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APPLICATItiN FOR CONSTRUCI iON PERMIT <br />r� E��v�� <br />LITV OF <br />everett <br />BUILDING DEPARTMENT <br />zss•ee�o <br />❑ DEMOLITION ,K <br />M�R <br />M�IL <br />TO BE COMPLETED IN INK—PLEASE PRINT <br />COMBINATION G BUILDING C MECHANICAL <br />everett <br />e <br />❑ PLUMBING D SIGN <br />�'iENERQCONTR�GTOR M�ILADDPE55 GITY ZIP PHONE UCENSE• <br />M�IL <br />Gf'" t� 7�� <br />1000N7R�GTOR MMLADDRE55 <br />= In <br />� EB�. f g. <br />PHONE <br />CLAS`u OF MM17RK <br />❑ NEW ❑ A�DITION O AITERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE�FRPL INSERT ❑ BUILDING REIOCATION <br />✓TEIUNiMPPOVEMENTORIMERqRREMODELONLY ��^SO �� <br />� �p1Tp�CT PR�LE OF WJRR: v� <br />� pE$�p16E NKNiK Np10 SOU�RE FOOT�GE �N%Y ED � <br />�Li/���l -1 r� �IIL� //�p <br />� V (, <br />IEWL DESCRIPTION <br />l0T_ <br />��. <br />�aK <br />:AUNDRVTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOFi DRAIN <br />BACKFLOW PREVEN' <br />ROOF DRAINS—RAIN <br />SINK (SERVICE—BAP <br />FRONT SETB�CN <br />BELOW OR <br />� — <br />REARSETB�CN <br />LOTAREA <br />6llOWABIE I TYCEOFCONSi.ACID�I <br />SQE OF BLDG. <br />OCCUPNJCYt0�0 <br />REASON FOP SPRINKLERS <br />APPUCATIqJAGG.BY <br />NO.OFSTORIES <br />FIRE SPRNKLEflS FEOD <br />❑ YES ❑ NO <br />PLANSAPPROJ BY <br />GOPIES) <br />5 <br />FEE S I <br />SIDE SETBAGK <br />VAGANT SITE ��^ <br />❑ YES �NO <br />acuo�rtr xomowtwxcuxrts <br />BASEMENT <br />❑ YES ❑ NO <br />NEIGIIT LIMITATION <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />CONT�CT VERSON AND PHONE NO. <br />I HEREBY CERTIFY THAT I HAVE READ AND ExAMINtu �nis <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNINCa THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PEFMIT DOES NOT PRESUME TO QIVE <br />AUTHORITY TO V�OLATE OR CANCEL THE PROVISIONS OF ANV <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PEFFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERtt TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE 3TATE <br />CONTRACTORS LAW 1827 RCW AND 296.200 WAC. <br />SIGN�NREOFCONTH�CTOROR�UTHORIZED�GENT ��TE <br />'�M,�i''�--- 12-i�-sy <br />APPLICANT I USINESSIICENSENO.ANDBU5INESSNAME <br />NO. TVPEOFEOUIPMENT <br />N�A/HNDLG UNITS—H.P. <br />FORCEO AIR SYSTEMS—B.T.U. M <br />L1NIT HEATERS—B.T.U. M <br />FAN <br />GAS <br />BUIL�IIIG . <br />PLUMBING <br />MECHANICAL <br />OTHER <br />STATE BUILDING SURCHARGE <br />STATEENERGYSURCHARGE <br />PUBLIC WORKS <br />TOTAL <br />& CHIMNEY <br />� <br />