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APPLICATIOI�.' FOR CONSTRUCTIvN PERMIT <br />fhe Evergreen <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />259•8810 TO BE COMPLETED IN <br />❑ DEMOLITION i COMBINATION : BUILDING <br />Y V 1- { �n Ci-�'. � I���aooA�ss -ri 11 � � �/� �:'1�hY. � <br />pE51GlIER <br />MRIL ADDRESS <br />Vti/ l <br />_`'1L <br />ZIP <br />ZIP <br />PRINT <br />PMONE <br />PHONE <br />everett <br />e <br />PLUMBING SIGN <br />� �— T��� <br />CUSS OF WORK <br />❑ NEW i , ADDITION <br />TEN�NTIMPROVEMENTOR <br />CONTR�CT PqICE OF W081 <br />� PNOPOSEDUSEOFBUILOINCyJ <br />� LEGAL DESCRIPTION Of PPOPE <br />� LOT BIOCK <br />i <br />WATER CLOSET <br />BATHTUB <br />LAVATORY�WAS <br />SHOWER <br />KITCHEN SINK 8 <br />DISHWASHER <br />LAUNDflYTRAY <br />MAIL RODR[55 <br />PHONE <br />LICENSE t <br />:. FEPAIR �. �. DEMOLITION : WOODSTOVE/FRPLINSEflT LJ BUILDINGRELOCATION <br />BELOW OR ATTRCH FOUP GOPIES) <br />OF _ <br />PEP.MIT <br />TOTALF <br />FRONTSETBACK REARSETBACK <br />USEZONE LOTAPEA <br />ivP[OfLONSi.ALlOWABIE lYPEOFLONSi.RCiOPL <br />9RE OF BLDG NOAF STORIES <br />OCCUPANCYIORD FlRESPRNhLER5RE0'D <br />� �. YES '���. NO <br />FC>SON fOR SPRINKLERS <br />APPLICATIONFCG.BV I PL/NS4PPPOV[Il9Y <br />CONIACi PEfi50N ANO FHONE NO. <br />I HEREBY CERTIFY TIiAT I HAVE READ AND E%AMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />f'ROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS NPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIEO HEREIN OR <br />NOT. THE GRAVTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEI THE PROVISIONS OF ANY <br />OTHEfi STATE OR IOCAL LAW REGULATING CONSTRUCTION OR THE <br />P�RFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CON?RACTORS LAW 18.27 RCW AND 296.200 WAC. <br />SIGNATUREOFCONTR/CTORORAUTHOPRE�RGENT ORTE <br />�PPLIC�I SCITYO Si ESSLIC� BUSIN SSNAME ��� <br />ucrueuirei <br />NG—qlnrvuLG Urvl I J—Y1.r. <br />FORCED AIR SYSTEMS—B.T. . <br />UNIT HEATERS—B.T.U. M � <br />� CLOTHES URYERS <br />VENTILATION FAN <br />flANGEHOOD <br />WATER HEATER <br />WOODS.TGVE <br />METAL FIREPLACE 8 CHIMNEY <br />FIREPLACE INSERT <br />� HEAT PUMP <br />GAS PIPING <br />i EXHAUST FAIJ <br />SID[ SETBACK �'L4N CHECK NUMB[F <br />J�JJl/ <br />VACANT SITE FEES <br />� . YES ��. NO BUILDING <br />acuwxcr xoo�owwivcun��s <br />eeouo PWM�ING <br />ons[MEN� ME'HANICFL <br />YES NO <br />H[IGMTUMITATION OTHER <br />_ STATE BUILDIYG SURCHARGE <br />STATE[NEHGVSURCHAPGE <br />CITY OF EVERETT PUBLIC WORKS <br />LOCAL SALES <br />TAX CODE IS 3105 TOTAL <br />SUB TOTAL S jO ' — <br />PERMIT $ /� i ' <br />TOTAL FEE $ /r;� � � <br />FEE FECEIPTNO. <br />