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APPLICAI _�N FOR CONSTRUI, f10N PERMIT <br />everett <br />!ne Everyreen � <br />CI i f OF <br />everett <br />BUILDING DEPARTMENT TO BE C MPLETED IN INK—PLEASE PRINT <br />259-8810 , <br />I I DEMOUTION I I COMBINATION � r 1 BUILDING i I MECHANICAL PLUMBING I I SIGN <br />OWNER . MAIL PO�RESS CITY I Z�P PI1011@ <br />J�'n'i!11L,� �7ci�,�, s < <, g„ �, ,� .';'� C►: i � i ! �� � �t'���ea�L�, ! ,.) `J �1'J: r . � 5 • 1 - � `I v �' <br />IEN�NT AILA�ORESS � QiV 21P PHONE <br />eonnrcciORnF51GNER AIAIIAD�RE55 dTY 21P PIIONE <br />C1A550F WORK <br />I I tiFW � I ADDITION I I ALTERATION � REPAIH I I DEMOLITION I i_ WOODSTOVE�FRPL INSERT I I BUILDING RELOCATION <br />TENRNiIMPROVENENTORINI <br />CMlTR�LT PRICE OF WORN:� <br />OESCflIBE WORH �ND SOU�R . <br />, • 1 <br />1 , r i �� <br />PR POSE E OF DUIIDING <br />a <br />i, <br />EGRLDESCFIPTIOIj OPI <br />� <br />LOT .. _ — OIOLN <br />nEniooei oN�v � � <br />��Ii)�1 <br />1GE INVOLV[0 ) <br />�� 1.��_ . �� /� �f LL��� <br />LLL6 <br />�/- \I <br />:)CC�C��/L ( <br />i110W�� OELOW OR RTTRGII FOUR COPIES� <br />_ OF <br />ADDPESS <br />����N�l' A��r� <br />MBING <br />TYPE OF FIXTI <br />WATER CLOSET (TOIL <br />BATHTUB <br />LAVATORY (WASH BA: <br />SHOWER <br />KI7CHEN SINK 8 DISP <br />SINK <br />FfiONT SEIBACK <br />USE 20N'c <br />iYPEOFLON51 AILOWP9L[ <br />SI2E Of OIOG. <br />REASON FOfl SPNINNLERS <br />�PPLICATION RLG.OY <br />ETC. <br />REAR bC <br />LOT RRF, <br />�. <br />1FIP PSON ur�ro�+euo, <br />r �f��-/�;��t��Y> 6.5,�_ 7v`rh <br />I NEREBY CEFTIFY THAT I HAVE READ ANG �%AMINED THIS <br />APPLICATION AND KNOW THF. SAIdE TO BE TRUE A'�D CORRECT. ALL �. <br />Pf'OVISIONS OF LAWS AND CRDINANCES GOVER�IING TIiIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEFEIN OR , <br />NOT. THE GHANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHOfiITY TO VIOLATE OR CANCEI TNE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAN' REGULATING CONSTRUCTION OH THE . <br />PERFORMANCE OF CONSTRIICTION. THAi I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORA9 THE WORK FOR WHICH <br />APPLICATION IS MADE :�ND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br />SIGIUIIINE OF CUIIIR�CTOR OR AU1110RI.GI] AGENI DAIE � <br />I <br />X ��,,,.,.�.(o2.T �l v�b `l o <br />APPIIGANISCIiY�USMESSLILENSENO RNDOUSINESS E <br />NO. <br />�E OF E�I IIPMEN' <br />G UNITS—H.P. <br />SYSTEMS—B.T.U. <br />IS—B.T.U. M <br />\TION FAN <br />HOOD <br />HEATER <br />METAL FIREPLAGE 8 <br />FIREPLACE INSERT <br />I1EAT PUMP <br />GAS PIPING <br />EXfiAUST FAN 1 <br />TOTAL $ i — <br />d1T $ ' _ <br />�L FEE $ <br />SI�ESEiBACN PLANGMECKNl1MBER F«, <br />i <br />VFCRNT SILE FEES <br />I I YES I I NO pUILDiNG <br />occu-nxcr xnamvuuxcuxns - <br />nn:m3 pLUMBING <br />NOAFS70RIE5 OASCMENT AIECHANICAL <br />�Z I I YES I I — <br />FIRESPIiNKLERSRGOD NEIGHTU!AITATIJN OTHER � ��_� � <br />I I YES I�O STATE OUIL�ING SUHCNAHGL <br />STATE ENEfiGY SURCHARGG <br />PLANSAPVROVE�OY CITY OF EVERETT PUDUC WO(iNS <br />LOCAL SALES <br />�( ��' TAX CODE IS 3105 Torn� _ <br />E.A. <br />� <br />RCEIPT N0. <br />i <br />