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APPLICATI�.N FOR CONSTRUC� �ON PERMIT <br />�n� E�,a,aa� <br />CITV OF <br />everett <br />BUILDING DEPARTMENT TO BE COMPLETED IN INK—PLEASE PRINT <br />259•8810 <br />I I DEMOUTION I I COMBINATiON i i BUILDING_ i I MECHANICAL <br />O,yrytq MRII.��DP[SS ---- CILY 1 IIP/ �� PIIONE <br />. 1 . • � _ / . l��7.\ O . .. L / i . _ i//' !'. LN. YY i, <br />Crtv Zm <br />VPLUMBING <br />everett <br />e <br />i i SIGN <br />�RGNITEGTORDESIGNER IAAIL�ODRE55 GTY IIP PMONE <br />GENERRIGONTP�GTOfl M�II��DNE55 CITV ZIP PIIOflE LILENSEI <br />MECN�NIC�LCONTR�CIOR IAFIIADDRE55 LITY 21P PIION[ LICENSEY <br />PlUA1BINGCONTR�CTOR MAILAOORE55 CIIY IIP P110HE �.��ENSE� <br />a��z D/ � � 'ac /•i % .1; �� L. '�___! Lv1L i " b' ••Ls � ��Ji%Zl�. - / t 7 /i i� <br />� <br />cuss oF� <br />1�'iNEW I I ADDITION I i ALTERATION i' REPAIR I � OEMOLITION I� WOODSTOVEiFRPLINSERT I I BWLDINGRELOCATION <br />TEN�NT IMPflOVEMENT OH INlteron ntmwu �m. <br />CqITRACi PRICE OF WOHK: <br />DESLRIB WORN AND SOUApE FWiPG[ INVdVED <br />� ' _---__ _ ___ '_____ <br />PROPOSEO E OF BUILDIN <br />�/. /G��t - <br />lEWl0E5GR1 TION OF PROPERTV ISHOWN BE/OW OR ATT�UI FOIIR COPIES� <br />101 ULOGK --__" nf .. _..____. _ _... — . __ . — <br />�ODRESS <br />SINK <br />CLOTHES <br />URINAL <br />SINK <br />b7:1 <br />FEE <br />� <br />� <br />� <br />=�:— <br />.�U i _ <br />T <br />�a✓ ' _ <br />--i— <br />1 ,. � <br />LOH7ACI PERSOtI RNJ PIIONE 1!O <br />I kiEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICA110N AND KNOW THE SAME TO BE TRUE AND CORHECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WOFK WILL BE COMPLETED WITH WHETNER SPECIFIED HEREIN OR <br />NOT. 11iE GfiANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AU7HONITY TO VIOLATE OR GANCEL THE PROVISIONS OF ANY <br />OTNGfi STATE OR I.00AL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER Of THIS PROPEFTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 1827 RCW AND 296200 W4C. <br />SIG1111UNCOPCONiR�C10NON�IIIMORIZEDAGEN7 O�TE <br />X � %� / - /7' 9`> - <br />� � <br />�_o_� � �.L� �� <br />APPI ICAN15: IY OUSiNE55 LICENSE NO AND BUSME55 NI.ME <br />FORCED AIR SYSTEMS—B.T.U. <br />UNIT HEATERS—B.T.U. M <br />CLOTHES DRYERS <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HENTER <br />WOOf. STOVE <br />METAL FIREPLACE 8 CHIMNEY <br />FIREPLACEINSERT <br />HEAT PUMP <br />FAN <br />_._...I _. __ . ; 'I__'__.I _—___ ' " <br />SUB TOTAI. <br />PERMIT <br />FNONTSETB�CN I RERPSETBACN I SIOESEiBACK <br />lISE ZONE I LOT �REA <br />7YPEOfCONSi.AILOW�BIE I iYPfOfCON57.RC7UAl <br />SRE OF BLOG. <br />OCCUPRNCYIOAD <br />f1EA50N FON SPRINKLERS <br />APPUCRTION ACC. BY <br />N0. OF STORIES <br />FIRE SPRNKlENS REO'D <br />I I YES I I NO <br />i•LO NS APPRnVEO OY <br />PIAt�CHECNNUTAtlER � FE[ <br />VACANT SITE FEES <br />I i YES I I NO BuiIDiNG <br />occuvrxcr xoorownnx�uru�s <br />cnour pWMBING _ <br />BnSEMENi MECIIANICAL <br />I I YES I I NO — <br />IIEIGI{iIIM17FT10N OTIIEIi <br />S1A7'E BUILOING SURCHARGE <br />STA7 E ENERGV SIIfiCliAliG[ <br />CITY OF EVERETT PUt3UC WORKS <br />LOCAL SALES <br />TSY COIIF IS A105 TOTRL <br />SUB TO <br />PERMIT <br />E.A. <br />—�— <br />— —�— <br />_ � <br />_.�— <br />$ � I <br />$ i <br />�— <br />$ � <br />fiECEIPTNO. � <br />FEE <br />�—� <br />O ' <br />/ � ; _" <br />--T' <br />��i <br />i <br />i <br />i <br />—i— <br />i <br />� <br />� <br />�T- <br />aa � ? — <br />�� <br />