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ApPLICATI� FOR CONSTRUC�N PERMIT <br />� everett <br />ub e�ero�e� � <br />� GTV OF <br />everett <br />BUILDING DEPARTMENT <br />259•8810 TO BE COMPLETED IN INK—PLEASE PRINT <br />1 !-1 DEMOLITION I 1 COMBINATION i 1 BUILDING _ I I MECHANIC.:I i 1 PLUMBING ❑ SIGN <br />� OWNER MAtLADORE55 CITY ZIP 1'�IONE <br />�� 1� l� "'h9n� 2SZ/-U�rs�'-i� /f.,e F✓T Z59-GiS"`� <br />'� TEN/JlT IAII.�ODRESS ' CIIY 21P PNONE <br />1 <br />' ARCNITEGTORDESIGNER I �DDIlES"� CItY ZIP PNONE <br />� GENEMLCONTR�CTDR � ADDRE53 CITY 21R PhONE LICENSEI <br />i <br />MECNNUCRLCONTR�CTOR `�LADORE55 CItY ZIP PIIDNE LICENSE� <br />+ w- w� �.�.a��� :� �;uu- �1�« A�� ��r 9Yz�>� ys �-r;�� N���W k �;-► KS <br />I _.........� .. .r.nu u�n �nnnFcc CIIY 21P PIIONE LICENSEI <br />❑ NEW V LI ADDITION I�f'ALTERATION I I REPNR I 1 DEMOUTION I I WOODSTOVE/FRPLINSERT I I BUILDINGRELOCATION <br />TEIUNT IMPROVEMENT OR INiERiOR REE10/D�[L ONLYO <br />CpITR�CT PRICE O( WORN: y� <br />DE/S�CR�IBE�NVi1NNID5/0U���Ei00TAGdE1 VOIVED <br />J/�c/�ii/.� i?i�s /71"�// <br />r seno1p/q ouseaFeui�oina <br />`C� <br />LEG�I DESCRIP7�ON OF PNd'ERrv �S��OWN BEIOwOI <br />�pT _ OLOCN OF _ <br />YI:LI'a <br />FRONTSETB�LK <br />USE Z(N!E <br />7YPE Of LONSI. AIlOWA9lF <br />SIZE OF Bl0(i. <br />pLGUPMICYL0A0 <br />PEASON FOR SPRINNLEIiS <br />�PPLIG�TION ACC. BV <br />SUBTOTAL 5 <br />—i— <br />P[RMIT 5 � <br />TOTAL FEE $ ' <br />NEFRSETFI�CK SIDESETBRCN <br />LOTAPEA VACANT517E <br />I I YES I: ] IJO <br />TYPEOftONSt.PLIWI occuvuKr xoaow¢uxci <br />f.aWP <br />NO.OFSTORIES OASEMENT <br />I I YES I 1 NO <br />FIRESPRNNLERSPEO'D IiEIGNiIIMITATION <br />I 1 YES I.l NO <br />PlANSAPPPOVEDOY CITYOFEVERETT <br />LOCAL SALES <br />TA% COOE IS 31U5 <br />CONL�Ct PERSON M�0 PNONE NO <br />I HEf;EBY CERTIFY THAT I HAVE READ AND E%AMINED THIS <br />APPLICATION AND KNOW THE SAME ?O BE TRUE AND CORRECT. All <br />PROVISIONS OF lAWS �ND ORDINANCES GOVERNING THIS TVPE OF <br />WORK IVILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE Gf7�NTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITV TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW flEGULATING CONSTRUCTION OR THE <br />PERFORMANCE Of CONSTi7UCTION. THAT 1 AM AUTHORIZED BY THE <br />OWNER Of THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICAiION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 10.27 HCW AND 296200 WAC. <br />SI6NAtlIPEOPCONfR�C10RO��UT110ARED�GENT OATE <br />" 2,�-�-- �� <br />NC—lvHNDLG UNIT: <br />FORCED AIR SVSTEA <br />UNIT NEATERS—B.T.I <br />CLOTHESDRYERS <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />WO00 STOVE <br />METAL FIREPLACE 8 <br />FIREPLACEINSERT <br />HEAT PUMP <br />PUN CHECN NUMBER <br />BUILDING <br />PLUMBING <br />MECHANICFL <br />OTHER <br />STATE BUILOING Sl1RCNARGE <br />S7ATEENEPGVSURCH�RGE <br />ruouc wor�ks <br />TOlAL <br />NO <br />FEE <br />�B.T.U. M E.A. <br />M <br />SUB <br />u <br />�$ <br />flECEIPT NO. <br />FEE <br />—�— <br />i <br />C� U <br />