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APPLICATION FOR CONSTRUGT�t�N P�RMIT <br />� flre Everyienn <br />�IN OF <br />everett <br />BUILDING DEPARTMENT <br />259-8810 TO B� COMPLETED IN INK—PLEASE PRINT <br />❑ DEMOUTION I• COMBINATION f) BUILDING I 1 MECHANICAL <br />, <br />� <br />! MECNANICRLCONTRRCTOR 6'41L�DORE55 CIIY 21P PNONE ULENSE� <br />, PLUIt1BINOCONTR(�CTOR , � M�ILAUDPES� � - C� ZIP PIIONE �ILENSEY <br />�ly S �li�V%2��98�P� ��t Cv Aia>� <br />I! DEMOLITION I I yypODSTOVE/FRPL INSERT I I BUILDING RELOCATION <br />I I PLUMBING <br />everett <br />� <br />❑ SIGN <br />�'lod��t' LUN�I /''I�,frn�2 <br />cussoF nK <br />' ❑ NEW I_] ADDITION I 1 ALTERATION ' I <br />'. TEN�NT IMPROVEMEUT ON INTENIOP REMO�EL CNLY <br />' CONTMCT PRICE OF WORN: <br />�or <br />i <br />: PRC <br />J <br />1 <br />t <br />N <br />BUILDINO <br />i OF PROPERtt �SNOWN BELON' JR ATTACH FOUR W PIE57 <br />e�ocK or <br />WATER CLOSET�TOIL <br />BATHTUB <br />LAVATORY(WASH BA: <br />SHOWER <br />KITCHEN SINK 8 DISP <br />URINAL <br />� DRINKING FOUNTAIN <br />� FLOOR DRAtN <br />. BACKFLOW PREVENTERS <br />� ROOFDRAINS—RAINLEAC <br />�� SINK (SERVICE—BAR, ETC <br />FRONTSETBACK <br />USEZONE <br />iYPE Of CONSI. ALLOWABLE <br />, SIZE OF BLDO. <br />OCCUPANCY LOA11 <br />REASON FOF SPRINNLERS <br />IAPPLICATIOK. ACG. BY <br />CONT�CT PERSON AND PIIONE NO. <br />I HEREBV 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 ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COA9PLETED WITH WHETFiER SPECIFIED HEREIN OR <br />NOT. THE GR�NTING UF A PERMIT DOCS NOT PRESUME TO GIVE <br />AUTHOHITY TO VIOLAI[ OR CANCEL THE PROVISIONS OF ANV <br />OTH[R STATE OR LOCAL lAW REGULATING CONSTRUCT�ON OR THE <br />PERFORMANCE OF CON3TRUCTION. THAT I AM AUTHORIZED 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 1827 RCW AND 296.200 WAC. <br />SIGN4iUREOFCONTRACtORORAULNORIZEUAGENT OATE <br />�.��� ��7��'�l�90 <br />pPP�ICANTSCITVBIISINE55lICENSENO.ANDBlI51NE55NRmc / <br />uccueuicei <br />N0. TYPE OF EOUIPMENT <br />NC—NHNDLG UNITS—H.P. <br />VENTILATION FAN <br />RANGEHOOU <br />WATER HEATPR <br />WOOD STOVE <br />METAL FIREPIA�:E 8 CHIMNEY <br />FIREPLACE INSGRT <br />I1EAT PUMP <br />GAS PIPING <br />EXNAUSTFAN <br />PERMIT $ � <br />TOTAL FEE $ <br />RE�qSEIURCR SIDESET�ACN PLANCNECNNUMBER <br />IOIAflEA MC�NT51(E FEES <br />I I YES I I NO BwLDwG ' <br />i�reorcoxst.ncmat a�ur.wcr Hnrroxnn�cux��s � <br />frNWF <br />PIUMBING <br />NO.OFSfOf11E5 D45EMEN7 MECHANICAL <br />I I YES I I NO <br />FIRESPNNNLERSflEO'� HEIGH�LIMIIAiION OTHER <br />I I YES I � NO STA7E PUII.DING SUfiCHAf7GE <br />SiATE ENERGI' SUFiCHAfiGE <br />PlAN5r1PP110VEU8V CITY OF EVERETT PU�LIC WORKS <br />LOCALSALES <br />TAX CODE IS 3105 Torn� <br />M <br />SUB TOTAL $ <br />PERMIT $ <br />TOTALFEE $ <br />FEE RECEIPTNO. <br />htt <br />.'�.1t):fF :Y."Y�H�i .. . <br />