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� <br /> AP�LICATION FOR CONSTRUCTIVN PERMIT <br /> „�E,�,�,�„ everett <br /> CITV bF e <br /> everett <br /> BUIL�ING DEPARTMENT <br /> 259-bd10 TO BE COMPLETED IN INK—PLEASE PRINT <br /> DEMOLITION COMBINATION BUILDING xMECHANICAL PLUMBING SIGN <br /> OWNER IdAll ADDRESS � C�TV ZiP pqpNE ! <br /> /�i/ce �i�r/iti , �-,,�17 ��oo����a,, �����' Y�vi � �- 7rz¢� <br /> ' TENAND�C/� ���AILAOC�17 (7rOA�G��) CI ����� ZIP PMONE I <br />� AFCHRECT OR DESIGNER MRIL ADOPE55 dTV 21P PHONE I <br /> GENERALCONTAACTOR MAILADDRESS CITV ZIP PNONE LICENSEP <br /> 7 <br />� MECNANIGALCONTRApTOR'/ /MRILADDBE55 CITV/�� -� 21Pg /� PHONE LICENSEI <br />�. �r�r�t�!/P_ �/{h7'�tA 7lJ¢9 �J. �!X/� f�� /`Ll+.I �L�gX �l/o3r6 �P'/'�Q/frJ �T <br />- PLUM G CONTRACTOR ADDRESS CITY ZIP PNONE LICENSE� <br /> C1A550F WORM <br />�' �. . NEW . ADDITION J' ALTERATION � . REPAIR � . DEMOLITfON !_�. WOODSTOVE/FRPL INSEFT '�,.; BUILDIPIG REIOCATION <br />��� TENANTIMPROYEMENiORINTERIpPPEMOD[LONLY CqNTACTPER$ONRNOPHONENO. �. <br /> �• CONTRRGT PRICE OF WORK: /n. � �, <br />�� DESCFIBE WORK AND SOUARE FODTAGE INVOWED I <br /> u� ' s. � i r � c�� �� 676 <br /> PROPOSEOUSEOPBUILDING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />� APPLiCATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br />���.,� �eca�oescniaTbH oF vaoreatv isNownee�owoa nrracN Fouacoriesi PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS NPE OF <br /> WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> :ot BLOCK oF NOT. THE GRANTiNG OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AUTHORITY TO VIOLATE OR CANCEL THE PROVI.�'ilONS OF ANY <br />�,. OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OH THE <br />�,: PERFORMANCE OF CONS'�RUCTION.THAT I AM AUTHORIZED BV THE <br /> P.. OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLV WITH THE STATE <br /> CONTHACTORS LAW 1827 RCW AND 296200 WAC. <br /> SIGNPTUHEOFCONiRALTORORAUTMOR2E�AGF.N7 DATE <br /> 1' <br />�a_, PPQIECTnDDRE55 r `�L�/ `� �--� �/y- <br /> � n�� '- / qPPIICANTSCITVBU5MES5tICENS[NOANDBUSINESSNFME <br />, V O�O�! �/ <br />� PLUMBIN(i MECHANICAL <br /> S'�`- NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EQUIPMENT FEE <br /> f <br /> , WATER CLOSET(TOILET) � / NC—AiNNDLG UNITS—H.P. <br />�t' BATHTUB ; FORCED AIR SYoTEMS—B.T.U. M E.A. � � <br />[�f� LAVATORY(WASN BASIN) UNIT HEATERS—B.T.U. M ' <br />!''��� SHOWER CLOTHES DRYEflS i <br /> KITCHEN SINK 8 DISP VENTILATION FAN <br /> DISHWASHER RANGE HOOD <br />� LAUNDRY TRAY ; WATER HFATER � <br /> CLOTHES WASHER � WOODSTOVE ; <br />�` URINAL ' �dETAL FIREPLACE&CHIMNEY � <br />- DRINKING FOUNTAIN ; FIREPLACE INSERT <br /> FLOOR DRAIN � HEAT PUMP �i <br /> - BACKFLOW PREVENTERS ; GAS PIPING <br />'J�. ROOF DRAINS—RAINLEADERS � EXHAUST FAN �— <br /> SVJK(SERVICE—BAR,ETC.) ; <br /> � ; <br />� � — <br /> � <br /> �— <br />�,� SUBTOTAL $ SUBTOTAL $ . 'C � <br /> PERMIT S � PERMIT $ — I <br /> TOTAL FEE S TOTAL FEE 5 ��' C� � <br /> FqONT SETBACN REAq SETBACK SIpE SETBACK PLAN CNECK NUMBER FEE RECEIPT NO. <br /> USEZONE LOTAFEA VAGFNTSITE FEES VALUATION FEE <br /> i �I VES � ' NO BUILDING i <br /> TVPE Of CON57.ALLOWABIE TVP[Oi CON57.ACTUAL occureNa Ha ar Uwuimc uxns � <br /> GPO�P � <br /> PLUMBING ' <br /> 512E OF BL�G. NO.OF STOPIES BASEIAENT /L S�L�` <br /> MECHANICAL � <br /> " �. ��. YES :J NO ' <br /> � <br /> OCCUPRNCV LOAD FIRE SPRNKLERS REO'D HEIGHT LIMITRTION OTHER � � <br /> i_��. YES ❑ NO STATEBUILDINGSURCHARGE � <br /> RERSON FOR SPPINKlERS I <br /> STATEENERGVSURCHARGE ' <br /> APPLICATIONACC.OV PLANSAFPROV[OBY CITYOFEVERETT PUL�LICWORKS � <br /> LOCAL SALES ' <br /> TAX CODE IS 3105 TOTAL �� �I ('(l, <br />