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.-. , <br />APPLICATIt.� FOR CONSTRUCT�JN PERMIT <br />everett <br />(IM E�Frq: PPp <br />��� Y �F � <br />everett <br />BUILDING DEPARTMENT <br />259-8610 TO BE COMPLETED IN INK—PLEASE PRINT <br />DEMOUTION COMBINATION BUILDING MECHANICAL PLUMBING SIGN <br />OWNEfi MAIL�D�RE55 CI1V � 11� PIIONE <br />l,�,i�, �-�.neS- SoIL. 5•=�-+ L., fvc��H- 9Y7�3 �S'J-.z /5'C: _ <br />1[NANt MAILAODR[SS GLV ZIP PMONf <br />��IM` <br />�RCHITELi OR pESIGNEN <br />CIiY ZIP PNON@ <br />G[NER�LCONTR�LTOR MMLRDDRESS CITV 21P PNONF LILENSEr <br />�.:;1�1e.� �<.Ie ���u1n�.civ�n �2S /aS��' S�i sr 9b'1�ob' 3`JY-'i`/)7 Ci��LDL"E�1�IpF <br />MECNANIG�1l CONTRRCTO MAR AUDRESS CITY ZIP f'NON[ IIGENSE � <br />PLUIdBINGCONTR�GTOR MRIIR�DNE55 <br />l�ero� f <br />CL�SSOF WOHN <br />�. NEW �. ADDITION AITERATION <br />TEN�NT iMPROVEAIENT OR iNTEARqR NEMODEL ONLV <br />'^VTR�CT PRICE OF WORK: !1 � �D O <br />DESCPIBE WORe AND SWpRE FOOT�G[ INVOIVC� <br />� �� S� � ^�t7'� <br />PNOPOSEDUSE BOILOrNG <br />lE WL DESCRIPTqN OF PROP[ <br />lOT _ BIOCK <br />PN0.IEGT <br />OF <br />FlXTURE OH ITEM <br />8 DISP <br />WASHER <br />ING FOUNTAIN <br />i ORAIN <br />=LOW PREVENTERS <br />DRAINS--RAINLEADERS <br />FPONiSETBRLN <br />USEZONE <br />TYPE Of CON51 FILOr�ABLf <br />SIZE OF BLIX'i <br />OGCUPANGYLOAD <br />RE�SON FOR SPRINKI[RS <br />APPIILAT10NRGG BY <br />CITY ZIP <br />f1EPAIR DEMOLITION <br />LOUR COPIE51 <br />FEE <br />SIIB TOTAL S � _ <br />PERMIT $ � <br />TOTAL FEE 5 <br />REARSETBACH SID[SEiBACN <br />LOT AREA VACANT SITE <br />YES ' ND <br />rvVEOlCONSiAC711A1 oc[unv � xomowluixr,ur.�5 <br />cAr.ur <br />NO.OFSTORIES <br />FlRE SPPNNLEFS REO'D <br />' YES NO <br />BAS[MENT <br />VES NO <br />NEIGHT UMITATION <br />PLANSAPPROVED3V CITYOFEVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />P11011E IIGENSE � <br />WOODSTOV6FRPL INSERT ��_ ] BUILDING RELOCATION <br />CON:AGT P[RSON AND PMONE NO <br />� 1�4� M�v <..� 3 `16'_ `/�l <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINEO THIS i <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF �, <br />WORK WILL BE COMPLETED WITH WHETHEF SPECIFIED HEREIN OR �� <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE I <br />AUTHORITY TO VIOLATE OH CANCEL THE PROVISIONS OF ANV ! <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION 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 LAW 1827 RCW AND 296200 WAC. I, <br />SIGNATUR60FCONTRRCiOROPAUTHORREDAGENT DATE 'I <br />X / r.�'� /C ��IC�/ J /� _ I <br />APPLIC�NTS CITV BUSiNE55lIGENSE N NU BUSINE55 N�ME <br />dR SVSTEMS—B.T.U. M <br />'ERS—d.T.U. M <br />DRYERS <br />ON FAN <br />WATER HEATER <br />WOUD STOVE <br />METAL FIREPLACF 8 <br />FIREPLACEINSERT <br />HEAT PUMP <br />G/:S PIPING <br />EKHAUSTFAN <br />PLAN CHECN NUMIlER <br />FEES <br />BUILDING <br />PIUM�ING <br />MECHANICAL <br />OTHER <br />STA7E BUIIDING SUflCNARGE <br />STATEENERGVSURCHARGE <br />PUBLIC V:ORKS <br />TOTAL <br />F[E <br />FEE <br />� <br />a <br />S <br />fl[CEIPi NO. <br />y �S� <br />T <br />� <br />i <br />�� <br />� � � S7� <br />