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APPLICATION FOR CONSTRUrT10N PERMIT <br /> «E�ro�� everett <br /> CI7Y OF e <br /> everett <br /> BUILDING DEPARTMENT <br /> 259-6810 TO BE COMPLETED IN INK—PLEASE PRINT I <br /> I I DEMOLITION ❑ COMBINATION CI BUILDING I I MECHANICAL I_I PLUMB{NG ❑ SIGN <br /> �OWt�EH n ///777 M4tt ADDf1E55 C11Y IIP PIIONE rti y <br /> . _ t WA10 � , .�.0 (l ��/- ���Q <br /> �3ENMif ���� MAIL A � E55 C�TY IIP PNONE �9 7� s�C!'� H J,✓ I <br /> ' /�(�f�v�(� i a sa8 Q.P��,�v �d, �ii.ta`✓ 1�o�oy - »G, �o 0o u-v� <br /> ARCHRECTOPOESIGNER M LAUDRL'S5 � CRV � ZIP � ppq�p �I <br /> GEHER/�ICANTRAGTOR M�M1ADDRESS GTV ZIP PNONE LICENSEI � <br /> �-�//����� I <br /> MEGIANIC CONTRACTOR M�R 11DDRE55 CITV 21P PNONE LICENSE� <br /> P�UMBINOCONiR�LiOR MARADDRE55 CI7Y ilP PIIONE LICENSE� � <br /> GLASS OF WORK <br /> I_] NEW IJ ADDITION ❑ ALTERATION LJ REPAIR U DEMOLITION 17 WOODSTOVFJFRPL RJSERT ❑ BUILOIN'd RELOCATION <br /> TEN�HT IMPROVEAIENT OR INTEPIpR REMODEL ONLY CONTACT PERSON AND PIIONE NO. ' <br /> CONTP�C7 iRICE OF W01iK: � . <br /> , DESCRiBE WO11N AND SOU�RE FOOTAOF INVOLVED ' <br /> X � � <br /> rnoP seouse �euaror ��/P,������`�� p � � �/ 1 HEREBV CERTIFY THAT I NAVE READ AND EXAMINED THIS <br /> x �i+�w .,��f'JB..ne��ai �G; /�-P/�-Q Gr./Qr �(/t�C� APPLICATION AND KNOW THE SAME TO BE?iiUE AND CORRECL ALL � <br /> LEG�L scam orrorrnor �s� ELOWORATI�CNFOURGOFIES� PFiOVI510NS OF LAWS AND ORDINANC[S�iOVERNING THIS TVPE OF ��. <br /> L�or a�_ e�ocK ov �.Lru.n,tt�t � �'✓ORK WILL 8E COMPLETED WITH WHLTHER SPECIFIED HEPEIN Ofl �, <br /> NOT. THE GRANTING OF A PERMIT DOcS NOT ?!iESUME Tr GIVe <br /> AUTHORITV TO VIOLAI E OR CANCEi THE PqUV�SIONS OF AtJY <br /> �o�-� � OTHER STATE OR LOCAL LAW REGUL4TING CONSTRUGTION OR 1HE <br /> PERfOHMANCE OF C7NSTRUCTiC^I. THAT I AM AUTHORREO BV THE <br /> OWNER OF THIS PROPERTY TO PI:RFORM THE WORK FOH WHICH <br /> APPLICATION IS MADF ANG I COIAPLY WITH THE STATE <br /> CONTRACTORS LAW 7827 RCW AWCi 296200 WAC. <br /> SIGNATUBE OF ONTRnCTOf1 OP 6U1MOqqF.0 AGENT D�TE <br /> � �(��� �-�.��- <br /> vAaEcr aooness n X v�t-''�-{-��� J'��'��'-VL �"7-"�--� <br /> ,( _.�{�/� // /.S . _ � �PRIC�NLSCI7YBUSUlESSLIGENSENO.�NDBUSMESSN4ME 4�� '1�9d <br /> /� � T O` 6.J�LOu L ( <br /> PLUMBIN6 MECHANICAL <br /> N0. TYPE OF FlICTURE OR ITEM FEE NO. TYPE OF EOUIFMENT FEE , <br /> WATEP CLOSET(TOILET) � IVC-NHNDLG UNITS-H.P. T— ' <br /> —r— i <br /> BATHTUB ; FORCED AIR SYSTEMS-B.T.U. M E.A. � � <br /> LAVATORY(WASH BASIN) � UNIT HEATERS-B.LU. M ; � <br /> SHOWER � CLOiNESDRVCRS —r- <br /> KITCHEN SINK 6 DISP ; VENTILATION FAN ; '. <br /> DISHWASHER � RANGE HOOD � ' <br /> LAUNDRY TRAV � WATER HEATER � <br /> CLOTHES WASNER r WpODSTOVE i . <br /> URINAL ' METAL FlFiEPLACE 8 CNIMNEY �— <br /> DRINKING FOUNTA!N I FIREPLACE INSERT ; . � <br /> FLOUR DRAM � HEATPUMP �— ' <br /> BACKFLOW PREVENTERS i GAS PIPING ' <br /> ROOF DRAINS-RAINLEADERS � EXHAUST fAN � <br /> - — -� <br /> SINK(SEHVICE-BAR,EiC.) ' � <br /> — � <br /> — � <br /> � — �— <br /> � � i <br /> ; � <br /> � i � <br /> i � <br /> SUB TOTAL S ; SUB TOTAL E ' � <br /> PEPMIT S �— PERMIT S i � <br /> TOTAL FEE S ' TOTAL FEE S � I <br /> fRONT 5[TB�CK RE�N SET6�CK SIDE SETB�CN PL�N CHE M NU PF,�� I fEE��-/y RECEIPT NO �� I <br /> L� � �JC<< � <br /> USE20NE �ornnea VAC�NiSITE FEES VALUATION PEE �� <br /> ❑ YES I I NO OUILDING i I <br /> iY1KOFGONSt�LLOWABLE �OfCONStALIU�I aulorxc xOmnw[wN0uen5 — ' � <br /> uWP � <br /> PLUMBING ' <br /> i <br /> --+— <br /> SIZE OF B106. NO.OF S�ES B�SEMENi � I � <br /> MECHANICAL i -�1 <br /> ❑ YES L�NO �� <br /> OGCU�O�O FIPESPRNNLERSRE ➢ HEIONTLIMITATIOH �T�{EA � <br /> U YES �O ST�TE BWLDING SURCNARGE � <br /> RE�SON FOq SPIiINNLERS —r— . <br /> STATE EIJEI7GV Sl1RCitARGE � „ <br /> i <br /> APf'LICATION�CC.�Y , PlANSAPPROVEDBY CITYOFEVEAETT PUBLICWOflKS - � � <br /> LOCAL SALES <br /> TAR CODE IS 3105 T�TI1L � <br /> I <br />