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� <br />!' ,, <br />APPLICATION FOR CONSTRUCTt�N PERMIT everett <br />me e�e�9reen TO BE COMPLETED IN INK—PLEASE PRINT � <br />CITV OF <br />everett CATING SYSTEM: U GAS U ELECTFIC ❑ <br />BUILDING DEPARTMENT <br />259-8810 <br />I J DEMOLITION I� CODABINATION i i BUILDING MECHANICAL i � pLUMBING i I SIGN <br />OWN[R �+ M4ILAOO�yi1ES�5 -7 �, CIfY Qn ]IryP � PN^O�NE (� / <br />�n., . l(:n�n�lS /Yi�� /_. �� J�� (CJG�-' � C-JC�� Z��l� <br />iENANT mniv�voncoa ..... _.. . ____ <br />RRCHREGTORDESIGNER MAILADDRE55 CIIV ZIP PMONE <br />GENEFA�CONTR/CTOR MAIL�OUiiE55 CIiY ZI^ PHONE LICENSE/ <br />MECNAHICALCONTR�CIOF M1I�IL�UDRESS CIIY tu• rrvnc u�u+��• <br />�o,S��r���j�C*nS I1�_ St Eof (�a��uJF� Cri�f' 9Q%bf a>.� 33:3/ (A�S�.�..g 2$�Cg <br />PWMBINGCONTAACTOR 61NlAD�RESS QIY ZIP PHONE LICENSEt <br />CLASSOFWORK � <br />I I NEW '� ADDITION �' ALTERATION �' REPAIR i�� DEMOLITION ' I WOODSTOVE/FRPL INSERT � i BUILDING RELOCATION <br />J — roNtnc�rensonnunm�onrr+a <br />:b <br />cor+rnncT Pnice or wonn � �O --_ ------_.—_'__ _ - ----- <br />OESCfiIBE W0lIN AN[150U4PElIX]iAGE INVOIVEU <br />PPOPOSEO USE U� 0UIL9iNu <br />sr-�� <br />ieca oescmm�orv or rnoren n isnowN nei ow on nT incn roun cori� s <br />�pT BIOCK or _ <br />PROJECTAODRESS <br />zgi`r zl S ��. <br />PLUMBING <br />NO. TYPE OF fIXTURE OR ITEM FEE <br />WATER CLOSET (TOILET) <br />BATHTUB � <br />— --i <br />LAVATORY (WASH BASIN) � <br />SHOWER <br />KITCHEN SINK 8 OISP <br />DISHWASHER ' <br />LP.UNDRY TRAY � <br />� <br />CLOTHES WASHER � <br />URINAL ' <br />QRINKING FOUNTAIN � <br />FLOOR DRAIN ' <br />BACKFLOW PREVENTENS � <br />ROOf DRAINS—RAINLE�DERS ! <br />SINK (SERVICE—DAR, ETC.) ' <br />— ----i <br />_— <br />_— � <br />SUB TOTAL $ ' <br />PERMIT $ ---� <br />r,�.re� cov c � <br />FOR OFFICE USE ONLY: <br />FRONiSE7BACN f1E�RSET�ACK SI�ESElOACH <br />USEZONE l0� <br />IYPEOFWNISAIIOWM1BIF IYfE <br />SIZE OF OLOG <br />OCCUPr1NCV I.OFp <br />REASON FO(i SPRINNI CN$ <br />INiANE BV <br />A(lE� I ��CANf5l7E <br />No or s�oraer <br />flf1E S�'ONNlERS <br />nrrnovEo ov <br />I HEREBV CERTIFY THAT I HAVE fiEAD AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE ANO CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANiING OF A PEiiMiT 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 AM AUTHOR�ZED BY THE <br />OWNER OF TIiIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 1827 RCW AND 296.200 WAC. <br />sicr+niun=_orcor+rnnctono �UI11011RED�GE�If oare <br />X `� � � � <br />\�c�-I�X t ( - z8 ._ �o <br />4PPI IC�Nt CIIY OUSMESS UGENSE NO. ANO BUS�NE55 N�ME <br />� <br />NC—AiHNDLG UNITS—H.P. <br />FORCED AIR Sl'STEMS—B.i.U. M E.A. <br />UNR HEATERS—B.T.U. M <br />CLOTHES DRYERS <br />VENTILATION FAN <br />F�NGEHOOD <br />WOOD STOVE <br />METAL FIREPLACE 8 <br />FIREPLACE INSERT <br />HEATPUMP <br />PIAN CHECH NIIM9ER <br />BUILDING <br />nccurexn unrno�vnux,uruix -- <br />r,nnw PWMBWG <br />anSEMGNi MECHANICAL <br />uElGrn urali�LO�� �DDITIONAL PL�N CHECK <br />OTI{ER <br />STATE BWLDING SURCHARGE <br />CITY OF EVERETT PUBLIC WORKS <br />LOCAL SALES — <br />TAX CODE IS 3105 TO7AL <br />SUBTOTAL S /f — <br />PERMIT $ /'.T � — <br />TOTAL FEE 5 3d ; � <br />