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APPLICATIO���`FOR CONSTRUCTI `�`N PERMIT e�e�e'c <br /> meeve�pmen TO BE COMPLETED IN INK—PLEASE PRINT � <br /> cirv oF � <br /> everett HEATING SYSTEM: ❑GAS ❑ELECTRIC ❑ <br /> , BUILDING DEPARTMENT <br /> 259-8810 <br /> I 1 DEMOLITION U COMBINATION ( I BUILDINCa ❑MECHANICAL �i�PLUMBING ❑ SIGN <br /> `. ' [q MAILADDRE55 � J CI1V '/� �, 21P,�` ' � PNONE <br /> ' � A'1!:K�/ 3n1`-� �Q7 l7 --f/-aC7L�7� �'4�` �� r�r ��5 7 `P O_G'� <br /> y. <br /> j TENANT AUM1�ODRESS CITY 21P PNONE ' <br /> -. s <br /> � yI pRLHITECTON�ESiGNER M�IIADDRE55 GTY ZIP PI/ONE ' <br /> _ y II <br /> � GCNEML/LONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE I � <br /> -� i lri��rl-.�A CJ I,F 1 — - _ _ �' <br /> � MECHANICALLONiPACTOR M�ILAUDPE55 LITY ZIP PIqNE LICENSE� ' <br /> �.: j l <br /> � IRUTABINOLONIR�CTOR M�ILAOUf185S LITY 7.IP PHONE LILENSE� <br /> I <br /> J'� � <br /> '• i cuss oF woeK � <br /> ;a� I J NEW I l ADOITION ALTERATION fJ REPAIR I_1 DEMOUTION ❑ WOODSTOVE/FRPL INSERT ❑ BUILOING HEIOCATION li <br /> ���. CONTACT VEHSON AND PHONE NO. ' <br /> -� j CONiA�CTPRICEOFWORK 3 .a� <br /> DCSCNIBE WOfiK AN�SWAAE FOOTAGE�NV0.VCU <br /> i <br /> � i <br /> I rnoroseouseoreunoir+c I HEREBY CEflTIFY THAT I HAVE READ AND E%AMINED THIS <br /> � � APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> � � PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEO�l0E5CPIPTKKI OF PPOf`EBTY ISNONT!BELOW OR ATI�CH FqIP CA�'IES� <br /> �a' � WORK WILL BE COMPLETED WITH WHETHFR SPECIFIED HEREIN OH <br /> � �or BLOCK oF NOT. THE GPANTING OF A PERMIT DOES NOT PRESUME TO 61VE <br /> „ � AUTHORITY TO VIOLATE OH CANCEL THE PROVISIONS OF ANY <br /> � OTHER STATE OR LOCAL LAW REGULATING CUNSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM RUTHORIZED BY THE <br /> ��. OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> � � APPLICATION IS MADE AND 1 COA'PLV WITy THE STATE <br /> �., � CONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br /> { SIGNRTURE O�CON1RRCiON OR AUiHORIZED AGENT D�TE <br /> r y <br /> • � y{I A <br /> !� t PPOJEGT�DONESS t ' <br /> �i� f ` APPLIC�NfSCITYBU NESSLICENSENO.ANOBUSINESSNAME <br /> ,4� LUMBING MECHAHICAL <br /> ��� N0. TYPE OF F TURE OR ITEM FEE NO. TYPE OF EOUIPMEIIT FEE <br /> °' }' WATER CLOSET(TOILET) � � /UC—A/HNDLG UNITS—H.P. � <br /> '�,�� ` BATHTUB ' FORCED AIR SYSTEMS—B.T.U. M E.A. � <br /> - � LAVATORY(WASH BASM) �� UNIT HEATERS—B.LU. M i <br /> ;i SHOWER ' CLOTHES DRYERS � <br /> KITCHEN SINK 8 DISP ; VENTILATION FAN � � <br /> T�� � DISHWASHER � RANGE HOOD � <br /> ��'T � LAUNDRY TRAY ; WATER HEATER ' <br /> �� � CLOTHES WASHEfl i WOOD STOVE i <br /> URINAI ' METAL FIREPCACE 8 CHIMNEY � <br /> � DRINKING FOUNTAIN i FIREPLACE INSERT i <br /> !�., } FLOOR DRAIN � HEAT PUMP � <br /> i BACKFLOW PREVENTERS i GAS PIPING ; <br /> . <br /> . 1 ROOF DRAiNS--RAINLEADERS � EXHAUST FAN � <br /> � SINK(SERVICE—BAR,ETC.) ; ' <br /> � <br /> � � <br /> � � <br /> � � <br /> � � <br /> — � � <br /> �� SUB TOTAL $ J � SUB TOTAI E ' <br /> � _ PENMIT� $ _�Q � '' PERMIT S i <br /> ' TOTAL FEE $ 'i TUTAL Fh� 5 . ' <br /> , FOR OFFICE USE ONLY: <br /> FRONTSETBACN �EA05ETBACK SIDE6ETBACK PLANCIIECKNOMBER FEE RECEIPTNO. <br /> �� use zoNe LOT�REA V�CANi SIIE FEES VALUATION FEE <br /> �UILDING � <br /> i ; IYPfOftONiS.PILOWABLE TYPEOiLUN51.�CtWL Occuv�xcr xoaOMuixGimit6 � <br /> ' �a� PLUTABING i <br /> ---�— <br /> ��' - 512EOFBlD(3. NOAFSTORIES BASEMENT MBCHANICAL � <br /> i <br /> OCCUP�NCYLO�D FIRESPRNKLERSREOD NEIGNTLIAIITAIION ADDITIONALPLANCHECK i �� <br /> — i � <br /> OTHER � <br /> PE�SON FON SPRINNLERS — --� <br /> STATE DUILDING SURCNARGE i <br /> – i <br /> IN7ANE BY PLANS APPROVED�Y CITY OF EVERETT PUBLIC WORK$ � i <br /> LOCALSALES � <br /> TAX.CODE IS 3105 Tor�i- � <br />