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.-. <br />.-, <br />APPLICATION FOR CONSTRUC7.ON :;'ERMIT <br />�n� E��ro«•���� everett <br />��r� oF e <br />everett <br />BUILDING DEPARTMENT <br />259-8810 TO BE COMPLETED IN INK—PLEASE PRINT <br />DEMOLITION COMBINATION �ILDiNG MECH.4NICAL PLUMBING SIGN <br />awr�en / % un��nooncss arv zm / r�wNc �+ <br />Sc�iPrUac h�-n5'f. /S�'i.T G�` J^2 AL� /U�� �=c�cGl ��a. 9�"��1.,2 C� S�-J��%6 <br />TEN�NT AIAIIA�ORESS GiV ZIP PI/ON[ <br />ARCHIIECTORUE5IGNER MMIADOR[SS CITY ZiP PHON[ <br />�': Me �S:�ni 'S ��`ru2� /G^`)'� ST $�✓ T'aC'c�m y �^ � 9�1�y � S��/ —�7 3��% <br />GENEF�LCONiqRGTOR I.I�ADDR[55 CITY ZIP PHONE UGBNSE��G 0/'� ���� <br />� <br />�(��1, �'o„5t. �soa� ����� �,,,� �v;. ST��.,�,�c�.,. 9�a9a �-s�- 5876 <br />MECNANIL�LCONIRR�TOR MAILA��RC55 piY 21P PNON[ IICENSE• <br />PWMBING GONTR�LTOA <br />�d0� WORN <br />NEW � � ADDITION <br />M 4iL ADORBSS <br />ALTERATION . . RFPAIR <br />dTY 21P <br />DEMOLITION <br />IICENSE I <br />WOODSTOV6FRPL INSERT ! _1 BUILDING RELOCATION <br />TENANT IMPROVEMENT ON INTERIOq ^EMOD[L ONLY I cON1ACT PERSON �ND PNONE NO <br />GONTR�C7 PRICE OF WORK: I <br />I(�..,P !_JCr_� <br />DESCRIBE YIORN �ND SOW RE FOOtAGE INVOIVED <br />11P4/ 1'�"'ti!_�t�if.�� /aAX �!-/I!/ <br />PROPOSFD USE OF BUILDING � J <br />IEGAL DESCRIPTION OF P�IOPERTV (SNOWN BEIOW OB ATfRCH FOUp C/OPIE51 <br />L0T�9,�v BIOCN 3ss OF ST �iGhrf IVS <br />VROJECT/�DDPESS <br />FRONT IETBACK <br />Z!� <br />Z <br />USE ZONE <br />iVl': J�I OWRBLE <br />v� <br />SIZE OF BLOG <br />��b c.� <br />OCGIIPANC LOnD <br />RCA50N OR SPRINKI[RS <br />qPPUCATION RCG BY <br />RE�R 5[1�ACK <br />Lo <br />LOTAREA <br />�� Zd�� . <br />ttPE Of LOH51. AGIUPI <br />w,v <br />NO.OF STGF:j�S <br />�: <br />FIRE SFliNhLGRS REO'D <br />VES K NO <br />PIFI.� RPPROVE� BY <br />� <br />�$ <br />SIU[ SETBACN <br />_. <br />VFCANi SITE <br />VES NO <br />octur�wa Nocrmvw�NGUYn: <br />BASEMENT <br />' YES } <br />NEIGHTIIMIT�iION <br />� .'� <br />I HEREBY CEIiTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TVPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPI�.^,IFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIi DOES NUT rRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANV <br />OTHER STATE OF LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPEHTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br />SIGNATURE�F� TRACTOqOq�UTHORIZE pGENi Dl�iE 3-ao-qa <br />/7 / <br />X��� ��% G % <br />�/��s �No�c�`1 �C)/t5� <br />�PPLiC�NTS CITV bU51NE55 �ICENSE NO. I.ND �Il51NE55 N�ME <br />TYPE OF EOUIPMENT <br />NC—NHNDLG UN�TS—H.P. <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />UNIT HEATERS—B.T.U. M <br />CLOTHES DRYERS <br />VENTILAT�ON FAN <br />RANGEHOOD <br />WATER HEATER <br />WOOD STOVE <br />METAL FIRE?LACE 8 CHIMNEY <br />F�REPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN <br />SUBTOTAL $ <br />PERMIT S <br />TOTAL FEE S ' <br />PI�NCHLCKNl1MBER FEE RECEIPTNO. <br />� 5� ,t)�C <br />FEES VALUATION FEE <br />—� <br />BUIL�ING ` � � <br />PLUMBING _ N`� { <br />�, <br />, <br />MECHANICAL <br />OTHER <br />�STATE BUILDING SURCHAFGE <br />STATEENEf:GYSURCHARGE i <br />CITY OF EVERETT .ruoucwoaKs <br />LOCAL SALES <br />TAX CODE IS 3105 rorn� <br />