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APPLICATIO.'� FOR CONSTRUCT��:,�N PERMIi everett <br />TO BE COMPLETED IN INK—PLEASE PRINT � <br />Ihe Evrrgreen <br />CITV OF <br />everett � <br />BUILDING DEPARTMENT <br />259-8810 <br />! I DEMOLITION I I COMBINATION <br />HEATING SYSTEM: <br />❑ ELECTRIC �] <br />❑ PLUMBING ❑ SICN <br />uwsen unanooaess /c�d Gv�'='`^��"""" ' nr PHONE <br />�'/-lLSi S%r�F�Ti"iZ �l'-�7.--c�7� � �%� �Szi Zc�-52�--/Z(_¢3 <br />IEN�Ni M�ILADORE55 CITY ZIP PIIONE <br />�'�-I-�-a�t,.�c-6.�7'�_ a�.�/� �ZU�-%�'' ��t/�z rS� 1:=t/>�C.EiT V��I� �SSz-11�S <br />ARCIIIIErT OR DF.SIGNER MAIL ADORE55 C�tY 21P PHONE <br />f.EN[fiALCONIMCTOR MNLAOOBESS� CI7V 21P PIIONE UCEI:SE� <br />(� � y / �n i,-lc-� ✓'v �� .�s S '1>tc��ai-, �� �-1 1.�/.a �/3S -5�io � �'�zv �L- /zz M�� <br />NECIIANICAL WNiPACTOR MML �DI/RE55 u� ZIP PHONE LIpENSE I <br />PLUMBINGCONTNACiOR MNIADDRESS CIfV ZIP PIIONE UCENSE� <br />CLASSOFWOqK / <br />' I NEW I I AUDITION � ALTERATION I I REPAIR I I DEMOLITION I I WOODSTOVFJFRPL INSERT ❑ BUILDING RELOCATION <br />OE�SqG(IIBE WORK AND 5 WAHE FOOiAGE INVOLVED <br />�d ��Y= f'�C.%�C•� �JIC. <br />PPOPOSED USE OF OUILOINO <br />%,S�Oie� i./G.� <br />lEGl1L DESCRIPTION OF PROPERTY (SNOWN PELOR <br />l0T BLOCK OF <br />� <br />'—CtiV <br />R0.1ECT AODRE55 r <br />`�'Zo� -7 �-` �%L (�� � <br />PLUMBINO <br />NO. TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY (WASH BASINJ. <br />SHOWER <br />KITCHEN SINK 8 DISP <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNiAIN <br />FLOOR DqAIN <br />BACKFLOW PREVENTERS <br />ROOF DRAINS--rIAINLEA�ERS <br />SUB TOTAL $ <br />PERMIT $ <br />TOTALFEE $ <br />FOR OFFICE USE ONLY: <br />Fnor+r sereacK <br />USE ZOIlE <br />IYPf Uf LONIS.AILOWdBLE <br />occurnr�cr �onu <br />❑f�SON f0(15PBINNIEl15 <br />IN i 1KE OY <br />PE4RSETBACK <br />IYfE Oi GONSt. A^.!Ilnl <br />NOAF S10f11E5 <br />Ol.i' / <br />FEE <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATIDN AND KNOW THE SAME TO BE TRUE AND CORHECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVEHNING THIS TYPE OF <br />WJRK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NGf. THE GRANTING OF A PERMI7 DOE5 NOT ?RESUME f0 GIVE <br />AU7HORi7Y TO VIOLA7E OH CANCEL THE PROVi^�nNS OF ANY <br />OTHER STATF. OR LOCAL LAW HEGULATING CONSTF �N OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHUiiiZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS lAW 1027 RCW AND 296.200 WAC. <br />SIGNATUREDFCONiRAC70flOR�UTNOflIZEDAGENT DATE <br />BUSINESS LICENSE NO. <br />NO. TYPE OF EOUIPMENT <br />NC—A/HNDLG UNITS—H.P. <br />FORCED AIR SYSTEMS—B.T.U. M <br />UNIT HEATERS—B.T.U. M <br />CLOTHES DHYERS <br />VENTILATION FAN <br />RANGEHOOD <br />WA7ER HEATER <br />WOOD STOVE <br />METAL FIREPUICE 8 CHIMNEY <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />E%HAUSTFAN <br />51DESE70nCK PLANCHECNNUMO[R FEE <br />vncnNr sne FEES <br />BUI! DING <br />acurnxcr xoaow[unmuxns <br />GR00r pLUMBING <br />OASEMENI l,IECHANICAL <br />NEimii uunqnoN �ODITIONAL PUN CH�CH . <br />O7HER <br />STATE BUILDING SURCHARGE <br />CITY OF EVERETT rUALIC WORhs <br />LOfALSALES <br />TAX CUOEIS 3105 TOTAL <br />NAME <br />SUB TOTAL $ <br />PERMIT $ <br />TOTALFEE $ <br />i <br />i <br />i <br />