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APPLICATI�N FOR CONSTRUCTi�N PERMIT <br />ms Everyrean <br />CITV OF <br />everett <br />BUILDII �G DEPARTMENT <br />259-8810 TO BE COMPLETED IN INK—PLEASE PRINT <br />O DEMOLITION ❑ COMBINATION ❑ BUILDING ECHANICA <br />PLUMBING <br />everett <br />e�� <br />❑ SIGN <br />� OWNER M�IL�DDHE55 ZIP PNONE_ � <br />W,W. Z. <br />� � %t�/E. �UE�1T Z , � <br />TENANT MA�I.ADDPESS CITY IP PIIONE .. <br />i <br />I MCMITECTORDESIONER 1M�L�DDRE55 CITY ZIP PHONE <br />OENERQCONTR�CTOR M�ILADDPE55 CITY ZIP PHONE UCENSE[ <br />� <br />(S�D�ST�R 0�. <br />nu+eino cairrucron <br />i y,v►,�woi�, �g°3d �67oN � <br />CITY 21P ' PNONF <br />. <br />L�CENSE 1 <br />K <br />O ADDITION ❑ ALTERATION ❑ REPAIq ❑ DEMOLITION ❑ WOODSTOVElFRPL INSERT ❑ BUILDINO RELOCATION <br />TENANT IMPiIOVEMEM OR INTEFIQR <br />CONTRACT PRICE OF WORIf: � <br />DEBCRMIEWORI i05IXMREFOOL <br />��,- , c� <br />PROPOSED USE OF BUILDIN6 <br />wRR�HoU5E � <br />ONLY <br />1� <br />IEWL DEBCHIPTION OF PROPERTY ISNOWN BELOW OR �Tf�CH FOUR COPIE51 <br />LOT BLOCK OF <br />►�o.��. �oo�ee <br />�ii�� . <br />�uMsnu. <br />UVATORY (WASH BA: <br />SM,�WER <br />KITCi+EN SINK 8 D!Se' <br />FRONTBET&1CK <br />U6EZONE <br />ttre a coHST. uiowrs�¢ <br />8RE OF BLDO. <br />OCCUPANCY LWD <br />REASON FOP SPflINNLEPS <br />REAfl SEIBACK <br />LOT AREA <br />TYPE Of CONS7. ACN�L <br />NO.OF SfORIES <br />FIRE SPRNNLENS REO'0 <br />❑ YES ❑ NO <br />APPLICATIOH ACC. BY PUNS �PPROVED BY <br />r <br />FEE <br />$� ' <br />SIDE SETBACK <br />VACANT SITE <br />❑ ves ❑ No <br />OCNMF".Y Npp{DWFIIINGI <br />onav <br />BASEMENT <br />❑ YES ❑ NO <br />HEqHT LIMITATION <br />CITY OF EYERETT <br />LOCALSALES <br />TAX CODE IS 3105 <br />� <br />CONTACi <br />C <br />6�-1q6� - <br />I HEREBY CERTIFY THAT I HAVE READ AND E%AMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS ANO ORDINANCES GOVERNINO TFIIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO 61VE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANV <br />OTHER STATE OR LOCAL U1W REGULAT�NG CONSTRUCTION OR THE <br />PERFOHMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND i COMPLV WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296200 WAC. �/�� <br />SION�NREOFCONTR�C ORA REDAOENT DATE ` <br />X � ����� <br />APPLICA T CITVBUSINESSLICENSENO.ANDBUSINEbSNAME <br />NO. <br />A/�A/HNULd UNITS—H.P. <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />UNIT HEATERS--B.T.U. M 17�.v r. <br />RANGEHOOD <br />WATER HEATER <br />WOOD STOVE <br />METAL FIREPLACE 8 CHIMNEY <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN <br />SUB TOTAL <br />PERMIT <br />TOTALFEE <br />PLANCNECNNUMBER FEE <br />FEES VALUATIOD <br />BUILDING <br />PLUMBING <br />MECHANICAL <br />OiHER <br />STATE BUILOING SUFCHARGE <br />STATE ENERGY SURCHAfiGE <br />PUBLIC WORKS <br />TOTAL <br />FEE <br />