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APPLICATIOYr FOR CONSTRUCTt�N PERMIT ` J <br /> everett <br /> ;+e Err,arn-n � <br /> CITV OF <br /> everett <br /> BUILDING DEPARiTAENT TO BE COMPLETED IN INK—PLEASE PRINT i <br /> p5g-8810 <br /> CEMOLITION , COMBINATION BUILDING �MECHANICAL PLUMBING _ SIGN <br /> � .�. � 10�N�EP MAhA[1DRE55 LITY Z��' �MONE <br /> ro �9 / <br /> io � s 1.L1��16' 1� �1�'QSE'� `� ��n Wl�C��1`1:915- �i,r���G'�� ��L' C'2�-LC'd � �'F'�-[!.� � 1J� <br /> C �y tENANi IAAhADDRE55 <br /> � y�. Z 1p�E��S�GNER MAILADDRE55 CITY 21P PHONE <br /> y H <br /> K y n <br /> }t <br /> GENERA GOPoTFACTO lA0DHE55 CfiV LP PHONE IiGEN5E1 <br /> � x � �(�� I��.r �lCli- �Q,D aLroS /Y�t�Fr��oQ fhl-��i"�&�n► ccca.s�- 5�19a <br /> � O I!ECHPNIG/�LC TA�LiOR MAllAOD(iE55 �� �.^ I 1 �.������/ � IL' E��t'` <br /> y H�-L r u � ;� / <br /> C N rp PNONE LICENSE� <br /> 'b n O e�W.�piNGCONIPACTOR M�RA��PE53 Cm , <br /> � :' R <br /> z y � CU��OFWOfiK - - <br /> � Fy NEW �...� ADDITION � ALTERATION . -I REPAIR ❑ DEMOLITION IJ WOODSTOVE/FRPLINSERT i : BUILDINGRELOCATION <br /> y IENRNTIMFPOYEMENTORIN HIORflEM00ELONlV CONTRLTiERSONRNDPHONENO- J <br /> M �T <br /> O N <br /> � r CONTRACTPPiGEOFWORK: `+�L�. � � I <br /> � O N oE7 (yG•��C OC .�R�OOiAGE�li'lOLYED C�'wlY"" • lW IW� - _ <br /> �J <br /> ��r� <br /> vnoPosEouseoFeui c� r��l) � I HEREBY CEfiTIFY THAT I HAVE°. READ AND EXAMINED THIS <br /> ,� �� APPLICATION AND KNOW THE SAMF TO BE TRUF AND CORRECT.ALL <br /> IEGALDESCRIPT1pHOf PROAERTY(SMOWN 6ElOW ON�TT�LMFOURCOPIES PROVISIONS OF LAWS AND OFGiNANCES GOVERNING THIS T/PE OF <br /> WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> tor eiocK oF NOL TNE GRANTING OF A PERMIT DOES NOT PRESUME TO GNE <br /> AUTHOPITY TO VIOLATE OR CANCEL THE PROVISIONS CF ANY <br /> OTHER STATE OR LOG.1L LAW REGULATING CONSTRUCTION OR THE <br /> PEPFORMANCE OF CONSTRUCTION.THAT 1 AM AUTh'ORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHIGH <br /> APPLICATION �5 MADE AND I COMPLY WITH iHE STATE <br /> CONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br /> SiGNnTUqEOFCONTP�CIORORRUtNOA2E0+�uENT DATE <br /> ( <br /> X �/ <br /> �����; ��t�u�'-_ , _d�i�1,�C� <br /> / �� PF0.IECTAODFE55 $` 1 I �}J <br /> I ��. _� f I I� j'I I,.L( I� ( AaPLiCAuiSGitY�U51';SSUC[NS[N3ANoBt15iNE55NRME <br /> �( l� � 1J � � \J <br /> � PLUMBIHG MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER C.OSET(TOILET) !UC—A'HNDLG UNITS—H.P. _ <br />� � � BATHTUB F07CE�AIR SVSTEMS—B.T.0 E.A. <br /> A <br />� �' LAVATORY(WASH BASIN) UNIT HEA7ER5—B.T.U. M <br /> � � SHOWER CLOTHES DRYERS <br />� ! KITCHEN SINK 8�ISP VENTILATION FAIJ �_., <br /> DISHWASHER RANGE HOOD <br />' � I �� LAUNDRV TRAV � WATER H[ATER <br /> � GLOiHES WASHER i WOODSTGVE <br /> � URINAL METAL FIR[PLACE 8 CHIMNEY <br /> � ' DRINKINC,FOUNTAM � FIREPLACE INSERT ._� <br /> � ��' FLOOR DRAIN � HEAT PUMP <br /> BACHFLOW PREVENTERS GAS PIPING <br /> ROOF DRAINS—RAINLEADERS EXHAUST FAN _ <br /> � SItJK(SERVICE—BAR,ETC.) — <br /> 70' — <br /> I �I,�I SUB TOTAI. $ SUB TOTAL $ {/ ; ' <br /> � PERMIT $ PERMIT S ( � <br /> - TOTAL FEE $ TOTAL FEE S r' <br /> FRONT SETBAGN RERR SETBACN SIpE SETBFLK PIAN LNLGK NUMBER FEE <br /> PECEIPT NO. <br /> I i7iAL�rY"`� � � - useza+e iornee� vecanrsrte FEES VALUATION FEE <br /> ' �` ' '. I YES t: NO BUILDING <br /> lYPEOitON57ALlOW19LE 1VFEOiCON51/�GtUAI ac•��� ���'''����'�cuuits <br /> cnar p�UlAOING <br /> 5REOFBLDG. ND.OFitOBIES OAS[MENT MECHANICAL <br /> _ i i VES iJ NO ; <br /> � OTHER ' <br /> OCCUPANCYLOAD �IFESPRNKLERSREOD ��EIGNTLIMITQION <br /> [ ; YES �I NO STldE OUILDING SURCHARGE � <br /> i <br /> --�— <br /> NEASONFOfiSPNNHLCRS � <br />_����-, .,. STATEENEHGYSUHCHARGE <br /> nPPLiG4TIONRLGOY PlANSAPPROVEDBY CITYOFEVEREIT FUOLICWORKS <br /> LOCALSALES � � <br /> TAX CO�JE IS 3105 rorn� <br />