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� j <br /> APPLICATIbN FOR GONSTRUCTy�N PERMIT <br /> everett . � <br /> Ms Everpreen � <br /> everett � � <br /> BUILDING DEPARTMENT TO BE COMPLETED IN INK—PLEASE PRINT ' <br /> 259-8810 , <br /> ❑ DEMOLITION ❑ COMBINATION ❑ BBIILDING O MECHANICAL PLUMBiNG ❑ SIGN ; <br /> pyy�E /�ILADDR S CITY ZIV�J PNONE <br /> k /")ll��(�(�1�����' 1��10Y�r, ' G� '�� <br /> TENANT ,j M�IL/� PESS � CIiY �IP PHONE <br /> ��, �.�� � ,a �«i u o lya� � -�. 31 �.;co�ul�� v � 'e'� ��-�s71 <br /> �PCMITECTORUEb�6NER MAILM�RESS CITY ZIP P�E <br /> l <br /> _ � <br /> GENER0.CONTMCTOR MAILADDRE55 CITY ZIP PNONE LILENSE� <br /> i <br /> MECN LGONTRAC H MAILAUDRESS CITV 21P PXONE ' LICENSE� � <br /> � ����.� � � <br /> PLUMBWOCONTRACTOfl MAILADDPE55 GiV 7.IP FHONE LICENSE� <br /> QASS OF WORI( ' <br /> ❑ NEW ❑ ADDITION ❑ AITERATION ❑ REPAIR ❑ DEMOUtION �J�1 WOODSTOVEIFRPL INSERT ❑ BUILDING RELOCATION ' <br /> 7ENANT MPflOVEMENT Ofi 1NTERIOR NEMODEI ONLV COHiACi PEPSON hN0 PHONE NO. � <br /> S <br /> GONTRACT PPILE OF WORN: <br /> OEBC IBEWdiNAND60UAREFOOT�OEINVOlVEO � <br /> x Y� �I �.�aocl 'on`�et - li hsP,�1 y s�- - <br /> rnoro useoFqw�oino I HEREBY CERTIFY THAT I HAVE READ AND EXAMINE� THIS <br /> x APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.AlL <br /> �ou 6CRIPTIDN PROPEHiY(SNOWNBELOWORATiACNFOUHfAF�ES) PROVISIONS OF LAWS AND ORDINANCES GOVERNINO THIS TVPE OF <br /> WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> �oi BLOCK oc NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AUTHORITY TO VIOLATE OR CANCFL THE PROVISIONS OF ANY � <br /> OTHER STATE OR LOCAL LAW REGULATIN6 CONSTRUCTION OR THE I <br /> PERFORMANCE OF CONSTRUCTION.THAT 1 AM AUTHORIZED BY THE � <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 1827 RCW ANO 296200 WAC. ' <br /> SIGNATUREOFCONTR�CTORORAUTHORIZEOAGENT D�TE � <br /> y ! <br /> A � 1 r <br /> i <br /> P CT OR SS � I <br /> � RP LIC TSCITVBUSINESSLICENS NO.ANDBUSI ESSNAME <br /> � � � U?� .1a�t , <br /> PLUMBINQ � ME ANICAI ' <br /> NO. TYPE OF FIXTURE QR ITEM FEE NO. TYPE OF EQUIPMENT FEE <br /> WATER CLOSET(TOILET) � A/C—A/HNDLG UNI7S—H.P. � '. <br /> BATHTUB � FORCED AIR SYSTEMS—B.T.U. M E.A. ' i <br /> UIVATOFV(WASH BASIN) r UNIT HEATERS—B.T.U. M � <br /> SHOWER ' CLOTHES DRYERS ' '� <br /> KITCHEN SINK 8 OISP i VENTILATION FAN i <br /> O�SHWASHER � HANGE HOOD � <br /> LAUNDRY TRAY ; WATEii NEATEfl ' <br /> � <br /> CLOTHES WASfiER � WOOD STOVE � <br /> URINAL ' METAL FIREPLACE 8 CHIMNEY ' <br /> DRINKING FOUNTAIN � FIREPUICE INSERT � � <br /> FLOOR DRAIN <br /> � HEAT PUMP ' <br /> BACKFLOW PREVENTERS ; GAS PIFING � <br /> ROOF DRAINS—RAINLEADERS � EXHAUST PAN � ��� <br /> � SINK(SERVICE—BAR,ETC.) � � � <br /> � ' <br /> � ' I <br /> ' i I <br /> i <br /> — i ' <br /> SUBTOTAL $ � SUBTOTAL $ ' � <br /> � <br /> PERMIT $ � PERMIT $ i � <br /> TOTAL FEE $ <br /> i TOTAL FEE E ' � <br /> FRONTSET�C" REAHS�R'GK SIDESETBRCN IJ )I PUNCNECNNUMBER FEE RECEIPTNO. <br /> i1 0 ��h�(A1 ��7i� <br /> U6EZONE LOT�flEA VACMlTSITE FEES VALUATION FEE <br /> ❑ YES ❑ NO BUILDING . � <br /> TYPEOFfANST.ALLOWABLE TVPEOFCONSi.ACNAI aNP��cr NOaO'M1uxGlmit6 � <br /> anao pLUMBINO i <br /> i <br /> SIZEOFBLDO. NO.OFSTOHIE9 B�SEMENT MECHANICAL ' ' <br /> ❑.YES n No ; t <br /> OCCUPANCYLOAD FIRESPRNNLERSflEOD HEIGNTLIMITATION OTHER � I� <br /> i <br /> C] YES ❑ NO STATE BUIL�ING SURCNARGE � <br /> REASON FOfl 6PflINKLERS � <br /> STATEENERGVSURCHARGE i <br /> � D <br /> APPLICATIONACC.BV PLANSAPPROVEDBV CITYOFEVERETT PUBLICWORNS � � <br /> LOCALSALES , I' <br /> TAX CODEIS 3105 TOTAL � ' i <br /> �IT�=^`!_' 1�'„�n�� YT �`.�� w��1�.x nM��•�. <br />