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APPLICATILA FOR CONSTRUCI %ON PERMIT 1 <br />GIOE <br />everett <br />BUILDING DEPARTMENT TU BE COMPLETED IN INK —PLEASE PRINT <br />259-8810 BUILDING MECHANICAL PLUMBING SIGN <br />DEMOLITION COMBINATION X F <br />CITY <br />OWNER MAIL ADDRESS `—^ .� 9 <br />G !/ <br />ENANT MAIL ADDRESS <br />CITY ZIP PHOLF. <br />ARCHITECT OR DESIGNER MAIL ADDRESS <br />CITY ZIP PHONE <br />CITY IIP PNONF. LICENSER <br />GENERALCCMTRACTOR MAIL ADDRESS d.7 <br />7700 -3o r' <br />IIP PNONE LICENSE <br />ADDRESS CITY <br />MELHANIWLCONTRAC70R MAIL <br />PLUMP,NG CONTRACTOR MAIL ADDRESS <br />CITY zip PHONE LICENSE A <br />CUSS OF WORK <br />'ADDITION ALTERATION REPAIR DEMOLITION PERsoNWOOLOwSNEOoE/FRPL INSERT I BUILDING RELOCATION <br />TENANT IMPROVEMENT OR INTERK)RREMODEL ONLY ^�.-,0 77 <br />CONTRACT PR ICE OF WORK: S / <br />DESCRIBE WORK AND SQUARE FOOTAGE INVOLVED Q <br />PROPOSED USE OF BUILDING �.r.a.J/A,",� f��o 1 I HEREBY CERTIFY THAT I IIAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />1 6- PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />LEG ALDESCRIPTIONGFPROPEPTY (SHOWN BELOW OR ATTACH FOUR COPIESI WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />^ NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />LOT _GQ_aLOLK OF �— I- 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 AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND 1 COMPLY WITH THE STATE <br />CONTWAC <br />SIGNATURE R OF CONTRACTOR RS LAW iS.27 RCW AND 2OO CONTRACTOR GIN AGENT DATE <br />PROJECT ADDRESS <br />APPLICANTS CWWISENOBSINESS NAME <br />�-1 i, Z ii ......,,nu <br />OF <br />8 <br />a <br />s <br />�J <br />FRONT_SF.T1ACN <br />REAR SETBACK <br />zoI <br />SIDE SETB(.CK <br />i <br />LLE <br />usEz E <br />LOT AREA <br />VACANT SITE <br />to YES NO <br />TYPE OF CONST AILOWASLE <br />TYPE DEL T. ACTUAL <br />rcaEAKAY Cad LLMIG WI,1 <br />clean <br />7AI <br />SIZE OF BLEKL <br />SFFFFFFT------DRIES <br />NO. OFSTORIES <br />BASEMENT <br />YES ; /NO <br />I <br />OCCUPANC LOAD <br />FIRE SPRNKLERS PEO'D <br />HEIGHTUMITATION <br />?.SE <br />f 1 YES filNO <br />REASON FOR SPRINKLERS <br />APPLN:ATION ACC BY <br />PLANS A/PPRO Bev <br />CVERETT <br />OF SIS1 <br />IL <br />LLDCAA <br />/ <br />DTY <br />05FTAE 3 <br />X <br />A/C--NHNDLU UNI I J—n.r. <br />FORCED AIR SYSTEMS—B.T.U. M <br />I(ANTM[ATFRS—B.T.U. M / <br />FAN <br />F FEE - I RECEIPT NO <br />PLAN CHECK NUMBER <br />I Qd <br />BUILDING <br />PLUMBING <br />P <br />MECHANICAL <br />�—I--' <br />OTHER <br />STATE BUILDING SURCHARGE <br />' <br />STATE ENERGY SURCHARGE <br />O <br />PU01.IC WORKS <br />15- <br />TOTAL <br />