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L►PPLICATIO►. FOR CONS'TRUCT[ N �EFtNA1T <br />IheEvergrBen TO BE COMPLETED IN INK—PLEASE PRIriT <br />CI7V OF <br />e�verett <br />BUILDING DEPARTMENT <br />259•8810 <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />everett <br />� <br />f I DEMOUTION I I C�MBINATION �, � BUILDING I I MECHANICAL �PLUMBING I i SIGN <br />OWNER / �y /p IA/R�'L�ACDnRESS y /y - n / I G�IT�Y /� 21P PHON /q 0,/py Jn,, ��� <br />TENRN�XLN�/L M\ LIY Y I�SS YI �I t' �L`I� I��S'� C11 `/�Y/ x ��' -,'(Z���/'//�I�-I//!/(�i i ��%". <br />5= <br />ARCMITEGTOfI DESIGNEfl MRI� ADORE55 CITV ZIP PHONE <br />GENEflALLONTflALTOR MAILAUDRE55 CIN ZIP PHONE UCENSEV <br />IAFf.HRNICRL CONTflFCTOR MAIL RDDRESS ��TY ZIP PMONE LIGENSE M <br />LONTflAGTOfl <br />IJ NEW <br />OESGRIBE WOflK <br />ADDITION ❑ ALTERATION <br />FOOTAGEINVOLVED <br />dTY ZIP PNONE LICENSE I �(Y� W �'� I <br />�_L!f% �-��stkllr--gAz7� 6S9��oy � <br />I I REPAIR I I DEMOLITION I I WOODSTOVE/FRPL INSERT ❑ BUILDING RELOCATION <br />ICONTACTPERSONANDPHONF.NO. <br />LEGAL OESCRIPTIOH OF PROPERTY �SHOWN BELOW OR ATiRCH FOUR LOPIES� <br />�or eiocK oF <br />f l� % c5 � �l��f�G i� �f11 � � <br />� ,� a�� � � <br />PLUMBING <br />p, TYPE OF FI%TURE OR ITEM <br />' WATER CLOSET (TOILETj <br />BATNTUB <br />' LAVATOFY(WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />I.AUNDRY TRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />FOR OFFICE USE ONLY: <br />FRONTSETBACK REAPSETBACK <br />USE20NE IOTAREA <br />ttPEOFCONfS.ALLOWABIE iYPEOfCONST.ACiUAL <br />SRE OF BLDG. NO. OF STORIES <br />OLGUPAHCV LOAD FIflE SPflNNlERS REO'D <br />qEASGN FOfl SPRINKLERS <br />INTFNE 9Y <br />ev <br />$ <br />$ <br />SIOE SETBACN <br />VACANT SITE <br />I HEREBY CERTIFY THAT I HAVE flEAD AND EXAMINED THIS <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 WHETHEH ;iPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERtiiIT DOES NOT PRESUME TO G�VE <br />AUTHORITY "f0 VIOLATE UR CANCEL T.HE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I pM AUTHORIZED BY i HE <br />OWNER OF THIS PROPERTY TO PERFORM iHE WORK FOR WHICfi <br />APPLICATION IS MA�E AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 182Y RCW AND 296200 WAC. � <br />SIGNhTUREOFCONTRaCTORORAUTMOHIZEDAGENT DATE <br />X��!/1 NV Y i/ <br />APPI ICANTS CITY EUSINESS LICENSE N0. AND BlI51NESS NAME <br />NO. <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />UNIT HEATERS-9.T.U. PA <br />CLOTHESDRYERS <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />WOOD STOVE <br />METAL FIREPLACE 8 CHIMNEY <br />F�REPLACE INSERT <br />FAN <br />BUILDING <br />OCLOGANLY NO Of OMIIINGONIR <br />�A�P PLUMBING <br />6ASEMENT MECHANICAL <br />HEIGHT Uh1ITATION ADDITIONAL PLAN CHECK <br />OTHER <br />STA7E BUILDING SUPCHARGt <br />CITY OF EVERETT PUOLIC WORKS <br />LOCAL SALES — <br />TAX COOE :S 3105 TO7AL <br />PERMIT <br />TOTALF <br />A <br />i <br />T <br />]O j 0 U <br />