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�-- APPLICATIt�V FOR CONSTRUCNON PERMIT� I� <br />everett <br />� I�e Everpreen � <br />� citv or <br />; everett <br />BUILDING DEPARTMENT TO BE COMPLETED IN INK—PLEASE PRINT <br />259•8810 <br />ION fl BUILDING �ECHANICAL IIPLUMBING C] SIGN <br />❑ DEMOLITION LI COMBINAT <br />��� t�`��T V'.1 L 1�f V 1�.� one s�� `f �� C13 r'cl �J ziv �� 4:��1 �1Oe�e ��J (�' I <br />� L <br />TENA�^^^ n MMLAO�RESS CITV ZIP PHONE — <br />� �� 1� W <br />AflCHITECTORDE5IGNEH mni�nvonoa <br />G\�A �TMC� �N 5 <br />MECHRNIC��� M41LA OA�55 <br />PIUMBINOCONIRACTOA MAILAODf1ES5 <br />CUSS OF WORN <br />f 1 NEW I�I ADDITION` . 6TERi <br />TENANT IMPROVEMENT OR INTER'pfi R� � E� <br />CONiRACTPRICEOqFWOFR: � � <br />❑FeroIBE RKA �SOU REFOpiRGEINVOWEC <br />e � . ��i �,�, � . <br />PROPOSED USE O! OUII <br />LEGr1L DESCRIPt10N OF P(10PERi V(SNDWN BELOI <br />LOT BLOLK OF <br />ur <br />� '1� Z'�.�������1� ��°��N�/5�U <br />-,� l� � s ec1���; <br />CItV �ZIP PHONE IICENSE� <br />c.(—l3 �j�c, <br />GTY 2�P P��ONE UCENSE • <br />� I I REPAIR I I DEMOLITION I I WOODSTOVEiFRPL INSERT I I BUILDING RELOCATION <br />> t�'�� — 5 t� � rc <br />BING <br />TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />BATHTUi3 <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHL•N SINK 8 DISP <br />ROOF <br />SINK 6 <br />CONiACT PERSON 4N0 PHONE NO. <br />I HEREBV CERTIFY THAT I HAVE READ ANU EXAM�NED THIS ' <br />APPLICATION AND KNOW THE SAME TO BE TFiUE AND CORRECL ALL �, <br />PROVISIONS OF LAWS AN[1 ORDINANCES GOVERNING THIS NPE O� <br />VlORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR � <br />NOT. THE GRANTING OF P. PERMIT DOES NOT PRESUME TO GIVE �, <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY I <br />OTHER SiATE OR LOCAL ! AW REGULATING CONSTRUCTION OR THE . <br />PERFORMANCE OF CUNSTRUCTION. THAT i AM �UTHORI2ED BY THE I <br />OINNER OF THIS PROPERN TO PERi�OPM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE '�. <br />CONTRACTOfiS LAW 18.27 RCW AND 296200 WAC. <br />SIGNRIUREOFWNIfiACiOR i11l1iNOfiIZ[OAGENT D4TE <br />X - `� � <br />A.PLIC�N;S^I.VOUS SSLI SENO.ANIIOUSINESSNA E <br />N0. <br />NC—NHNDLG UNITS—H.P. <br />FORCED AIR SVSTE�dS—B: <br />UNIT HEATERS—B.T.U. M <br />CLOTHES DRYERS <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />WOODSTOVE <br />METAL FIREPLACE 8 CHIMt <br />FIFF.PLACE INSERT <br />HEAT PUMP <br />- SUB TOTAL $ I <br />PERMIT $ �— <br />TOTAL FEE $ ' <br />FRONTSETBACH �EARSET6RCK SIOESETBAGK PIANCNEGNNUMBER FEE <br />115EZONE LOTANEA VACANi51TE FEES <br />I 1 YES f.7 NO BUILDING <br />iYPEOiCONSi.ALIOWRBIE 1�PEOFCONSf.AGiUAL o[cureHtr xoofmvauxGuxns <br />�RO�P PLUMBING <br />SREOFBLDG. NO.OFSIDf11E5 BASEMENT MECHANICAL <br />I-I YES I I NO <br />OCGUPANCYlOAD FIf1ESPiiNHlER5RE0'D HEIGHiUMITATION OTHER <br />I 1 YES f; NO STA1E BUILDING Sl1RCHARGE <br />1iEA50N FOR SPNINNLEqS <br />STATEENERGYSURGHARGE <br />APPUC�TIONFLC.BY PLANSAPPROVEDOV CITYOFEVERETT PUBLICWOPNS I <br />LOCAL SALES <br />TAX CODE IS 3105 TOTAL <br />$ 'r--- <br />g �� <br />RECEIPI N0. <br />FEE <br />��— <br />i <br />� <br />� <br />i <br />—� <br />� <br />i <br />i <br />i <br />—T <br />