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APPLIC�ION FOR C4NSTR�TIAN <br /> PERMIT <br /> rne Everoree^ cvcrett <br /> CITY OF � <br /> everett <br /> BUILDING DEPARTMENT <br /> 259•8810 TU BE COMPLETED IN INK- PLEASE PRINT <br /> OWNER <br /> MAILA�OflESS G11Y 21P FMONE <br /> L-Lo�1.�' G'��O S'U(L N FJ \ � <br /> L �Z, ��� GIiY ZIP VNONE <br /> TEqN�NT MRILApORESS <br /> I1'10� � C.L`V-'� ��� GITY 2iP PMONE <br /> ARCHITEGTOROESIGNEN M�ILADDRE55 <br /> ' GF.NEP�LCONTRPCTOR MRRR�DRE55 CITY ZIP PHONE LICEM1dE• <br /> MEGH�NIG�I.CONTHACTOR M�IL�DDRE55 GI1V ZIP PMONE VCENSE• <br /> /.�c P;K �sv� ���-.r � � �. a�� Ev-�-�-Es-��i r� <br /> �uL �£� �� � /" MRILADDRESS GITY 21P PMONE UC[NSE• <br /> PLUMB OGONTRAGTOR <br /> ClA$5 f WORK <br /> �EW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ �EMOLITION ❑ WOODSTOVFJFRPL INSERT ❑ BUILOING RELOCATION <br /> TEN�!IT IMPROVEMENT OR INTEFIOR RFMODEL ONLY '/ O / <br /> GONTAGT PERSON PND PHONE N0. <br /> CANiRAGT PPILE OF WORK 1�l N SA LJ �S�< ���1� <br /> OESCRIBE WORK FND 50 WRE i00T�GE INVO WED <br /> . V�� lA trledh NS �� 1 �.J � vn � <br /> PROPOSED 115E OF BU�LOINO I HEREBY CERTIFY THAT I HAVE READ AND EaAMINED THIS APPLICATION.1ND <br /> � KNOW'HE SAME TC BE?GUE AND CORFECT.ALL PROVISIONS OF LAWS AND <br /> ���JiC L OR�INANCES GOVcRNING THIS TYPE OF WORK WILL BE COMPLEiED WITH <br /> LEGALOESGRIPTIONO�PROPEPiY15MOWNBELOWORAITAGH�OUPCOPI[51 WHETHERSPECIFIEDHEREINORNOT.THEGRANTINGOFAPERMITDOESNOT <br /> PRESUME TO GIVE AUIHORIN TO VIOLATE OR CANCEL THE PROVISIONS OF <br /> �or o�ocK__ oF ANYO7HERSTATEORLOCALLAN'REGULAtINGCONSTFUCtIONOR7HEPER� <br /> FORMANCE OF CONSTRUC710N.THAT I AM AUTHOAIZED BY THE OWNFR OF <br /> ANID PRCOMP VTWITHRTOHE STA Ew00NTRNCTORSH A�L�82T�OR�1�AND <br /> , 29fi.200 W>C. <br /> SIGNATUREOfCONTPRG'OROR09iHOR12ED�GENT OATE <br /> �- z�-s•i <br /> . X ��- �� �3 �'�..� <br /> PROJEGT AG�RE55 APPLICANLS GIY BUSINE55 L�CENSE N0.FND BUS�NESS N�ME <br /> Iz��S ( n . <br /> MECHANICAL <br /> PLUMBINO <br /> FEE NO. � TYPE OF EOUIPMENT FEE <br /> NO. TYPEOFFIXTUREORITEM q�C—q/HNDLGUNI75—H.P. <br /> WATER CLOSET(TOILET) <br /> FORCED AIR SVSTEMS—B.T.U. M EA _ <br /> BATHTUB <br /> � LAVATORVIWASHBASIN) _ UNITHEATERS—B.T.U_M _ <br /> CLOTHES DRYERS <br /> SHOWER � :L <br /> KITCHEN SINKB DISP. VENTILA710N FAN <br /> DISHWASHER ��i RANGE HOOD — <br /> WATER HEAIER <br /> LAUNDRVTRAY <br /> CLOTHES WASHER WOOD STOVE <br /> METAL FIREPLACE 8 CHIMNEY <br /> URINAL <br /> DRINKING FOUNTAIN FIREPLACE INSERT <br /> HEAT PUA1P <br /> FLOOR DRAIN <br /> BACKFLOW PREVENTERS GAS PIPING <br /> ROOF ORAINS—RAINLEADERS EXHAUST FAN <br /> SINK�SERVICE—BAR,EfC' _ <br /> SUBTOTAL S SUBTOTAL 5 <br /> PER6117 S <br /> PERMIT $ / <br /> TOTALFEE g <br /> TOTALFEE $ FEE PECEIFiNO. <br /> FRONTSEfBAGK PEPRSEiBAGK SIOESETOAGK <br /> PUN Ct1ECN NIIMBEH <br /> �prpq�, VAGANTSITE FEES VALUATION FEE � <br /> 115EZONE ❑YES ❑NO <br /> BUIIDING <br /> ttPEOFCANST OGCUPANCYGROUP NOAFDWELLINGUN65 <br /> p��pW�BLE/AGTUAL PLUMBING <br /> SIZEOFBLDG. NOOFSTOR�ES BSMT. OCGLOAD MECHANICAL � <br /> ❑Y <br /> ❑N <br /> NEIGNTLIMITATION OTHER <br /> FlRESPRINKLERSREOl11RED ❑�ES ❑HO SIATEAUII.DWGSURCHARGE <br /> STAT[ENflRGY SURCHAFGE __ <br /> PVP4CATIONAGGBY PUN3h�pp.B'! � pUBLICWORKS _ <br /> � �lIV '^" .`' C�,� <br /> �,v� TOTAL � <br />