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A <br />tl <br />APPLICATIOrI FOR CONSTRUCTIflN PERMIT <br />me E�ro.�� <br />cirv uF <br />ever�ett <br />BUILDING DEPARTMENT TO BE COMPLETED IN <br />259-8810 <br />❑ DEMOLITION I I COMBINATION I I BUILDING <br />OWNER AIL ADDOE55 CIiY <br />.BlLL.IL-. F1�� I I'�1 w 11RFHJ� Vi�W D�, <br />iENANT M�II ADDFESS CITY <br />.�. �.-. A t79'G�r%I 11h I� 1 eT <br />PRINT <br />! I PLUMBING <br />�RCHIiECT OR OESIGrvGn mm� no�ncoa - <br />GENERALCONTR�CTOA MRILAO�RESS CITY ZIP PNONE LICENSE� <br />everett <br />e <br />❑ SIGN <br />55 OF WUHM1 <br />NEW ❑ ADDITION I I ALTERATION I I REPAIR 1 I DEMOLI i ION I I WOODSTOV6FRPL INSERT I 1 BUIIDING RELOCATI <br />TENANTIMPROVFMENTORiN1 Hiun/�¢cmG��c/w�r.0 <br />COMTRACTPRICEOFWORR: � p(�rrl.�c� <br />UESCRIBE WORK ANO SWARF FOOIAGE INVOLVED <br />I�a;TA H�����C. s�;'�' <br />PROPOSED USE OF BUILOING <br />�rA�)F�N'T <br />LEOAL OESCR�FTION OF PPOPERTY (SNOWN BEIOW CR A7TRCH <br />LOT BLOCN �F <br />DNESS <br />t W, MAF�I I�� V! L�J <br />lING <br />TYPE OF FI%TURE OR ITEM <br />NATER CLOSET (TOILET) <br />3ATHTUB <br />LAVATORY(WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />LAUNDRI'TRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />ROOF DRAINS-RAINLEADERS _ <br />SINK (SERVICE-BAR, ETC.) <br />, FRONTSETBACK <br />' USE20NE <br />i <br />iVFEDFCONST,ALIUWABLE <br />, SIZEOFBlDO <br />� OCCUPANCYLOAD <br />i <br />< <br />; PEASON FOR SPRINNLERS <br />SUB TOTAL $ �� <br />PEPMIT S ' <br />TOTAL FEE S ' <br />REAR SE70ACK S�OE 5@TBACN <br />IOi�REA VRCANTSIIE <br />I-1 VES I�l NO <br />7VPf Of CONSi. ACiUXi aN�r.un NO m mv[luNni <br />Gnplv <br />NO.OFSiORIES BASEMENT <br />I I YES I I NO <br />FlRESPRNKLEPSFEO'0 HEIGHTLIMIIATION <br />CI YES i I NO I - <br />� hPPIICATIONPCC.BY PLANSAPPROVEDBY CITYOFEVERETT <br />M� ��� LOCAL SALES <br />TAX COOE IS 3105 <br />CONTACL PERSON AND Pf10NE NO <br />Drl� ('�-iY 1 � <br />0 /v-I'tnv <br />1 HEREBY CERTIFY THAT � HAVE READ AND E%AMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TPUE AND CORRECL ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITFi WHETHCR SPECIF�IED HEREIN OR <br />NOT, THE GRANTING OF A PERMIT DOES NOT PRI_SUME TO GIVE <br />AUTIiORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHEFi STATE OR LOCAL LAW REGULATING CONSTfiUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. TI1AT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICAT�ON IS MADE AND I COMPLY WITH THF STATE <br />CONTRACTO LAW 1B27 RCW AND 296.200 WAC. <br />SIGNATU TRAC;' �iU�OBI2EOA�/���E .� l� �^ <br />X ��� �� �; <br />�PPL1GnNt5 CIiY DUSINES^ UCENSE NO. AND BUSINESS N�ME <br />Mt0�1N1YIl:PL <br />NO. TYPE OF EQUIPM <br />A/C—NHNDLG UNITS—H.P. <br />FORCED AIR SYSTEMS—B: <br />UNIT HEATERS—B.T.U. M <br />CLOTHES DRYERS <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />WOOD STOVE <br />METAL FIREPLACE 8 CHIMt <br />FIREPLACE INSERT <br />HEAT PUMP <br />( GAS PIPING <br />EXHAUSTFAN <br />PL�N CY.ECN NIIM�ER <br />FEES ,_ <br />BUILDING <br />PWfdBING <br />MECHANiJAL _ <br />OTIiER <br />STATE BUILDING SURCHARGE <br />STATEENERGYSUFCHAFGE <br />PUBLIC WORKS <br />rorn� <br />E.A. <br />SUBTOi,�L $ <br />PERMIT $ <br />TOTALFEE $ <br />KEE RECEIPT <br />VAIUATION <br />