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APPLICATION �FOR CONSTRUCTIV� pERMIT everett <br />rne e�eiq�ee� TO BE COMPLETED IN INK—pLEASE PRINT � <br />CI7Y OF <br />everett <br />BUILDING DEPARTMENT HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ _� <br />259-8810 <br />�EMOLITION COMBINATION P.�JILDING <br />,/ " l^/ �/ rnm�aooaess ��irv MECHANICAL ,PLUMBING 7 SIGN <br />i` . Y. F`V �!" �_ {� � O� \ S � 1 y^ ZIP PHONF. <br />TENANT � , • `S�� �V1`v�� qg2.�� Z_ <br />MAIL AD�flE55 ���, S� ^ �� ��, <br />Z�P PMONE — <br />aRCHITECTORDESIGNER MA!�q00RE5S <br />��TY Z�P PNONE <br />GENERALCONTRpCTOR MAILFOORESS <br />�� `� �1 _ �'� �� � �= �`�TM 21�P ���� PHUNE LICENSE I <br />MEC4qNICALCONfFAGTOR `O MqILADDqESS �`v� � - �� 3� ��S V <br />CIT ��Z�O� ^ <br />Z�P PMONE UCENSE t -- <br />PWMBINGLONTRqLTOR MN�qpDRESS <br />GTY ZIP PHONE <br />LICENSE / <br />CLASS OF WOBN <br />� - NEW . _. ADDI710N �� ! qLTERATION �REF,.IR � � <br />.' ] DEMOLITION .�. WOODSTOVE/FRPL INSERT !� BUILDING RELOCATION <br />� CONlFCTPERSONANDPHONENO. <br />CONTRACTPRICEOFWOfiR S 4 00, a� <br />DESCRIBE WORK AN� SOUARE FOOTqGE INVOLVED <br />� ,�o� `�. �-r, 3��..,,pv� — <br />_ <br />PROPOSED USE OF BULLDING <br />I HEREBY CERTiFY THAT I HAVE REhD AND EXAMINED THIS <br />LEGAL DESCRIPTION OF PqOPE �iY �SHOWN BELOW pp pTTqCN FOUR COPIcS) PROVISIONS OF I,AWS AND 0 DA ANCES GO ERNING TH S TYPE OF <br />�or BLOCK __�_ OF WOflK WILL BE COMPLETED WI'�i WHETHER SPECIFIED HEREIN OR <br />NOT. THE GP..INTING OF q PEHMIT DOES NOT PRESUME TO GIV� <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 AN AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM �:IE WORK FC� WHICH <br />— APPLICATION IS MADE AND i COMP:/ WITH THE STATE <br />CONTRACTORS LAW 78.27 RCW AND 2g6200 WAC. <br />SIGNATUREOFCONTRACTOdORqUTHOq2EDAGENT OATE <br />vHo.iEGT ADDRESS <br />i�� r q-.�► ��- pa S� <br />PLUMBING <br />NJ• TYPE OF FIXTURE OR ITEM <br />_ WATERCLOSET(TOILET) <br />BATHTUB <br />8 <br />DRINKING <br />FLOOR DF <br />BACKFLOV <br />ROOFDRA <br />SINK (SER' <br />FOR OFFICE USE ONLY: <br />FRpNTSETBACK REqRSETBACK <br />USt ZONE i m ..,�. <br />NO OF <br />IOAD FIRESf <br />INTqKE BV <br />TYPE OF EQ <br />A/C—A/HNDLG UNITS- <br />FORCED AIR SYSTEM; <br />UNIT HEA— TERS--- <br />CLOTHES �FV <br />VEN71L1TIOPJ FAN <br />RANGE H�_ <br />WATER HEATER <br />WOODSTOVE <br />METAL FIREPLACE 8 CI <br />FIREPLACE �NgEq7 <br />HEAT PUMP <br />GAS PIPING <br />EXHAUST FAN <br />SUB TOTAL $ � <br />PERMIT $ T— — <br />TOTAL FEE $ <br />SIDE SETBACK PLqN CHECK NUMBER <br />VACANT SITE FEES <br />BUILDING <br />UAl OCCuvANtv KO oipyrELiIAGUWtS <br />GFOOV <br />PLUMBI�G <br />BASEMENT <br />MECHANICAL <br />REOU MEIGMTLIMITqT10N ADDITIONALPIANCHECK <br />O7HER <br />S7ATE BUILDING SURCHAqGE <br />'B'' CITY OF EVERETT <br />LOCAL SALES PUBUC WORKS <br />TAX CODE IS 3105 ror�� <br />NO. RND BUSINE55 NAME <br />u <br />� <br />--�--- <br />SUB TOTAL $ � <br />PERMIT $ <br />TOTAL FEE $ <br />FEE PECEIPTNO. <br />