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�� � ,� � <br /> � APPLICATI�� FOR CONSTRUCT�JN PERMIT 1 <br /> everett <br /> .�E��� e <br /> CITV OF <br /> everett <br /> +��� ' , BUILDING DEPARTMENT TO BE COMPLETED IN INK—PLEASE PRINT <br /> 259•8810 � <br /> � f i DEMOLITION COMBINATION �UILDING MECHANICAL PLUMBING i i SIGN <br /> �J ONMEP M�iL�ODHE55 GITV ZiP PNONE <br /> F�� ,Qovc.a.u0 CULZdGVRaL s/O JOGt/FkSONP,L[�O• EU�FPT ���v/ ZS�•/o�� <br /> FI TEIUMT M�IL�ODNE55 <br /> M <br /> ~�� cltv zlv PHONE rG <br /> /� �pCNITEGTOH0E6K.NER M�IIAD�RESS �ze ��p �I��.� <br /> � 1��,y P,d7e��.,. G,es.�r,v,�N �s�b,u z6.P�,orr�o.�.va� � ,S�nn� ��ioz A <br /> . t1 � OENERQLp1iP�CTOH M�Il�00NE5S CITY ZIP PHONE LICENSE� SYS/ <br /> � 7ZS� f RiaG N� ,oR r✓ic1n uin 9,f 270 6.f?- � p <br /> 6� Ye�K��y CONlTRUCT/�.r� 7 77N � r or�e ��ecNse. f�ECKGG / 47 <br /> MECHNIICALCONTRAGTOR M�ILAODPESS <br /> LILY Z�P <br /> �A CILV 21P FMONE IILENSE� <br /> r PIUMBINOCONTMC70R M�ILAODPE55 <br /> M <br /> H � cussoFwa+K : <br /> �,y f�.i NEW '..�'� AD�ITION �ALTERATION � REPAIH DEMOLITION WOODSIOVBFRPL INSERT ! � BUIL�INC3 RELOCATION <br /> �p� CONT�CT PERSON ANO PNONE NO <br /> TENNITIMPRWEIAENTOfiINTER gEMODELO�N.rLY� <br /> � CONTRACT PRIGE OF Wd�N: �j� O!/✓�� �' <br /> � pEBCRIBE WORN�MD 60U�flE fO0T�0!INYOLVED S� � C 56O <br /> � /l��Ne� L� �NS OD$L ! <br /> ppOPOSEDUSEOFBUILUINO I HEREBV CERTIFV THAT I HAVE READ AND E%AMINED THIS <br /> � �ES/O�.t?/AL APPLICATION AND KNOW THE SAME TO BE TRUE ANO CORRECT.ALL <br /> � �EpµpESCq�pTqNOFVROPERTY�SNOVMOEIOWON�iTACNiOURCOPIES� PHOVISIONSOFLAWSANDOR�INANCES60VERNINOTHISTVPEOF <br /> �� � ���� � � WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> ioT O e�ocK �1L. oF � NOT. THE GRANTIN6 OF A PERMIT DOES NOT PRESUME TO OIVE <br /> •/S `�3 AUTHORITV TO VIOLATE OR CANCEL THE PROVI910N3 OF ANV <br /> TJ L'U�i2F OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUC110N.THAT I AM AUTHORIZED BV THE <br /> � OWNER OF THIS PROPERTV TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE ANO I COMPLV WITH THE STATE <br /> CONTPACTORS LAW 18.27 RCW AND 296200 WAC. <br /> �IO AGU&/tiO� ��`��� SIGN�T EOFCONTP�GTORORAULIIORIZED�fiENt DATt <br /> Eu�Rl-77 !e/d. %� Z0 / �.dTR/G/�4 �NN�4�OEliyA) <br /> PRQIELiA00RE5S 1 ANiSCIi BU INESSLICENSENO�NOBUSiNE55NAMf <br /> "�� PIUMBINO MECHANICAL <br /> � FEE <br /> N0. TYPE OF FIXTUHE OR ITEM FEE N0. TYPE OF EOUIPMENT <br /> WATER CLOSET(TOILET) NG—NHNDLG UNITS—H.P. <br /> BATH7UB FORCEO AIH SYSTEMS—B.T.U. M E.A. <br /> C�� LAVATORV(WASH BA'iIN) UNIT HEATERS—B.T.0 M ' <br /> SHOWER CLOTHESDRYERS ' <br /> � ' KITCHEN SINK d DISP � VENTILATION FAN <br /> DISHWASHER <br /> RANGE HWD <br /> LAUNDFYTRAV WATERHEATER <br /> � �� CLOTHESWASHER �' WOODSTOVE -- <br /> METAL FIREPLACE 8 CHIMNEV <br /> I URINAL <br /> DRINKING FOUNTAIN FIREPLACE INSERT <br /> FLOOR DRAIN HEAT PUMP _ <br /> � dAS PIPING <br /> I �� BACKFLOW PREVENTEHS — <br /> pOOF DFiAINS-HAINLEADERS E%HAUST FPN <br /> SINK(SERVICE—BAR,ETC.) �� � . d <br /> i _� -- � � <br /> 1 SUB TOTAL S /Y � � Sl1B TOTAL S <br /> � PERMIT f PERMIT E �r_ <br /> TOTALFEE S � ' TOTALFEE S <br /> PLNICHECnN�MHER fEE PECEIPTNO <br /> FRONTSEiBAGN;a� RE�RSEi6��( ��� SiDE�EtBIC. � /� ,3 S fY.3 <br /> �z•z s-e �a v,� �a�y. �. <br /> LOi�REA V�CANT 511 FEES VALUATION FEE <br /> USCZONE � -D <br /> �F'i•"'� I S��2 VES � BUILDING ___ _ �S <br /> LYYE Of CONSi�llOWl9l[ I�Of GONSI Id1iUl �qar r �iv�«���°1'"s PLl1M�ING /+ '� <br /> �y 1L N <br /> 5RE oP ALDO No of sloniES FeSEMENT MLCHANICAL <br /> O D Z VES NO <br /> OTHER <br /> OCLUPU1CYlO�D fIRESPRNNLER5RFG0 NEiG�rtLiMlt/iiON __ <br /> VES �l NO SiATEBUIIDINGSURCHARGE _ i � <br /> R[�SON FOR 5vair�rclENS STATE ENERGY SURCHARGE <br /> AGPIIL�LION�CC B� PUNS�PPR�� OOV CITY OF EVERETT PUBLIC WORNS <br /> IOCALSALES 3a ; pu <br /> TAX CODE IS 3105 roT�i <br />