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APPLICATII�! FOR CONSTRUC7�JN PERMIT <br />everett <br />rt�e E�+erpreen � <br />LITY OF <br />everett <br />BUILDING DEPARTMENT <br />259-8810 TO BE COMPLETED IN INK—PLEASE PRINT <br />I 1 DEMOLITION I_1 COMBINATION f�BUILDING I 1h1ECHANICAL (]PLUMBING ❑ SIGN <br />OWN[N N�RADDOE55 CITY 21P PIIONE <br />V�cToR DiAu�uscw 13of� MLDn,.�.� EueteK l8t o i 2S"2 -$'7 9 1 <br />TENANT MAILAD�R[55 ---� CITY ZIP CHONE <br />ARCIIII[CiORDE51GNEfl M�IL�UDflE55 CITY LIP PIIONE '�� 't1.j'� <br />�uq.._ D_�aCC 2010 ?5��5TSe �vs,t�,-tf rji�t•) 3�3-GGre <br />NERNLCONTNAGTOR MAILADORE55 CITY ZIP PHONE LICENSE� <br />� 'eR, . ,vOat� 5�4�w.s. V1CToA A/s3 LZ- <br />MECH/JlIGALCONTRACIOR MRIL�ODNE55 CITV ZIP PNONE LILENSE� <br />PLUMBING <br />Mnn �ooness <br />zm <br />3 <br />LIGENSE � <br />i94Z <br />WORN � <br />17 ADDITION I l ALTL�RATION I 1 REPAIR f 1 DEMOLITION I I WOODSTOVE/FRPL INSERT ❑ BUILDING RELOCATION <br />TEN�NT IMPROVEMENT ON INTERIOR REIAODEL ONLY <br />oescRioe <br />raoroseo <br />LEGAIDES IPTIONOFPFori <br />i IOi BIOCK <br />.9�14 �1 i�y <br />ouow on �nnc�� <br />DRESS . <br />��i" n� � C �I� <br />iIN6 <br />TYPE OF FI%TURE OR ITI <br />JJATER CIOSET (TOILET) <br />BdTHTUB <br />LAVATORY�WASH BASM) <br />SHOWER <br />KITCIIEN SINK 8 DISP <br />DISHWASHER <br />LAUNDRYTFAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR ORAIN _ <br />BACKFLOW PfiEVENTERS <br />ROOF DRAINS—RAINLEADERS <br />SINK 1SEHVICE—BAR, ETC.) <br />IROIIi SLTOACH <br />_�� <br />IYPL N CON57 PI I O,W/ApI [ <br />�'�'1 <br />sizr oF t�� nc <br />ZL� <br />RE�R SElOACK <br />20' <br />I OT /JIGA <br />�— <br />lYPlO( f01l51. ALIIIAI <br />al. "�'i <br />NO Of 570111L5 <br />DCCIMAI�C�'{OAD FlpE SP1iNY.LEBS RE00 <br />� � I l YES �PNO <br />ne�sorvror+srni�uK�ens ' <br />APPIICAl101IALC.OV I PL�NSAPPRCVGDOY <br />S.P. �3�8�9 <br />FEE <br />j,�ri((� COIlIACTPE SONANDPHONE <br />Z �i c�i� .' f <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAtAINEO THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORHECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERN;!JC THIS TYPE OF <br />WORK WILL BE COMPLETED WITIi WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTfiORITY TO VIOLATE OR CANCEL THE PR(1VISIONS OF ANV <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />UWNcfl OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATiON IS MADE AND I COMPLY WITI. THE STATE <br />CONTRACTOFS LAW 18.27 RCW AND 296200 WAC. <br />SIGNRTIIfif.OFCONTRACiORORAUT110RIZE��GENT D�TE <br />X lC�.�.C-r- .V` Gts��C� - / �- /�1-�`% <br />RPPLICANTS CITV OI15ME55 LICENSE NO. AND BUSINE55 NAME <br />AIC—AMNDLG <br />FORCED AIF S <br />u�er�a:Fy <br />�' 7j RANGE HOOD <br />WATER HEATER <br />WOOD STOVE <br />' METAL FIREPLACE 8 CHIMNEY <br />FIREPLAC[ INSENT <br />HEAT PUA1P <br />$ � �' � � <br />SIDE56111RC�H � PIANCII�CKNUMfIGR <br />VACANT SI1F. <br />I I YES I I NO <br />OCLIII?NCY NOfNUW1111XG1 <br />WIpIP <br />Ons�— i� <br />I I YES t�GT10 <br />H[IGNT LIIAITAIION <br />w�♦ <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX COOE IS 3105 <br />� FEES <br />�111LUING <br />PLUMUING <br />MEGI IANICAL <br />OTHER <br />STATE BUILDING SURCHARGE <br />STAIEENGRGVSURCHARUE <br />PUOLIC WORKS <br />TO1AL <br />M E.A. <br />SUBTOTAL <br />TOTALFEE 8 <br />ree necnvTno. <br />3 98'Z 2� <br />� / C� <br />ret <br />