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� <br /> APPLICATIO�J FOR CONSTRUCT.JN PERMIT evere[t <br /> rne e�reren.e� TO BE COMPLETED IN INM.—PLEASE PRINT � <br /> CITY OF <br /> everett HEATINGSYSTEM: �GAS ❑ELECTRIC ❑ 1 <br /> BLIILDING DEPARTMENT <br /> 259•8810 <br /> OEMOLITION COMBINATION BUILDING �MECHANICAL PLUMBING SIGN <br /> OWNEN IAML�O�RE55 CIiY ZIP PHONE <br /> (Y,.,�,rQ.Q i::l,_F� Co. 26to W las�no Rd Evv� wn .__ <br /> TENANT MMl ADDRE55 CITV ZIP PHONE <br /> SkM,a bs AgoVe <br /> �RCHITECTORDESIGNER MMi���RE55 CRV ZIP PNd1E <br /> RO(rER N, Fi�2 8SZ0 186�" ST' SW Edmordr 4W 48o1.G (2ot+) 77B-4boo <br /> 6ENERKGONTP�CTOH MAILADDFEFS CIiV 21P HONE LICENSE� <br /> �}y�w��„ Cov�sf►�K,c.,h,.,_, P.O. Brnt ZS� S�r� wIF 95t2p I-8�•8'►6 -2Y� NORrNGW 37s"No <br /> IAECMANIC�L GONTR�CTOR MAIL�DDRE55 CIT 21P PNONE LICENSE� <br /> Vb6 a.. 1, -, <br /> ' _Q ?;�,t '�,�4 �I6 ISI���10'1 Boh.C.1.0 w��'iSe!( 486•4!P/ RoBsoMsl73o� <br /> PLUMBIN6CONTR�GTOR MA1 ADDRESS CITY � 21V PHONE LICENSE� <br /> �C SS OF WONI! <br /> NEW ' � ADDITION ,_I ALTERATION � REPAIR DEMOLITION ��. WOODSTOVE/FRPL INSERT i_; BUILDING RELOCATION <br /> ���� CONUGT PERSON�ND PNONE NO <br /> CWTR�GT PRICE OF WORK <br /> DESCRIBEWOf1KANO50U�RE OOTAOEINVOLVEO <br /> PROPOSEJUSEOFBURDINO I HEREBY CERTIFV TF!AT I HAVE READ AND EXAMINEU THIS <br /> Cn� APPLICAI'ION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> LEOIIL DESCRIFTION OF P ERtt ISMOVM BEIOW �TTRCH FWR COPIES� PROVISIONS OF LAWS AND ORDINANCES GOVERNINO THIS TYPE OF <br /> WORK WILL BE COMPLETED WITH WNETHER SPECIFIED HEREIN OR <br /> �or e�xK oF NOT. THE GRANI�ING OF A PERMIT DOES NOT PRESUME TO IiIVE <br /> AUTHORITV TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATINO CONSTRUCTION OR THE <br /> — � PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BV THE <br /> OWNER OF THIS PHOPERTV TO PERFORM THE WORK FOR WHICH <br /> — APPLICATION IS MADE AND I COMPLV WITH THE STATE <br /> CONTRACTORS LAW 1827 RCW AND 29G200 WAC. <br /> 51GN�IDHEOFCONTR�CTOPOP�UTIqRIZE7�0ENT D�TE <br /> PRWECTMDRE55 /��, {� � � C� � <br /> �IO W. l�L����O ���`. �[.f� �P�" NTFCI B INESSIICENSEIq.I1N0BUS�NE55N�ME <br /> p��s�p MECMANIC <br /> N0. TYPE OF FlXTUHE OR tTEM FEE N0. TYPE OF EOUIPMENT FEE <br /> . WATER CLOSET(TOILET) � A/�A/HNC G UNITS—H.P. � <br /> BATNTUB ' FORCED AIR SYSTEMS—B.T.U. M E.A. <br /> LAVATORY(WASH BASIN) � UNIT HEATERS—B T.U. M _T <br /> SHOWER � CLOTHESDRVERS <br /> KITCHEN SINK 8 DISP � VENTIUITION FAN _� <br /> DISHWASHER � RANGE HOOD � <br /> LAUNDFiV TRAV ; WAiER HEATER ' <br /> CLOTHES WASHER � WOOD STOVE � <br /> URINAL ' METAL F�REPLACE 8 CHIMNEV ' <br /> DHINKING FOUNTAIN � FIREPLACE INSERT � <br /> FLOOR DRAIN � HEAT PUMP ' <br /> BACKFLOW PFlEVENTERS ; GAS PIPING ' <br /> pOOF DflA1NS—RAINLEADERS EXHAUST FAN � <br /> SINK(SEAVICE-9AR,ETC.) � <br /> � <br /> � � <br /> � � <br /> � � . <br /> — — � <br /> SUB TOTAL E ; SUB TOTAL S ; <br /> PERMIT E PERMIT S F � <br /> TOTAL FEE S TOTAL FEE S �� <br /> FOR OFFICE USE ONLY: <br /> FRONTSETBACM RE�RSETB�CK SIOESETBACN PUIICMELKNUMBEr FEF PECEIPTNO <br /> USE 20NE LOT ARE� v�cu�T site FEES VALUATON FEE <br /> BUILDIN6 ' <br /> TVPt Of CONTS�ILOW�BIF fYPF Of CON51�GNAL oCcunurt� n0 a vMu�Mc ux�n � <br /> �"p'o pIUMBINO <br /> _' — i <br /> uRE OF BLD6. NO OF STCM�ES BASEMENT MECNANICAL ' <br /> � <br /> OLGUP�NCY LOID FIRE SPPNRLERS REO'D MEIGMT LIMIT�710N ADOITIONAL PLAN CHECK � <br /> � <br /> OTHER ' <br /> RE�SON iOR SPRINMLERS T— <br /> SfATE BUILOINO SURCHRRGE � <br /> _ i <br /> MUMEBY Pl.�NS�PPROVEOfiY CITYOFEVERETT FUBLICWOHKS � <br /> LOCAL SALES , <br /> TAl(COOE IS 3105 T�T�� ' <br />