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APPLICAYI� FOR CONSTRUC7�r�DN PERMIT <br />Ine Eveip�nen <br />GTV OF <br />everett <br />BUILDING DEPARTMENT TO BE COMPLETED IN INK—PLEASE PRINT <br />259•8810 <br />❑ DEMOUTION f I COMBINATION I I BUILDING L 1 MECHANICAL L I PLUMBING <br />OWNER MRILPDORESS C�TV 21P PMONE ap <br />� i_ . r r� ,. �� c �n �- P. r-/rx.. /,C„n �i/0/.0/�- /.fl� ZO �(`i <br />everett <br />e <br />O SIGN <br />U/� <br />�cy – <br />TENANT M�ILAOORE55 �"' "' ���- <br />ARLHITECTOFDESIGNEfl MAILAD�AE55 CITY 21P PMONE <br />li OFF/v/P1'� <br />MAIL <br />ZIP rnurve <br />��4 II/ /1 ' Zi�I <br />LICEHSE � <br />MECNANIC��Nip��T�� MAILAODRF.55 Cltt � ZIP PIIONE LlGtnst+ <br />PIUMBINGCONTRRCiOR MAILA�DRESS GTV 21P P��ONE UCENSEI <br />G1A550F WORN <br />❑ NEW �� ADDITION f 1 ALTERATION <br />TENANTIMPROVEMENT�3INTERIORR[M00[IONLY <br />WONK AND SOUARE POOtAGE <br />ATT�CN <br />I.l FEPAIR I- 1 DEMOLITION I I WCJDSTOVE/FRPL INSERT ❑ BUILDING ^.EIOCATION <br />LOT OLOGK OF _ <br />� �o`�o-i C�,� q � ,�1 .S S� � �' <br />'Klrr�c .LIa ICn�ut o�LOLA1elI <br />S <br />� <br />FRONTSETOACK , <br />v <br />USE 2�_� <br />TPC Of CONSi ALLOWABIE <br />j <br />8 <br />CONTACi PERSON AND PIIONE NO. � <br />I <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS I <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL �, <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYP6 OF I <br />WORK WILL BE COMPLrTED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT F'RESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANV <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPEFTY TO PEFiFORM THE WOHK FOR WHICH <br />qpPIICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW �827 RCW AND 296.200 WAC. <br />SIGhA1UPfOFGONiRnC10RORAUTHORiZEDAGENT DRTE <br />X � , i�j ...ro�// '/ /%���.%i <br />�P LICPN75 CITY OUSINE55 L GENSE NQ RND BlI51NES5 N�ME <br />FORCED <br />UNIT HE� <br />HEAT PUMP <br />GAS PIPING <br />EXHAUST F/ <br />SUB TOTAL $ � _ <br />PERMIT $ _! _ <br />TOTALFEE $ ' <br />REARSETOACK SIDESETB�CK PUNCHEGR OMBER <br />i � <br />lOT EA �ACANT SITE FEES <br />Z��C�Ti'�75� ! 1 YES '-7 NO �UILDINO <br />7VCEOFWNC1 AC7UAL allo�.YCr xoc:owtWxauvrts <br />"1 �"�'�. ..�- PLUMBIIJG _ <br />1 <br />SREOFBLDCi. I NOAFSTGPIES BAC�EIdEN1 MECHANICAL <br />�� T 4 �— ❑ YES O NO <br />OCCUPAHG—=LOAO FIRESPIiNdLERS�,,���R///EOD''' NEIGNTL�MIVd10N _OTHER <br />CI YES I�'rv0 �i STATEBUILUINGS::i7CN"RGE <br />PE�SONFORSPRINNLERS <br />� � <br />APPLICATION �CQ BV <br />. )MYJ�, <br />STATEENERGYSURCNAFGE <br />a�o� av CITY OF EVERETT PUBUC WOI1N5 <br />//-� � LOCAL SALES ' <br />��" TAi! COQE IS 3175 TOTAL <br />B.T.U. <br />M <br />FEE � � � <br />$ <br />RECEIPT NO. <br />tl <br />� <br />