUILnING <br />KE�i � '7'e �c� <br />LEGRL DESCiiIPTION OF PROPEflN �SN01YN DELO� <br />L0T BLOCN OF <br />�p 4 cc �s � n f <br />�ACY�I �o Z�� �i1 <br />/Vlcr Ic 1 "'o/'w�l sP< <br />PRQIECT ADDRE55 /�r <br />� �O p2 S E 7�uy'�� <br />Fi.UMBING <br />NO. TYPE OF FIXTURE OR <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISP <br />�SERVICE—BA� <br />i � <br />FPONTSETBACK <br />IISE 7�ONE p <br />�� ' � /� <br />se <br />ATTACH FOUR COPIES� <br />��J <br />I HEREBY CERTIFY THAT I HAVE READ AND E.XAMINEO THIS <br />APPLICATION AND KNOW THE SAME TO BF TRUE AND CORRECL ALL �. <br />PROVISIONS OF LAWS AND OfiDINANCES GOVERNING THIS T'PE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERLIN GA � <br />NOT. THE GRANTIFIG OF A PERMIT DOES NCT PRESUME TO Gl��E <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF qNY <br />OTHER STATE OR IOCAL LAW REGULATING CONSTRUCTION OR TrvE . <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY'iii5 ' <br />OWNER OF THIS PROPERTY TO PERfOFM THE WORK FOR WHICH <br />APPLICAT�ON IS MADE AND I COMPLY WITH THE �T4TE ' <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />SIGNATUFEOFGONTRACTOROFAUTHORITE�AGENT DATE <br />r�u����Nv W=IrTN�esT <br />x � ��, � <br />APPLICANTS GIN BUSINE55� WSE NO AND B I SS NAME � <br />MECHANICAL <br />FEE NO. TYPE <br />AIR <br />T.U. M <br />METAL FIFEPIACE 8 <br />FIREPLACF INSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN <br />SUB TOTAL $ ' SUB TO' <br />PERMIT $ � PERMIT <br />TOTALFEE $ ' TOTALF <br />REAR SETBACN SIOE SETGALK PLAN CNECK NUMDER FEE <br />,�rSTr�.Jc�- — ia ��i6� -`�r <br />LOTARER VACFNTSITE FEES VALUAT <br />iVP€OiLJN57.ALlOWABLE 7YFEOFCONSiACTUAL <br />�� <br />SIZE OF BkB9. SPI��t NO.OF SjORIES <br />1v2� �f � <br />OCCUPANCY LOAO FIRE SPRNKLERS REO'D <br />� � YES L 1 NO <br />flEASON FOfl SPRINNLERS <br />APPLICATION RCC. BY <br />ev <br />I�I YES J/ Nl+ Bl11LDING <br />occuvr.xcr xo orowuuxcumis <br />aoue �_ p�UMBING <br />•Z <br />BRSEMENT MECHANICAL <br />(] YES �NO <br />NEIGNTLIMITATION OTHER <br />STATE BUIL�ING SURCHARGE <br />STATE ENEPGY SURCHAtiGE <br />CITY OF EVERETT PUBLIC WORKS <br />LOCALSALES <br />rev r.nnF is sin � rorn� <br />RECEIPT NO. <br />3�oi�% <br />FEE <br />. <br />n <br />1� <br />