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APPLICATIVN FOR CC�I�STRUC7'�N PERII�IT <br />Ne Evergreen <br />CI7Y OF <br />everett <br />BUILDING DEFARTMENT <br />259-8810 TO BE COMPLETED IN INK—PLEASE PRINT <br />DEMOLITION COMBINATION ��LDING MECHANICAL <br />AP.rqi1 EGT OR OESIGNER <br />MECHANICALCONTRAGTOP <br />MAILA�DRESS CITV ZIP n PNONE <br />� isvaE��s ���.,i.� �,-r..,�o� c.�,.- <br />MAILp�DRE55 CI7V ZIP PHONE <br />MAILADDFESS Cltt ZIP PHONE <br />��n n- �/`�1�2�' iCJ9'�- STSc./ a�cinw G/� �" <br />qILRO 55 CIN 21P PHONE <br />r%" /�O.�C i9'r� i��E /Vc/ /onc..c�Ti�� G� <br />MAILAUDRE55 Cltt ZIP PHON[ <br />MAI� ADORE55 GTY 2iP PHONE <br />CL OFWOfiK <br />� NEW i_I ADDITION .. � ALTERATION ... REPAIR <br />TENANiIMPROVEMENTORMTERIORPEMODELONLY � Uy� <br />CONTPAGTPRICEOFWORK: ��9 nl R <br />DESCRIBE WORK AND SOVAR)E FOOT�GE INVOLVED <br />NP ✓ nr�5 �rn I',-o � Fny� <br />PROPOSED USE OF BUILOING <br />< _ / . �.._.. � /.. <br />� <br />LEGAL D CRIPTION OF PROP RTY ISNOWN 9fLOW OR �iTPCN FOUR GOPI[5) <br />� LOT�, 3a 9tOGK ��� oF 5� ✓1��e�0/4 <br />NO. TYPE OI <br />WATERCLOSET <br />BATHTUB <br />�_ LAVATJRY(WA; <br />SHOWER <br />KITCHEN SINK f <br />DISHWASHER <br />LAUNDR�iRAY <br />.^.LOTHES WASF <br />URINAL <br />ORINKING FOUI <br />FLOOR DRAIN <br />BACKF�OW PRI <br />ROOF DFAINS— <br />SINK (SERVICE� <br />FRONTSEiBACK <br />z U� <br />USE ZONE� <br />7YPEOFGON� S7.pI.LOWABl1 <br />V-n! <br />512EOFBL�G � <br />I _�p <br />OCCUPANCVLO�D <br />f1EA50N FOP SPRM E <br />1346�� +� <br />qPPUCAT10N ACC. �V <br />OR <br />REAR SE�ACK <br />7_C� <br />LOTAREA <br />p Q � <br />iVj'E OF LONSi. RGI IIAL <br />ND. OF STQPIES <br />� <br />FIRE SPRNKLERS REO'0 <br />i_! YES X NO <br />runs nralloveo or <br />)TAL 5 <br />f S <br />fEE S <br />ISIDE SEIDFCH <br />� i.. / <br />PLUMBING <br />everett <br />� <br />SIGN <br />UCENSE/$Cl�o�rc /7CJ</= <br />�,l G5-2-Kf.r7G <br />U ENSE � <br />LIGENSE t <br />DEMOLITION ..� WOODSTOVE/FRPL INSEH7 ��. _ BUILDING RELOCATION <br />� <br />CONTACT <br />. � <br />�' ` p' i°�" � � — . <br />I H REBV CEF Y THAT I HAVE READ AND E%AMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT, ALL <br />PRnVISIONS OF LAWS AND OFiDINANCES GOVERNING THIS NPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AIA AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPL�CATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br />SIGNATURE OF CONTRACiOR��O�R AUiNO�RIZ[O AGENT OATE 3�O -9� <br />X��J _�-✓�. <br />C? ��;— ����G��l r'�hs% <br />pPPLICANTS CIiY BUSIYE55 LICENSE NO. FND BUSME55 NAME <br />FORCEDF <br />UNIT HEA' <br />CLOTHES <br />VENTILATi <br />RANGE H( <br />WATER HE <br />WOOD ST <br />HEAT <br />IR SYSTEMS—B.T.U. M E.A. <br />ERS—B.T.U. M <br />�RYERS <br />JN FAN <br />iOD <br />ATER <br />)VE <br />EPLACE 8 CHIMNEY <br />=1NSERT <br />P <br />G <br />FAN <br />�S VES [ I NO BUILDING <br />OCLUC�4CI NOOfOWRLIYG11WI6 <br />r,eou� pLUMBING <br />�3 I <br />BASEMFNT MLCHANICAL <br />YES O <br />MEIGNTIIMI�TioN �THER �'(��h r�ll � <br />Z S S7ATE DUILDING SURCHARGE <br />SThTFENERGVSURCHARGE <br />CITY OF EVERETT PUBLIC WORKS <br />LOCAL SALES <br />TAX CODE IS 3105 TOiAL <br />FEE <br />r�' REC� ��� (� <br />�5a�° <br />