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pPPLICATION FOR CONSTRUCTIvN PERMIT everett <br />TO BE COMPLETED IN INK—PLEASE PRINT � <br />Me Everg�een <br />CITV OF <br />everett HEATING SYSTEM: �GAS ❑ ELECTRIC ❑ <br />BUILDING DEPARTMENT <br />259•8810 <br />DEMOLITION COMBINATION BUILDING MECHANICAL PLUMBING SIGN <br />Q�ER MFILADDRE55 ��tt 21P PHONE <br />�ou�ts�w (�. T�s� �tsi� w vi�n� Ev�zetr,wA 9�a43 asa.-5�7 <br />TEHRNT <br />MAILADORESS CITY ZIP PHONE <br />n 11 CITV ZIP FMONE <br />pRGHIiEGTORDESIGNER MRILADDFESS <br />G[NERALCONTRRCTOR MAIIADDFESS <br />CITY ZIP �HONE LICENSE � <br />C t�A1 � <br />.y�"• PHONE lIC[NSE� <br />MELNRNICRIGONTRAGTON MRILRDORESS <br />CITY ziP <br />M�IL pODPE55 <br />��T, Z�p PHONE LICENSE� <br />GUSSOF WORN . <br />; I NEW %C ADDITION �. ALTERATION .�� REPAP� ��. DEMOLITION .�. WOODSTOVElFRPL INSERT � I BUILDING RELOC <br />� � CONTAGT PERSON AYD PNON[ N0. <br />--..__._.��,����w�o. ,����-.., �, 3ra .�K .7r�sr�+ as2--��7 <br />DESCRIBE WORN ANO SOURRE F W TAGE <br />(t00 ONT� NPi�`-� ' <br />PPOPOSED USE OF BUILDING <br />LEGRL DESGR�FTION OF PROPEflTV <br />LOT�� BIOCN _ <br />v�.� A�k <br />WATER CLOSE7 (iUi� <br />BATHTUB <br />LAVATORY(WASH BA: <br />SHOWER <br />KITCHEN SINK & DISP <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRItJKING FOUNTAIN <br />BELOW OR <br />OF _ <br />FOR OFFICC USE ONLY: <br />FPONTSETBRCK REARSET9�CK <br />Z, Zo <br />USEZONE LOTAREA <br />�<-1 Z �g �zs <br />tYPEOiCONiS.ALLOWABIE iVPEOiLGNST ACiU�I <br />'ff-N Sf-nr <br />SIZE OF BLOG NOAF STORIES <br />DCCUPANLV LOAO FIRE <br />REASON OF SPRINNlERS <br />INTArcE BY P�A� <br />REOU <br />FOUR COPIES� <br />� <br />FEE <br />$ <br />$ <br />SIDE <br />..,..NG , <br />p([poU;(Y NOIXUNR�IN4UMI15 <br />upio <br />-3 ( <br />ND I �• <br />ISAPPROVEDBV CITY OF EVEREIT <br />J�} LOCAL SRLES <br />1� ��24�9'L TAX CODE IS 3105 <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND OFDiNANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH VJHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PF.RMIT 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 AUTNORIZED BV THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />('rJNTRACTORS LAW 1827 RCW AND 296.200 WAC. <br />S�GNATUREOFCONTRRCTOROR UTHONIZEDPGENT DRTE <br />a I a -�o -9i <br />RP CANTS CITV BUSINE55 U ENSE NO. FND BUSME55 NRME <br />OF <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />UNIT HEATERS—B.T.U. M <br />FAN <br />FAN <br />SUBTOTAL $ <br />PERMIT S <br />TOTALFEE $ <br />;NECK NUMBER <br />5-�fL <br />BUILDING <br />PLUM91NG <br />MECHANIGAL <br />ADDITIONAL PLAN GHECK <br />OTHER <br />STATE BUILDING SURCHARGE <br />PUBUC WORKS <br />TOTAL <br />FEE <br />� `r 3 t` <br />--r— <br />� <br />� <br />