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APPLICATIOI� FOR CONSTRUCTIvN PERMIT everett <br /> TO BE COMPLETED IN INK—PIEASE PRINT � <br /> fl�e Eveqreen <br /> qTV OF , � <br /> everett HEATING SVSTEM: f��GAS `-J ELECTRIC ❑ <br /> BUILDING DEPARTMENT <br /> 259-8810 <br /> DEMOLITION COMBINATION BUILDING '(r1A�CHANICAL PLUMBIN(i SI(iN <br /> pYMER M�IL�OORE55 CITY 21P P110pE <br /> • � / Ca 1�+� 2d to ?�t5 ^ 2 399� <br /> 7EN�NT M�IL�DOPE55 CI7Y ZIP ��E <br /> k . �.. �to — <br /> � t � <br /> �RGHITEGT OR DE5�6NEH MAIL I1�DBE S ��T� Z�P PN�E <br /> ��! ` � ��T� 21P p�qHE LICENSEI <br /> 6ENERMGONTR�LTOR MMLADDRE55 <br /> s r..c Ce,.,c T 909 S'�-''�a L��rT- 9F��Ci� itB�9r� o.S <br /> MECH/J1IG�LCONTR�QOR M�R�DDRE55 dTV Z�p PNONE I�GENSEt <br /> � � ' .v f�Ta �'-Nc �G o r ��J�i-t {•�,iu�nma�JP�Qa3� 7�!=�r.�c �rL�zx�r��7fXd <br /> %UMBM(iCONTR�CTOR YA �DDRE55 <br /> QTY ZIP PIIONE IICENREf <br /> GUSS OF YI'3NK � �_, <br /> I ', NEW i �� ADDITION �TERATION . - REPAIR � '� DEMOLITION '', ��� WOODSTOVE/FRI L INSERT .i BUILDINO RELOC <br /> LONT�CT PERSON Ml0 GIIOME MO <br /> Cd1TR�C7 iRICE OF M'OfIN �6, �"� <br /> DESCRIBE V�N�ND SOUARE FOO�OE INVOIVED <br /> C <br /> PROPOSEDUSEOFBUILOIN6 I HEREBY CERTIFV THAT I HAVE READ AND E%AMINED ?HIS <br /> ��/-/C E SOA G r. - AFPLICA710N AND KNOW THE SAME TO BE THUE AND CORRECT.ALL <br /> LEO�LOESLR�FTIONO�PRO�ERTVISNOWNBELOWOAATT�CNFOURCOPIE51 PHOVISIONSOFLAWSANDORDINANCES60VEHNIN6THISTYPEOF <br /> WORK W�LL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> LOT e1�N � AU?HOflITVR O VIOLA E OR CANCEL THE PROVISIONS OF AINY <br /> O?HER STATE�R LOCAL UW REOULATIN6 CONSTRUCTION OR THE <br /> PERfORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BV THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLV WITH THE STATE <br /> CONTRACTORS LAW 1827 HCW AND 296200 WAC. <br /> SIONATUNEOFCONTMC70ROA�UTNOHIZED�6ENT DI1TE '��(�'/ <br /> �ti 2� ����J,�v� <br /> pROJEGT IIDDRE6S �pp���NTS CITY BUSMESS IICENSE NO.�ND BUS�NEBS NM1E <br /> O S/N o A• ��ANICAL <br /> PLUMSMlO FEE <br /> NO. TYPE OF FlIITURE OR ITEM FEE N0. NPE OF EOINPMENT <br /> , q/G-ARINDLO UNITS-H.P. ' <br /> WATER CLOSET(TOILET) � <br /> � FORCED AIR SYSTEMS-B.T.U. M E.A. <br /> BATHTUB ' <br /> LAVATORY(WASH BASIN) � UNIT HEATERS-B.T.U. M � <br /> � CLOTHESDRVERS � <br /> SHOWER � ; <br /> KITCHEN SINK 6 DISP � VENiILATION FAN <br /> OISHWASHER RAN6E HOOD ' <br /> IAUNORV TRAV ; WATER HEATER � <br /> CLOTHES WASHER � WOOD STOVE � <br /> � METAL FIHEPLACE 8 CHIMNEY � <br /> URINAL FIREPLACE INSERT ' <br /> DRINKIN6 FOUNTAIN , HEAT PUMP � <br /> FLOOR DRAIN OAS PIPINO <br /> BACKFIOW PREVENTERS � EXHAUSTFAN ' <br /> ROOF DFAINS-RAINLEADERS ' <br /> SINK(SEHVICE-BAR,ETC.) � ' <br /> � <br /> � � <br /> � � <br /> � <br /> � � <br /> SUB TOTAL S ' SUB TOTAL S �_ <br /> � PEHMIT f ' <br /> PERMIT S ' TOTAL fEE S ' <br /> TOTALFEE S � � <br /> FOR OFflCE USE ONLY: neeeirrra <br /> PL�NCNECNNUMBER FEE <br /> FRONT BETB�CIt REAR 6ETB�Ck 61DE SETB�CN ��� <br /> FEES VALUATION FEE <br /> USE20NE IOi�HE� WCANTSITE i <br /> BUILDINO � <br /> i — <br /> 1YPE OtCONTS AIIOWABLF 7Y7E Of CONST/�CiWI �� �d�,�����n PLUMBIN(3 1 <br /> SRE OF BlDO. NO OF 6TORIES B�SEMEN7 MECHANICAL '� �G� <br /> � <br /> i <br /> �OCITIONAL PUN CHECK ' <br /> OLCUP�NGY lOAO FIRE SPPNI(LERS REO'D HEN3HT IMAIUTION � <br /> i <br /> OTHER ' <br /> _ � <br /> REASd1 FOR 6PRINKLERS ST�TE BUILDINO SURCHARGE ' <br /> INT�NE BY PLANS�PPAOVED BY CITY OF EVERETT PUBLIC WORK$ .T� <br /> LOCAL S11LES �l�� <br /> �� TAX CODE IS 3105 *aT�� <br />