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APPLICATIGA FOR CONSTRUC7.JN PERMIT <br />Inn EESTpl,—" <br />CITY Or <br />everett <br />BUILDING DEPARTMENT TO BE COMPLETED IN INK —PLEASE <br />PRINT <br />259-8810 <br />DEMOLITION 1 I COMBINATION <br />BUILDING <br />1 PLUMBING <br />_MECHANICAL _ <br />�nnnfesF*-Awr�/'o'. <br />�M�Q!17 <br />cencr�=f./11�� <br />`2E1OZ <br />ONP �� <br />,nJi/i�it.'% 5 -- <br />vnNt <br />' /dCADM1KS MAIL ADDRESS <br />• <br />cn4 <br />7�l'B�i%r <br />` <br />L7L • t='f <br />PHONE <br />SS <br />ARUITLCI OR DESIGNER M I DRREE/.- <br />CITY <br />soww <br />71P <br />Q1 <br />�� A ♦7%%� <br />y <br />�A/ <br />bv <� W;4 ' 7 m <br />!Is <br />PITONS LICENSE E <br />GENERAL ONiRACIOR MAI1 ADDnr SS <br />CITY �y <br />�Nw� <br />LIP <br />4 <br />MECHANICAL CONinACT IT MAR ADDRESS <br />CiTY <br />Zlp <br />PHONE LICENSE IT <br />PIUMBMG CONIRACToII MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE LICENSE A <br />CLASS L1f WORN <br />I MmADDITION �ALTERATION I I REPAIR I I DEMOLITION I WOODSTOVE/FRPL INSERT BUILDING RELOCATION <br />w i _ <br />TENANT IMPROVEMENT OD mtngn <br />7ESCTIME WORN AND SCUAHE <br />PROPOSED USE Or SUII.OIHO <br />LEGAL DESCRIPTION OF PROPS <br />LOT____ SIOCK <br />PROJECT ADDRESS <br />DRAIN <br />OOD <br />INVOLVED <br />OFl.s'%. Or- rJ �. <br />V ISHONN BELOW OR ATTACH FOUR COPIFS <br />of <br />BASIN) <br />DISP <br />FRONT SETBACK <br />REARSETBBAA�CK <br />USE <br />LOT AILf � <br />N <br />PIPE OF CONS? ALI OWABH <br />' L <br />IIVVTT��FF 01 CONSI A <br />517E OF BLDG <br />0' TOWE <br />�NO <br />OCCUPANCY <br />TITIESLE <br />\IS <br />I YES <br />REAsa+ rOR spnINKLERs <br />CONTICI <br />N!'•ypN/�oZ7 <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO DE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORM. WILL BE COMPLETFO WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT 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. 1 HAT 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 />CONTRACTORS LAW IS 27 RCW AND 296.200 WAC. <br />SIGNATUREOFCONIRACIOn ORAUIIIDRI7EDAGENT DATE <br />APPLICANTS CITY BUSHES ENO AND BUSINESS NAME <br />FORCED AIR SYSTEMS-B.TU. M <br />- <br />�— <br />UNIT HEATERS-B.T.U. M _ <br />CLOTHES DRYERS <br />- <br />- <br />VENTILATION FAN _ <br />RANGE HOOD_ _ <br />-"----- <br />WATERHEATER _ <br />- <br />------' <br />WOOD STOVE <br />'- <br />---- <br />METAL FIREPLACE B CHIMNEY <br />"- <br />— --1__- <br />FIREPLACE INSERT <br />- <br />—�-- "- <br />-- - <br />HEAT PUMP <br />- <br />---I <br />GAS PIPING <br />EXHAUST FAN <br />SIDE SETBACK <br />VACANT SITE <br />1 YES 4-1NO <br />nmmA4Lr xo RMyirw <br />BASEME <br />YES I I NO <br />S BEOD HEIGHT LIVITA71014 <br />I I NO <br />APPLICATION ACF BY PLANS APPROVED BY <br />�1 <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />BUILDING <br />PLUMBING <br />MECHANICAL <br />OTHER <br />STATE BUILDING SURCHARGE <br />STATE ENERGY SURCHARGE <br />PURLIC WORKS <br />TOTAL <br />