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APPLICATI4� FOR CONS'�TRUCT�dN PERMIT <br /> �����« <br /> ;rrr ccrrOrren � <br /> QTV O� <br /> everett <br /> BUILDING DEPARTMENT <br /> 259-8810 TO BE COMPLETED IN INK—•PLEASE PRINT <br /> � r� ' DEMOLITION COMBINATION BUILDING MECHAN:ICAL PLUMBING SIGN <br /> . <br /> y OWNER MR�LRD�R[55 GTY ZIP PHONE <br /> q� H �1,7/E!'fTt �71oYaR i.t/N E✓�Ef� Yt/�8�/ (�o l Sf'—6/3 / <br /> �j F3�/J TENRNT IAAiIA�DR[55 GITv 21P PHpNE <br /> r � 5'/ LC�O o?3�/ 7 7 4!�'!/Ir ln� • ��/c�.�F1P�3G �f3-87.1 5� <br /> �� � aRGNRECtOR0E5�GN[R M4�LRDDRE55 LITY 21P � PHON[ <br /> H xl <br /> �H� (;LNENRLCOMTRACTOR MPiLA0�RE55 GITY 21P PHONE LICENSEY <br /> VJ H � <br /> �'-/..-�tGv <br /> .�C �R� MEGHRNIG4LCONLRAGTOR MAI'_RDDRE55 C�TY .LIP PMONC ��CENSE' <br /> �� �] d <br /> O N PWMBINGCONTRAC70R MAILqDDRESS GTY ZIP PHONE LICENSE� <br /> � �g <br /> 7Y �] <br /> LLASSOF WOFN <br /> y NF.W � � ADDITION ALTERATION � REPAIR � DEMOLITION �..� WOODSTOVE/FRPL INSERT � BUILDING RELOCATION <br /> M <br /> 'Z H <br /> � H y T[hANTiMPPOVEM[NTORINiERi0i1N[MOOEI �NIV CONTACTPFRSONANOPHCNE..). <br /> �J W � CONiPAGTPRiCLOFWOPN: Q� / <br /> �"y DESCRiBE WON4�ND SOURRE FOOTAGE INVOLVED , <br /> V � <br /> � oC'EPt/�cc ?f ace L�.eGe „�,,.per.�r u.r(JN N� <br /> �`� � PROPOFEOWEOFBU�LDING . / 'Y� � o.�t I HEREBV CERTIFY THAT I HAVE PEA� AND EXAM{NED iHIS <br /> y p y � _� J APPLICPTION AND KNOW THE SAME TO BE TRUE AND CORREC'.ALL <br /> �/ETTE-Z EY�S/�N6 <br /> �eca��esceianor+orcRoveanis�wwrveeicwoaatucnFouecoaiEsi PROVIS1�NSOFLPWSANDORDINANCESGOVERNINGTHISTVPEOF <br /> . WORN N�ILI 8E COIdPLETED WITH WHETHER SPECIFIED HE'�EIN OR <br /> �ot � BLOGN � OF NOT. Tlil: GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AUTHOPiTV TO V!OLATE OR CANCEL THE PROVISIONS OF ANV <br /> OTHER S�ATE OR I.00AL LAW REGULATING CONSTPUCTION OR THE <br /> PERFORtJ�ANCE OF G�NSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS FROPERTV TO PERFORM THE WORK FOR WHICH <br /> APPLICAl10N IS MADE AND I COMPLV WIT `1E STATE <br /> CONTRACTOPS LA`N 1827 RGW AND 296200 WAC. <br /> SIGHAIUREOFGONiFAGTORORAJtHOPiZEOPG[Ni�A I� <br /> v <br /> X %/J - / 3zi � <br /> /�O � r /� D _I /�/ // � <br /> PROJECTAp9PE55 –�`--� <br /> qPPUGRNTSGITYP :�1:135LICEN���ESSNAME <br /> /— �., PLUMBING MECHANICAL <br /> i���- NO. TVPE OF FI%TURE OR ITEM FEE N0. �TYPE OF EOUIPMENT FEE <br /> WATER CLOS[T(TOILET) AiC—A�HNDLG UNITS—�H.P. <br /> � I � — BATHTUB FORCEO AIfi SVSTEMS—B.T.U. M EA. ; <br /> 1 LAVATORY IWASH BASIN) UNIT HEATERS—B TU M <br /> � �� SHOWER CLOTHES DRYcRS —T <br /> , ��I KITCHEN SINK 8 DISP VENTILATION FAN <br /> ', , DISHWASHER RANGE HOOJ <br /> � LAUNDRV TRAV WATER HEATER <br /> CLOTHES WASHER i WOOD STOVE � <br /> � ��� _ URINAL METAL FIREPLACE 8 CHIMNEY --� <br /> DRINK�NG FOUNTAIN FIREPLACE INSERT <br /> I FLOOR DRAIN HEAT PUMP <br /> --� <br /> BACKFLOW PREVENTERS ; GAS PIPING <br /> � �� ' ROOFDRAINS—FAWLEADERS � EXHAUSTFAN <br /> � � SIIJK(SERVICE—BAR,F i C.) ; <br /> � 1�� — <br /> SUBTOTAL $ SUBTOTAL S <br /> PERMIT $ PERMIT $ <br /> t� TOTAL FEE $ TOTAL FEE $ <br /> � <br /> ��, <br /> FRONi5E1R4CN PEFNSETDALN SIDESETBRCK PIANCHEGKNUMB[B �E[ RECEiPiNO <br /> use zorve ioi�nee vacnr�t si� FEES VALUATION FEE <br /> f_: YES Li NO sui�oirvc �p� Jr'l/ � o� <br /> tYPEOfLONSi.AILOWA9lE TYPEOfCONST.AL7IIAL occunwtr Naaow[wN4tMns — <br /> �aW� PLUMBING � <br /> SIIEOFBLDG. NO.OFSTONIES BASEMENi MECHANICAL <br /> Ci YES CI NO <br /> OCJUPANCVLORD FIRESPPNKLERSRE00 HEIGHiLIMIT�TION OTHER i <br /> I� YES I-1 NO STATEBUILDINGSURCHARGE �{� <br /> RERSON FOR SPRINKLEflS � <br /> STATEENERGYSURf,NARGE <br /> APPLICATIONACC.BY PUNSAPPRWEDDV CITYOFEVERETT P!J6UCWORHS <br /> � LOCAL SALES �� <br /> TAX CODE IS 3105 TOSAL �jv <br />