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� � <br />APPLICATIt�A FOR CONSTRUCTrON PERMIT <br />� E�� everett <br />��r� e <br />evQrett <br />BUIIDING DEPARTMENT <br />259-8810 TO BE COMPLETED IN INK—PLEASE PRINT <br />❑ DEMOLITION u COMBINATION �! BUILDING fCMECHANICAL : PLUMBING ❑ SIGN <br />_ pWNER M�IL �CORE55 CITY 21P PHOHE <br />X �Y�RY Q��e,v,v7 ,(�ny' �N��n.�zr� �v.e7 G✓n �6'ao3 sss-o�Yl <br />7EIUN7 IMILMp1E55 CITY DP PHONE <br />MiCXITECTOIiDESIGNER MAtLADORE55 CITV ZIP PHONE <br />GENERAICONTRACTOR M11LMDi1E55 CITV 21P PHONE UCENSEII <br />/AECNMIILALCONTMCTOR MRILADDRE55 Q�x^ CITY ZIP PHONE LIGENSEI <br />�C ,, '�r�sn�--�-,� _ _ ` ��;-��— <br />PLUMBIN(3CONTRAGTOfl MAIL117DRE55 CITV ZIP PHONE LICEN9E� <br />�NEW ❑ ADDITION ❑ AITERATION ❑ REPAIR I. I DEMOLITION I� V/OODSTOVE/FRPL INSERT ❑ BUILDING RELOCATION <br />TEIUM IMPROVEIAENT OR �NTERIOfl REMMEL O/]NIY CONT�CT PEFSON. W D PHONE NO. <br />CONiRIICTPRICEOFWORK: O� � <br />/pESCpIBE WOAN AND SOyU�J�pE FOOTAOE INVOLVED <br />7� . �/���/ `_ .� <br />IEML DESCRIPTION OF PROPI <br />LOi BLOCK <br />�OORESS <br />WATER <br />UUNDRV 7R� <br />CLOTHES WA: <br />URINAL <br />DFINKING FOI <br />FLOOR DFAIN <br />BACKFLOW PI <br />FRONTSEiBACK <br />USE ZONE <br />iYPEOfCONST.ALlOWABLE <br />SIZE OF BLDO. <br />OCCUPANCY lMD <br />REASON FOfISPRINNLERS <br />APPLICATION ACC. BY <br />1 HEREBY CERTIFY THAT I HAVE READ AND E%AMINED THIS <br />���a�f APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />BELOW OR �TTACN Fq1R fAPIES� PROVISIONS OF UWS AND ORDINANCES GOVERNING THIS TVPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />_ oF NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHOHITY TO VIOLATE OR CANCEL THE PROVi310NS OF ANY <br />OTHER STATE OR LOCAL U1W REGUUTING CONSTAUCTION OR THE <br />PERFORMANCE 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 />CONTRACTORS UW 1827 RCW AND 296200 WAC. <br />SIGNATUREOFCONTR�CTOROHAUTHORIZEO�GENT DATE <br />X Q�.tv �C�� .z-fl- iD <br />. �� APPL NTSCI USINESSIICENSENO.NIUBU51NE55NM1E <br />REAHSETBACK <br />LOT AREA <br />1VPE OF CONST. ACiVAL <br />NO.OF STOFIES <br />FIRE SPPNKLEPS REO9 <br />❑ VES C NO <br />PUNS APPROVED BY <br />S ; <br />E ' <br />SIDE SETBACK <br />VACANT $ITE <br />�� N� <br />FORCED AIR SYSTEMS-B.tU. M <br />UNIT HEATERS-B.T.U. M <br />CLOTHES DRVERS <br />WATER <br />WOOD <br />8 <br />HEAT <br />GASI <br />SUB TOTAL S <br />PERMIT E ... <br />TOTAL FEE $ <br />PV�NCHECKNUMBER FEE NECEIPTNO. <br />❑ YES BUILDING . <br />oxur��r xaaorrtwxcm+ns <br />eaa? pLUMBING <br />BASEMENT MECHANICAL <br />❑ YES �! NO <br />HEIGMTLIMITATION OTHER <br />STATE BUIL�ING SURCHARGE <br />STATEENERGVSURCY.RRGE <br />CITY OF EYEflEiT PUBLIC WORKS <br />LOCAL SALES <br />TAX CODE IS 3105 �TAL <br />