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APPLICATI0.4 FOR CONSTRUCT►JN PERMIT <br />TO BE COMPLETED IN INK —PLEASE PRINT <br />Flla Everpmwi <br />CITY OF <br />everett I HEATING SYSTEM: GAS ❑ELECTRIC ❑ <br />BUILDING DEPARTMENT <br />259-8810 PLU RING SIGN <br />DEMOLITION COMBINATION BUILDING MECHANICAL <br />_ PHONE �y <br />OKI �'\•1J1 �ilZIP PRI <br />G11MA1L A�� \I CITY <br />'J`'� l-1 �•i `�c�Ci �f� <br />We J <br />MAIL <br />CRY <br />ENE ACTOR VALLEYAANATIIRAL GAS, INC. �L I Cj ' n I <br />259:5492 — 355Jnn _ T42 cTv ZIP PIroNE LICENSE A <br />MECNANILAL CONTRACTOR 28b9°ff68ugaII <br />Evs2t Waalilnelnn eGf l CITY ZIF PHONE IICENSEA <br />PLUMBING CON TRACTOR MAIL ADOPESS <br />SS OF WORK <br />NEW ADDITION ALTE ATION REPAIR <br />0 <br />LEGAL DESCRIPTION OF PROILRII 1N"--- <br />LOT BLOCK OF <br />IOhCT ADDRESSL- (7/'-I vI V u (\ <br />ITEM <br />DEMOLITION WOODSTOVEIFRPL INSERT BUILDING RELOCATION <br />CONTACT PERSON AND PHONE NO <br />I HEREBY CERTIFY THAT HAVE READ 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 />NOT THE GRANTING OF A PERMK WILL BE COMPLETED WITH IT DOES SPECIFIEDHETHER <br />DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF ISPROPERTY <br />WHICH <br />APPLICATIONIS MADE ANC PI RH O <br />COMPLYWITH KR THE STATE <br />CONTRACTORS LAW 16.27 RCW A -D 296.200 WAC. <br />SIGNATUREOFCONTRACTORORAUTHORM 'AGENT DATE <br />X/�I U N k�'� • ad��� <br />APPLIOANTSCRY BUSINESS LICENSE NO AND BUSINESSNAME <br />NO. I TYPE OF <br />METAL <br />TOTAL <br />FOR OFFICE USE ONLY: <br />FRONTSETBACN REAR! <br />ZONE <br />LOT AREA <br />VACANT SITE <br />FEES <br />BUILDING <br />OF CONTS ALLOWABLE <br />TYPE OF CDNST ACTUAL <br />OR IM a avLunrt WiIS <br />PLUMBING <br />MECHANICAL <br />DPDLDG <br />NO OF STORIES <br />BASEMENT <br />ADDITIONAL PLAN CHECK <br />:UPANCY LOAD FIRE SPRNKLERS REDID HEIGHT LIMITATION <br />OTHER <br />STATE BUILDING SURCHARGE <br />SON FOR SPRINKLERS <br />PUBLIC WORKS <br />AKE BY PIAN$APPROVED—By <br />CITYOFEVERETT <br />LOCAL SALES <br />TAX C00� IS 3105 <br />TOTAL <br />D <br />c <br />