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APPLICATIOrI FOR CONSTRUCT�ON PERMIT <br />�, ,E�,,,Q,,,� TO BE COMPLETED IN INK—PLEASE PRINT <br />ciTv ur <br />everett <br />BUILDING DEPARTMENT. <br />259-8810 <br />DEMOLITION <br />OW/N7Eii , MAI <br />s/) QIFS��-l�/i/�/n,a <br />1[NANT MAI <br />COMBINATION <br />AODPE55 <br />HEATING SYSTEM: O Gl.� ❑[LECTRIC O <br />MRiI NODRf5C5' / <br />��OG otGart�/�C� <br />IApit ADpRESS <br />e �(i.�E /�_ <br />MAIL PDDR[SS <br />MAIL PO�BE55 <br />BUILDING MECHANICAL <br />CIiY Z�P FIIONE <br />� �ao �rJ /���,�03 .'� 9G -� <br />p�Ty ZiP PNONE <br />CITY 21P PHONE <br />�rJ %�'�O3 ,�9a- <br />GITY 2�P PMONE <br />C11Y ZIP PNONF. <br />qTY ZIP PMONE <br />PLUMBING <br />i ;. <br />LICENSE • <br />LICENSE • <br />LILENSF � <br />SIGN <br />NEW � ADDITION .� ALTERATION REPAIR DEMOLITION VlOODSTOV6FRPL INSERT ��. BUILDING PELOCATION <br />// (J CONLAGT PEPSON AND PNONE NO <br />��iRRCTPRIC[OF1YOii8 /��� /�' /� -�1���✓ �l.i.�. � __ . _ <br />PROPOSED USE OF OUILOING <br />LEGAL OES:PIPiION OF PROPF <br />LOT BIOCN <br />nooness <br />WATER CLOSET (TOII <br />BATHTUB <br />LAVATORY�WASH BA <br />SHOWER <br />KITCHEN SINK 8 DISf <br />DISHWASHER <br />LAUNDFiV TRAV <br />CLOTHES WASHER <br />URINAL <br />DRINhING FOUNTAIN <br />SINK <br />FOR OFFICE USE ONLY: <br />fPONi5Ei0ACK NERR: <br />usezoHE iota� <br />m <br />TOTAL <br />NO OF $TURIES <br />FIpE SPRNKlERS R[O'0 <br />1 �cR50N FOR SPRINNlEPS <br />INTAN[BY �lANSAPPROVEDOY <br />I HEREBY CERTIFY THAT I HAVE READ AND E7fAMINED THIS <br />APPLICATION AND HNOW THE SAME TO BE TRUE ANG CORRECT. ALL <br />ILOPiES� PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT, THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITV TO VIOLATE OR CANCEL THE PROVISIONS OF AN'� <br />OTHER STATE OR LOCAI LAW REGULATING CONSTRUCTION OR THE <br />PERFOPMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPE.'TV TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLV WITH THE STATE <br />CONTRACTORS LAW 1927 RCW AND 296.200 WAC. <br />SIGNqtUfiE OF CONLNACTOP OR POiI ORIZED AGENT DAT[ <br />X �'� � �� - vJ � � /./,L91�>.a�aJ <br />_/� p/��� APPCICANi5C1 BUSW[55 JCENSENO ANDBli5ME55NAME <br />/ /i d <br />FEE <br />NC—A�HMDLG UNITS—H.P. <br />FORCED AIR SYSTEMS—B: <br />UNIT HEATFRS�—B.T.U. M <br />CLOTHES DRVERS <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />WOOD STOVE <br />METAI FIREPLACE A CHIMP <br />FIREP�ACEINSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUS� FAN <br />SIDESEiOACK PLANCHECNNIIMBER FEE <br />3 5�/ �.3 <br />VACANiSrtE FEES <br />BUILDING <br />OCCu��Htv NOdM.IW.:l\'.IS <br />caruv p�UM01NG <br />OnSEMENr ��ECHANICAL <br />MEIGNi UMIiAiION ADDIiIONAL PLAN CNECH <br />OTHEfl <br />$TATE BUILDING SIIRLHARGE <br />CITY OF EUERETT PU�LIC WORNS <br />LOCALSALES <br />TAX CODE IS 3105 TOTAL <br />PERMIT <br />p0 <br />sa <br />