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AP'PLICATItAAI FOR �ONSTRUC1.dN PERMIT <br />everett <br />fho Eve�gieen � <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />259-8810 TO BE COMPLETED IN INK—PLEASE PRINT <br />❑ DEMOLITION I COMBINATION ✓ BUILDING MECHANICAL PLUMBING 1 SIGN <br />OW�lER MAILA�OPESS CITV 21P PMONE <br />Jerr� b2,u�n ���� q�-h ��e. r�, �a�-ass� <br />TB:ANT MFILA�DRESS CITV ZIP PHONE <br />ARCMITEtT OR <br />GENERAL <br />MAII FDDPESS <br />MAIL ADDRESS <br />Iq7� s <br />MAIL AOORE55 <br />MAIL A�DRESS <br />CLA55OF WORK <br />�'�NEW Ci ADDITION �. ! ALTERATION <br />TENANT IMPROVEMENT OH INTERIOR flEM00EL ONLY <br />CONTfiACT PRICE OF WOPN: <br />OESCRIBE WORK AND SOUAflE FOOTPGE INVOLVEU <br />G aaar� f` wcn K s �+� P- S <br />PROPOSEDUSE <br />LEGAL DESCFIPTION OF PROPERrV �SNOWN �ELOW OR <br />�or i 6 BLOCH O�✓O L�_ V� pp _ <br />i, � , . <br />�6 !�� <br />PLUMBIN4 <br />O. TYPE OF FIXTURE <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY�WASH �ASIN) <br />SHOWER <br />KITCHEN SINK & DISF <br />DISHWASHER _ <br />LAU�JDRY TRAY <br />CLOTHES WASHEH <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOH DRAIN <br />6ACKFLOW PREVENTER; <br />ROOF DRAINS—RAINLEAI <br />CITV 21P <br />CITY <br />o rs. 9$� <br />CIiY <br />cin <br />�'.J REPAIR ���. � DEMOLITION <br />>lRKckecLbci dn. coNrncr <br />� <br />lc F1t,aN+e • .$Ca K <br />FEE <br />ZIP PHONE LICENSEa <br />'� 381-1476 MAG�t[q3 ! 88 W� <br />=� — <br />2�F PHONE UGENSF.A <br />21P <br />LICENSE M <br />'�. �: WOODSTOVE/FRPL INSERT '. I BUILCING RELOCATION <br />'ON AND PMON° NO. <br />7,... /1/1.._ „n ?S7i—/47l� <br />I HERE6Y CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND OR�INANCES GOVERNING THIS TYPE OF <br />WORK VJILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUMF TO GIJE <br />AUTHORITY TO VIOLATE OR CANCEL 7HE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF TFIIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 78.27 RCW AND 296200 WAC.�j / <br />SIGNATUREOFCOVTRACTORORAUTMORREDAGENi OATE J ZZ 9D <br />APPLIC�NTSqTV�CEN5EN0. BUSINESSNAME <br />OF EOUIPMENT <br />FORG�D AIR SYSTEMS—B.T.U. M E.A. <br />UNIT HEATERS—B.T.U. M <br />VENTILATION FAN <br />RANGEHOOD <br />WOODSTOVE � <br />--. <br />METAL FIREPLACE & CIiIMNEY <br />FIREPIACE INSERT <br />HEATPUMP ' <br />GAS PIPING ' <br />EXHAUSTFAN � <br />SUB TOTAL $ SUB T07AL S <br />PERMIT $ PERMIT 5 <br />TOTAL FEE ?i TOTAL FEE S <br />FPONTSETBACK REARSE�CI� SIDESET�ACN PLAN HECN M9EF FEE ('�j �l RECEIPTNO. <br />---�+F— �CJ vn���nnnu F <br />USEZO LOTAREA �ACANTSITE PEES <br />—� JpkUZa -'��L17 � C YES ��, NO BUILDING <br />iVPLOFCONST.ALL�Wl.9LE TYPEOPCONSi.AC.TUAL o[Ccvnrv[v x0a�mvkl.r:cuvn, <br />\ / caouv pLU)ABING <br />V � �� ✓ - N M- � <br />SIZEOFBi�G. 1 NC.OFSTORIES BFSElAENT '/ MECHANICAL <br />�� � �'�'F � . YES /�NO <br />OCCUPANCVLOF� FIRESPRNKL�RSFEO'D HEIGHTLIl,97PTION OTHER <br />..�' YES K NO S' STATEBUILDINGSUiiCHARGE <br />pEA50N FOR SPRINNIERS <br />STATEENERGYSURCHARGE <br />RPPLICATIONALC.BV PI�tN�PP�DOY CITYOFEVERETT PUBLICWCRKS <br />Y LOCAL SALES <br />� � TAX CODE IS 3105 I TOTAL <br />�l.szo I i3f�oo <br />��` <br />