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_ _ <br /> APPLICATI� FOR CONSTRUCI .�N PERMIT <br /> I (� � `� t�� � u u � � everett <br /> rne e�eroreen � ..j <br /> everett �� ' ^ "�� ��'� �' <br /> l.p , �, f'� . ,� � <br /> BUILDING DEPARTMENT <br /> 259-8810 TO BE CO LETED IN INK—PLEASE P�ika�TT BUILDING DEPT. <br /> C DEMOUTION COMBINATION '/�BUILDING MECHAk1ibA PLUMBING SIGN <br /> OWNEF M�II ADDRES$ QTY 21P PHONE <br /> - ^ � 1, �� • , d �Q f�or<� `I'rti;�)l 1�': 5'i°/y <br /> R� n�l:.� �� N� � ;�.�)Y� r <br /> TEN�Ni M�IL AD�RE55 CITY 21P PHONE � <br /> �RCHiTEGTOFDES��NEN M�IL�DDRESS GITV 21P PMONE . .ry <br /> ��� <br /> r'r ,. , <br /> 6ENER0.CONTR�CTOR M�KADDRE55 CITY 21P PHONE IICENSEI <br /> a� <br /> ' A <br /> MECN�NICQCONTR�CTOR M�IL�OORE55 CITY T�P P�E LICENSE� " ��.,;`� <br /> i ^'� <br /> PLUMBINOCONTR�GTOR M�ILAODRE55 CITY ZIP P1qNE UCENSE� I � ?R� <br /> ! � <br /> CUSSOFWORK � � ' ��'� <br /> f-.�I NEW '�. i ADDITION � -� ALTERATION � REPAIR DEM ITION WOODSTOVE/FRPL INSERT �. BU�LDIN6 REIOCATION ��;! <br /> TEN�NTIMPROVEIAENTORINiER10RNEMWEIONLY CON�7f�C,iPERSpN�NDPNONENO � C. <br /> CONTR�CT PRICE OF VIORK: � tt1 •� �`Y • ,�""vV �C:C �r,�� ���L c'r . ....':�t <br /> DE5CRIBEWORRANUSOWREFOOTAOE VOLVED � � � �� ''�'� <br /> , y <br /> C,�.rr�'P �,e_P 653— �� 3`( a',;;.� <br /> Vl/�� � �J��(' '��_ �� � �. <br /> PROPOSEDUSEOFBUIl01N0 I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS . ,��',,_�y� <br /> c C . ��' , APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL ' <br /> IEUAL0E5CBIPT10NOFPROPERTYISHONTlBEIOWOR�TTICHFWRCOPIES� PROVISIONSOfLAWSANDORDINANCESGOVERNINGTHISTVPEOF ��''"' <br /> z�- a i � WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR �" `' <br /> �or 4S��D eiocK �_ oF ��'� ' �� ` N07. 7HE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE � <br /> AUTHOR�TV TO VIOLATE OR CANCEL THE PROVISIONS OF ANV . <br /> = r_r �J��e OTHER STATE OR LOCAL LAW FiEGULATING CONSTRUCTION OR THE ' �,.; <br /> C PERFOPMANCE OF CONSTRUCTION.THAT 1 HM AUTHORI2ED BV THE <br /> OWNER OF THIS PROPERTV TO PERFORM THE WORK FOR WHICH r <br /> APPLICATION IS MADE AND I COMPLY WITH THE STAfE ��,-:,-.� <br /> CONTFACTORS LAW 18.27 RCW AND 296.200 WAC. , <br /> SIGNATUNh OF CONTR�CTOR OR�UTNORIZED�GEN7 D�TE <br /> X � � �� f';. <br /> � �J ,''.:; <br /> PiqJECT1IDDRE55 � �:;�,F <br /> I � �PPUC� TSCIiV9U5MG5Sl NSF.NO �NDBUSMESSN�ME J� <br /> r � �(N P (�n/�2� ' � <br /> PLUMBINO MECHANICAL `, _'� <br /> yp, TVPE OF FIXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE � ...rc� <br /> WATERCLOSET�TOILET) NC—NHNDLGUNITS—H.R � "";=�� <br /> BATHTUB ; FORCED AIR SYSTEMS—B.T.U. M E.A. ; ' `��'� <br /> LAVATORY(WASH BASIN) UNIT HEATERS—B.7.U. M � , ��.-"�'�� <br /> SHOWER CLOTHES ORYERS ' <br /> KITCHEN SINK 8 DISP VENTILATION FAN I � <br /> DISHWASHER RANGE HWD � ��`��"��,' <br /> LAUNOHV TRAV WATER HEATER ' � � . ���.�,."if' � <br /> CLOTHES WASHER � WOOD STOVE � _ <br /> URINAL METAL FIFEPLACE 8 CHIMNEV ' � "I <br /> DRINKING FOUNTAIN � FIREPLACE INSERT � <br /> FLOOR DRAIN HEAT PUMP ' � <br /> BACHFLOW PREVENTERS i GAS PIPING _�_ I� <br /> ROOFDRAINS—RAWLEADERS � E7(HAUSTFAN ' i <br /> SINK(SERVICE—BAF,E7C.) I ��, <br /> ' I� <br /> K�n. — i I <br /> ' — — i <br /> SUB TOTAL E SUB TnTAL S <br /> PERMIT S PEi1M1T S _ <br /> TOTAL FEE S TOT E._ ' I <br /> fRONTSETB�CK HE�PSET&1CN SIOESETB/�CN PL� NECN MBER FEf a P tv(/p EC P I <br /> � � ;�µ� 9 <br />'r use LOfARE� , V�C�NTSITE FEES VALUATION FEE <br /> �. X n �ES � - NO S�( ;OD <br /> BUILDING <br /> i_ <br /> ttPEOiLONS1�lL0VA8LE TYVEO�GON51�CiVAL atuw,wcr Nadowtwx�M�rs - �— — i <br /> GR0°� I PLUMBING � i <br />� 82E OF BLDO. NO OF STORIES BASEIAENT MECMANICAL � <br />� VES � NO ' <br /> OCCUPANCYLO�O FIRESPRNNIERSREQD HEIU1rtUMIT�T10N �T�{�R �IQN C�� �� �� <br />�I '. I VES NO SiATE BUILDING SURCHARGE <br /> qE�50Nid1£FRINKLERS i <br /> SiATEENERGVSURCHARGE <br /> �PPIICAT10NACC eY PUNS�PPROVEDBv CITY OF EVERETT PUBLIC WORNS <br /> �/ LOCALSALES � 0 <br />� � I TAX COOEIS 3105 ror�� ' <br />