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. • ��"'J i`�'�� <br /> APPLICATIIi+N FOR CONSTRUCI rON R�RMIT <br /> c�E�.�,�e„ everett <br /> ��r oF e <br /> everett <br /> BUILDING DEPARTMENT <br /> 259-8810 TO BE COMPLETED IN INK—PLEASE PRINT <br /> ❑ DEMOLITI�N ❑ COMBINATION ❑ �UiLDING ❑MECHANICAL U PLUMBING ❑ SIGN <br /> OWNER /� IM0.ADURE55 GI'iYV 7 I I I PIID�NEj `�,,� /J <br /> �/�G'rC7T / !^Ff.I�l9� �Yepf..tN S G�C �ca�� ���Ii-�l A / IlR_� �p�=� ��g `"1`� <br /> TENANT MAry,ADIX1E5S CIfY ZIP PIqNf <br /> ANCNRECTORDESYJItl.l1 MRRMDPESS CITV ZIP PHONE <br /> OE/NER���LCONIR�GTOR 6UILAO�RESS CIiY plP PHONE UG[NSE� <br /> C�+K'�'t"� <br /> MELHANICAICONTR�CTOP MAILAOORESS LI7Y ZIP PNONE IICEN5E1 <br /> ��/JuI !J^E`c�4+��cqL /l�G �'.oa/61//S/O!✓ <br /> PLUMBI;lOCONTR�CTOR M�I1A007En5 CITY ZIP Pf10NE IILENSE� <br /> S93s A.P/17/,'? /�� /�9A.ey.{d��1.G f W q <br /> cuss oF won� <br /> ❑ NEW ❑ ADDITION G�ALTERATION ❑ REPAiR ❑ DEMOLITION O WOODST04E/FRPLINSERT ❑ BUILDINGRELOCATION <br /> TENANi IMPNOVEMENT OP INTERqR REMODEIOHIY CONTACi PERSONANO PNOHE N0. <br /> CONTRACTPRICEOFWOI'.N: �n�C7 ,IJ0 <br /> DESCRI E ORNAHDSOUAfiEFO07AGEINVOLVED <br /> � � <br /> veor__vnuseoF I1ILDINO I HEREBY GERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> �r —I C� APPUCATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> LEOALDESCNIPTqNOFFROPERN�SHOWNBELOWORATTACNFWRCOPIES� PROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTVPEOF <br /> WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEHEIN Ofl <br /> ior e�ocrc oF NOT. THE GRANTING OF A PERMIT DOES NOT PRESUM[ TO GIVE <br /> AUTHORITY TO VIOIATE OR CAMCEL THE PROVISIONS OF At1Y <br /> OTHER STATE OR LOCpL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT 1 AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PeRFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br /> SIGNRTUNEOFCONTq�CTb�ORAUTNORIZEDAG[NT D�iE <br /> oR C� 1RECK0� �/ I^ �� �I L1 � L����(/� • � _ - I <br /> y ) APPLICANTSCITVBUSMESSL�CENSENO.ANDBUSMESSNAME <br /> �cJ <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILEn � AIC—A/HNDLG UNITS—H.P. � <br /> BAiHTUB ; FORCED AIR SYSTEMS—B.T.U. M E.A. � <br /> LAVATORY(WASH BASIN) i UNIT HEATERS—B.T.U. M ; <br /> SHOWER � CLOTIIES DRYERS � <br /> KITCHEN SINK 8 JISP ; VENTILATION FAN ; <br /> DISHWASHER � RANGEHOOD �— <br /> LAUNDRYTRAY ; WATERHEATEf'� � <br /> CLOTHES WPSHER � WOODSTOV[ � <br /> URINAL � METAL FIREPLY�CE 8 CHIMNEY � <br /> DRINKING FOUNTAIN � FIREPLACE INSERT ' <br /> � <br /> FLOOR DRAIN � HEAT Pl1NP i <br /> BACKFLOW PREVENTERS � GAS PIPING ' <br /> ROOF OFAINS—�RAINLEADERS � EXHAUST FAN ' <br /> SINK(SERVICE—BAR,EiC.) '— �— <br /> � <br /> i , <br /> T <br /> 1 � <br /> 1 � <br /> 1 � <br /> 1 � <br /> SUBTOTAL $ �� SUBTOTAL $ � <br /> PEflMIT $ '��'—" FERMIT $ ; <br /> TOTAL FEE $ TOTAL FEE $ � <br /> FPONTSETO�CK ItEAR5ET0ACN SIDESETHACK PUNCHECNNUTABEii FEE REGEIPiNO. <br /> USEiONE LOTAREA v�c,wisir¢ FEES YALUA710N FEE <br /> ❑ YES ❑ NO DU�LD�NO ' <br /> tYPEOFCONS[ALIOWABLE TYPEOifANSf.ACiWL ottuv�ncr xo.aowilurmuxit6 � � <br /> �� PLUMBING ���-- <br /> i <br /> SIZEOFBlDO. ND.OFSTOqIES BASEMENT i <br /> MECHANICAL � <br /> ❑ YES O NO <br /> OCCUPANCYLOAD FIqESPRNKLEA5RE0"D HEIGNTIIMITATION OTHER � <br /> ❑ YES ❑ NO STATE BUILDINO SURCHARGE i <br /> PEASON FOfl SFRINKLERS � <br />�`.:1 n —� <br /> , .r,.,T:, STATE ENERGY S��RCHARGE i <br />'.:��'iNPtICATIONACC.BV PUNSAPPROVEDBV CIiYOFEVERETT PUBLICWORKS � <br /> LOCAL SALES <br /> TAX CODE IS 3105 TOTAL �� � <br />