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APPLICATI�rN FOR CONSTRUCT�bN PERMIT <br /> everett <br /> !ho Gvergreen � <br /> CITV OF <br /> everett <br /> BUILDING DEPARTMENT <br /> 259-8810 TO BE COMPLETED IN INK—PLEASE PRINT <br /> ❑ DEMOLITION I I COMBINATION I I BUILDING MECHANICAL �PLUMBING I:1 SIGN <br /> OWNER M1AILAD E55 IIY 21 PIIONE <br /> 7������ �M�AO f1E5Sl � CI1V � 21P ���PIIO��� <br /> AiiGHIiECTO11�E51GNEf1 MAILADDRESS CITY ZIP PHONE <br /> GENERALGONTRACiOfi MNLAD�OESS QTY ZIP PIIONE I�CENSE� <br /> AIECHANk:F' :.O'+UNCIGfI �LADORE55 CIiY ZI PHONE UCFNSEM <br /> LQ1�ST/}P. CS� G Q i 2'�7� 5W L�vNwooh� So. ' G Io-I'1G� LoD�S�c►"7�+Kc; <br /> r�uMmr+oca+rnncron _� MAIL�DDPE55 cttr zm . ruouc � LICEN5E1 <br /> CL SS OF WOBN <br /> �.. NEW ❑ ADDITION fJ ALTERATION I I REPAIR I I DEMOLITION I I WOODSTOVFJFRPL INSERT LJ BUILDING RELOCATION <br /> TEN�Ni1MPROVEMENTORINTEf�1011REh10DE�LY CONTAOi`ERSOt!- AN�\IIONEN��T'��1�� /�Q�����\ <br /> IL \S� � � <br /> GONieACTPRICEOF WORH: lr '�f � � <br /> DESCiiIBEWORNAND50U/.IlEF007 GEINVOLVE� <br /> In��t.� (� , �S (�i i��T Hr�`� G-7� — I`�G8 <br /> �r seousepreua v+a � I HEREBV CERTIFV THAT I HAVE READ AND EXAMINED THIS <br /> �.�� APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT,ALL <br /> i�cn oescniairorvoFrnorEntv is�+owNoetowonnrTncF�Founcomes� PROVI;IONS OF LAWS ANO ORDINANCES GOVERNING THIS TYPF OF <br /> WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> �or s�ocK oF NOT. T!IE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AUTN�RITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANV <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZE�BY THE � <br /> OWNER OF THIS PROPERTY TO PE�iFORM THE WORK FOR WHICH <br /> APPI.ICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br /> SIGNATl1RE CONTRA TOfiO AU1110RRED�GENT U4TE <br /> X �� ,, L�D� A <br /> PR0.1ECiADORE55 — <br /> I t , / 4PPLIC iSGI Y�USINESSLICENSENO.�NDO SWESSNAME <br /> W <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) � NC—NHNDLG UNITS—H.P. � <br /> BATHTUB ; FORCED A�R SVSTEMS—D.T.U. M E.A. ' <br /> LAVATORY(WASH BASIN) --,—�_ UNIT HEATERS—B.T.U. M � � <br /> SHOWER � CLOTHESDRYEHS ' <br /> KITCHEN SINK&DISP � VENTILATION FAN _�_ <br /> DISHWASHER � FANGE HOOD � <br /> � LAUNDRYTRAY ; WATER HEATER ' <br /> CLOTHES WASHER �— WOOD SiOVE � <br /> URINAL ' METAL FIREPCACE 8 CHIMNEY ; <br /> DHINKING FOUNTAIN i FIREPLACE INS[RT i <br /> —T. <br /> FLOOR DRAIN � HEAT PUMP � <br /> BACKFLOW PREVENTERS ; _L GAS PIPING � <br /> ROOF DR�INS—RAINLEADERS � EXHAUST FAN � <br /> SINK(SERVICE—BAR,ETC.) ; � <br /> � <br /> � � <br /> --�— <br /> , — � <br /> � � <br /> � � <br /> �— _*_ <br /> � � <br /> SUB TOTAL $ ; SUB TO'AL $ <br /> PERMIT $ � PERMI'� S � <br /> TOTALFEE $ ' TOTALFEE $ ' <br /> FRONT SEiBACK RERfi 5ET0�CH SIOE SETOACN PLAN CNECK NUMBER FEE RECEIPT NO. <br /> USE20NE �oranen vncnNrsne FEES VALUATION FEE <br /> fJ YES I I NO pUILDING . � <br /> tYPEOiLCYSIALOWABIE 7YPFOfGONST.�CNAL OCNrer�cv rmMmttlunGuxnS i <br /> �a� PLUM�ING � <br /> -r <br /> SIZEOFOLIX3. NO.OFSTOfiIES OASEMENT MECNANICAL � <br /> O YES CI NO � <br /> OCCUPANCYLO�D FIRESPfiNKLERSPEOD NEIGHTLIMI7AilON OT���R � <br /> Ll YES L 1 NO STATE UUILDING SURCHARGE � <br /> REASON FOR SPRINRLEPS —T <br /> STATEENERGVSURCHARGE i <br /> i <br /> APPLICATIONACC.�Y PUNSAPPROVE�UY CITY OF EVERETT pUOUC WOfiNS i <br /> LOCALSALES <br /> TAX COUE IS 3105 rorn� � <br />