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pppLICpTII.�iV FOR CONSTRUC7�.ON PERMIY <br /> everett . <br /> �E��,�� e <br /> cm oF ' <br /> everett <br /> BUILDING �EPARTMENT Tp gE COMPLETED IN INK-PLEASE PRINT <br /> 259-8810 �SIGN <br /> ❑ DEMOLI710N ❑ COMBINI9TION ❑ BUILDING ZPMECHANICAL oNE ❑PLUMBING <br /> ��E M�ILADDHESS C�TY �-p OD <br /> s �� Z � 70 �� <br /> TEN� MAIL ADDRESS <br /> GITY ZIP PMONE <br /> ARGHITEG70RDESIGNEfl MAILADDRESS <br /> CIiV 21P PNONE <br /> �/ CITY q ZIP/ PNONE LICENSEf <br /> p RALCOKTR�C(OR MAR�D01�5�' � _ ,I �7�I'�� /O�/ 776 �YB�S B�lufN�'��n <br /> �z �T r N Nc r ✓^�!' �� e =�rn PNONE LICENSEI <br /> MECNANIC/�ICONTRpCTOH MAtL�0URE55 <br /> cirr <br /> pWMBIN6CON�A�CTOR MAlI.A0�RE55 <br /> GITY ZIP PHONE LICENSE� <br /> C SS OF�'40fiN <br /> NEW ❑ ADDITION I_J ALTERATION 1_] REPAIR I-1 DEMOLITION L1 WOOOSTOVElFRPL INSERT ❑ BUILDING flELOCATlO <br /> � COJ�iAGTPEPSON�A�OV(E11 .�/'4.1 Jl/H�N / /� �8�'3y <br /> tEN�NT MPROVEMENT OA INTERION 5(f.10�E1 ONT <br /> /J !d U!N' M � <br /> CONTR�CT PRIGE OF WORN: ��� � 1 V <br /> DEbCN�BE WORN ANO SOURRE FOOTAGE INVOL\'EO ,ONw�+c-+�T S/� <br /> MSrn.L S E uuN�N'1h3' <br /> pppPOSE0l15EOF8UILDINO I M'EREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> APPLICATION AND KNOW THE SAME TO BE TRUE AND CORHECT.ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEOALDESCAIPTIONOFPFOPEf1T'ISHOWNBEIOWOPATiPCNFWRCOPIES) yrORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> ior e�ocK ov NOT. THE GRANTING OF A PERMIT OOES NOT PRESUME TO GIVE <br /> AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> PERFORM�NCE OFOCONSTRUCt ON.LTHATG AM AU HOFI ED BY THE <br /> APPLICATION'SISRMADET ANDPE COMPLYH WIT�HKT ER STATE <br /> CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br /> S�GNATUREOfCONTR�CTORORAUIHO EDPGENT DAtE <br /> _— <br /> X Q,� �''�(-l��`1 5 i3-9a <br /> PROIECTA�DHE55 ppp� �f/ly.j�U°l.':c LI EN N0. 95NE <br /> ��j�� /Q� � , r <br /> PL_.LZ�"N Y-- MECHANICAL FEE <br /> FEE NO. TYPE OF E�UIPMENT <br /> �p, TYPE OF FIXTURE OR ITEM -- , <br /> WATER CIOSET(TOILET) � a'C—a'�`���-G UNITS—H.P. �— <br /> � FORCEO AIR SYSTEMS—B.T.U. M E.A. 1 <br /> BA?HTUB ' — � <br /> UNIT HEATERS—B.T.U. M ' <br /> LAVATORY(WASH BASIN) ' T— <br /> � <br /> CLOTHES ORYERS � <br /> SHOWER ._ , � <br /> VENTILATION fAN � <br /> KITCHEN SINK 8 DISP ' <br /> � RANGEf1000 � <br /> DISHWASHER � WATER HEATER � <br /> LAUNDRYTRAV ' � <br /> CLOTHES WASHER � WOOD STOVE <br /> � METAL FIREPLACE 8 CHIMNEY ' <br /> URINAL � fIREPLACEINSERT ' <br /> DRINKING FOUNTAIN ' <br /> i HEAT PUMP � <br /> FLOOR DRAIN � GAS PIPING ' <br /> BACKFLOW PREVENTERS ' � <br /> ROOF DRAINS—RAINLEADERS � EXf1AU5T FAN <br /> � <br /> � <br /> SINK(SERVICE—BAR,ETC.) � ' <br /> � <br /> � �T— <br /> i <br /> : <br /> � <br /> � ' <br /> � <br /> � <br /> i , <br /> SUB TOTAI $ SUB iOTAL $ ', <br /> --� PERMIT $ ' <br /> . �RMI7 S ' <br /> TOTALFEE S ' TOTALfEE $ ' <br /> REARSETB�CK SIDESETBA�N PLANCHELNHUMBER <br /> FEE RECEIPTNO. <br /> FHONTSETBRC+[ '� <br /> S O FEES VALUA'fION FEE <br /> USE ZON^ LOT AREA VRCANT SITE �J � : <br /> ,�Z ❑ YES N NO BUILDINO � � <br /> ucuw.rKr xa.aow[uixcu�nn — � <br /> ttPE Oi CONSi.ALIOWABtE TV7E Oi CONSI.ACTOld � , <br /> �"0°v pWMBINO �—i— <br /> i <br /> SREOF�l00. NO.OF6TOF�ES BASEMENT MECHANICAL � ' <br /> Il YES I I NO � � <br /> OTHER <br /> OCCUPNICYLO�D FINESPRNNIERSPEO'D HEI�M{L1ITATION � <br /> ❑ YES ❑ NO I STATE BUILDINO SURCHARGE _� , <br /> i <br /> REASON FON SPNINKLEflS STATE ENERGV SURCHARGE ' <br /> �PPLICATION ACC.BY PLANS A FOVEO BY CITY OF EVERETT PUBLIC WORKS � <br /> LOCAL SALES ; <br /> TAX COOEIS 3105 TOTAL <br /> --_,s,e-.. ,___�__.. ..... ; <br /> .. ... _ . , . <br /> _. .. ._ .. <br />