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APPLICATIOA FOR CONSTRUCINON PERMIT <br />IRAErWPPPn 9VBrett <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />259.8810 TO BE COMPLETED IN INK —PLEASE PRINT <br />❑ DEMOLITION LI COMBINATION ■ BUILDING CI MECHANICAL I I PLUMBING 1-1 SIGN <br />OW11ED WEADDBEM CITY tP PI <br />EVBmFrr r4yow ,vEr7, f73/ ewerAfr, Evarsrr a9>rol 399 • 4911 <br />CITY IF %QIF <br />ADa0TEC70F0E51CM11 WILADODESS CITY iM %TONE <br />f/.7'Cew ArrA/ 1zerri 710. eer /'y _6 s"F"rr gQtoc ?ra G}s/ <br />OENERALCa1TRACIOR MALACKAEU CITY iF PIXF9 LICENSEI <br />4ECN.WCw Cd111UCIM W1 ACCOESS CITY IF %IpE LICEIISEE <br />0.U1B%OCa1TMC1M &IAL AIpDEW CITY FF MICCE LICEIMI <br />O NEW ❑ ADDITION 1.1 ALTERATION LI REPAIR I DEMOLITION I WOODSTOVEIFRPL INSERT SBUILDING REI OCATION <br />If~ wfgf E1R 011 W15EP RE&IWEL CMY <br />CdIH1ACI PRICEWNpaI: gjpo. P•/oNYr. <br />Ca11ACr PEDSUII wID %IDNI TO <br />M/eK?!c J,vonl:Afltrf <br />SCROf WaMAMS01:A e:44.rDEI OEfv Clopre rc <br />//Af7.7dlC! elArfros.�.!' E nF/I/LJ tGe~ <br />f/NLlf7 orflN/rlCl✓' R9-9 Gf7l <br />%gaosfooeEawao+q <br />'r eR�/� • <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME 70 BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. TILE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE. Cr CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION 15 MADE AND I COMPLY WITH T14E STATE <br />CONTRACTORS LAW IB 27 RCW AND 296.200 WAC. <br />6y10NAIURE OF Ep11RAC1(Nial AUDgRNED ADEIII DATF <br />l[Dw OftLPoPIpIa PIgPFNYryg1'M BELOW OA ARACII/dRI LOP[SI <br />Lor BLoa aF <br />fa! A/rr07r4'v0"0 ✓'/!F /LAN, <br />7421 6eV5F"'y LAIJO 6VEIM11' ke4dd <br />AP0.1CJ4TS CITY Bxws-sl WrNst Too A,xIwwwNwE <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />AIC-AAINULG UNITS --HI. <br />_ <br />BATHTUB <br />_ <br />FORCED AIR SYSTLMS-B.T.U. M EA. <br />LAVATORY (WASH BASIN) <br />UNIT HEATERS--R.TU. M <br />SHOWER <br />_ <br />CLOTHES LAYERS <br />KITCHEN SINK, A DISP <br />VENTILATION FAN <br />_ <br />DISHWASHER <br />_ <br />RANGE HOOD <br />T <br />LAUNDRY TRAY <br />_ <br />WATER HEATER <br />CLOTHES WASHER <br />_ _ <br />STOVE <br />_ <br />URINAL <br />_WOOD _ <br />HETAL FIRF.r LACE 6 CHIMNEY <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />_ <br />FLOOR BRAIN <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />_ <br />_ <br />GAS PIPING <br />_—_�— <br />_ <br />ROOF DRAINS-RAINLEADERS <br />EXHAUST FAN <br />— —i—_ <br />SINK (SERVICE -BAR, ETC.) <br />SUBTOTAL S <br />SUBTOTAL $ <br />_ <br />PERMIT f <br />PERMIT $ <br />�— <br />TOTAL FEE S <br />TOTAL FEE . <br />�— <br />_ <br />fRa1T SETBACK <br />REAR BEIBA[N I <br />- � <br />SIDS BEIBACIs ' <br />ZS +-lo <br />%AN CJ[[F, I�A� <br />.J(Yd <br />PFF. <br />_ <br />RE[FFIFq <br />usE iaN <br />to, AREA <br />VACwrtvIE <br />I 1 YES Ll'RO <br />FEES <br />VALUATION <br />FEE <br />WILDINGi <br />� <br />--- <br />/fD <br />ImaCorsi wlmvwl <br />ski <br />ITnaCCMI wTVw <br />®Lsr <br />AvowKurun <br />61FE DP Bl00 <br />NO CP SIM[S <br />I <br />BASFMENI <br />I I YES ?G NO <br />MECHANICALMAke, <br />OUTER <br />— <br />— — F— <br />_ <br />OCa W'LOAD r"BPNMLERSPE00 Ma" ITATKKE <br />3�_ LI YES Of NO <br />gEASO11 rm SPAIAQFM <br />STATE au0.OD10SUBCIIAROE <br />STATE ENEIIGY SURCHARGE <br />AMlKA1KY1 Aee. er <br />r1ANBAwRDVToer <br />J /�j � <br />CITY OF EVERETT <br />LOCAL SALES <br />AX CODE IS 3105 <br />� <br />Pun'q WORKS <br />roue <br />/)q, O <br />