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�' APPLICATI�iN FOR COI�STRUCTriON PERMIT <br /> everett <br /> �E���� e <br /> cin oF <br /> ! everett <br /> BUILDING DEPARTMENT <br /> 259-8810 TO BE COMPLETED IN INK—PLEASE PRINT <br /> � ❑ DEMOLITION L7 COMBINATION ❑ BUILDING ❑MECHANICAL ❑PLUMBING ❑ SIGN I <br /> I OWNEH M"�LA�ORE55 1 CI7Y ZIP PNONE . <br /> � F✓�rs'�I Pr<�, PraPpr'F��tr t.V .L��ox 5633 t'✓�Pret}' 9$�ot, aS9-NssN ' <br /> TEqAHT MAILADDPE55 41TY 21P PNONE <br /> � <br /> � AXCXITECTORDESNINER MNLADDNESS GITV ZIP PHOlIE I� <br /> � I <br /> jOENEIULCONTMCTOfl M�ILAODRESS CITV 21P PNONE LICENSE/ I <br /> f <br /> I MEGHANICA�CONTRACiOH A'�AILA�DAE55 CIiV ZIP PHONE LICENSE� � <br /> � CV�fwfPPn Sr10.'�a S).^� P.0 Q�F /roa r✓rn�} 9Pz.b 1S.z•s�iy c�v-eR•Gs-s�,��h7 <br /> � PL INaCONTRACTOR MAlLA0DRE55 CITY ZIP PHONE LICENSE� <br /> ) <br /> � CUBSOFWORN <br /> � ❑ NEW ❑ ADDITION bS ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL INSERT ❑ BUILDING RELOCATION <br /> i TENANTIMPROVEMENTOHMTERIO�IREMODELONIY CONTACTFER�,SONAND NONENO. � <br /> � CONTP�CTPRICEOFWORK: i l%� Dvv -�oQ rl�%'� T � S� -�11 N <br /> � UEBCRIBEWqiK�NDSOUAREF00T�6E11 OLVEU � <br /> i , � � SO <br /> , PROPOSEDUSEOFBUIlDINO I HEREBY CERTIFY THAT I HAVE READ AND E%AMINED THIS <br /> i '��� t APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> � �au.o�RIPTIONOFPROPERTY�SHOWNBELOWORATTACNFOURCOPIES) PROVISIONS OF LAWS AND ORDINANCES GOVERNINO THIS T�PE OF <br /> ' WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEP.clt1 UA <br /> � iot e�ocK oF NOT. THE GRANTING OF A PERMIT DOES NOT PRESUMF. TO OIVE <br /> I AUTHORITY TO VIOLATE OR CANCEI 7HE PROVISIO'iS OF AN:' <br /> � OTHER STATE OR LOCAL UW REGULATING CONSTRUCI'ION OR THE <br /> � PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZ_D BY THE <br /> ' OWNEH OF THIS PROPERTY TO PERFORM THE WORK FJfl WHICH <br /> � APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> � CONTRACTORS�AW 18.27 RCW AND 296200 WAC. <br /> �I SIGN�NR80FCONTMCTONORAUTHORIZEDAOENT D�TE <br /> ! � �..(�� <br /> { PRQIECTADDPE55 q <br /> 2'72z c�16,, � qG� .(�� �PP�ICAN IiYBU5MES5LICENSENO.ANDBU51NE55NAME <br /> � PLUM91� MECHANICAL � <br /> � NO. TYPE OF FIXTURE OR ITEM FEE N0. TYPE OF EOUIPMENT FEE <br /> � WATER CLOSET(TOILET) � A/C—AMNDLG UNITS—H.P. � - <br /> � BATHTUB ; FORCED AIR SYSTEMS—B.LU. M E.A. � <br /> 1 <br /> .) UVATORY(WASH BASIN) i UNIT HEATERS—B.T.U. M ' i <br /> SHOWER � CLOTHES DRYERS � <br /> I KITCHEN SINK 8 DISP ; VENTILATION FAN � <br /> DISHWASHER � RP.NGE HOOD � <br /> �� LAUNDRY TRAV � WATER HEATER ' <br /> 1 CLOTHES WASHER � WOOD STOVE i <br /> URINAL ' METAL FIREPLACE 8 CHIMNEY � <br /> � DRINKING FOUNTAIN i FIREPLACE INSERT �_ <br /> I FLOOR DRAIN � HEAT PUMP � <br /> i _ BACKFLOW PREVENTERS i GAS PIPING ' <br /> ROOF DRAINS—RAINLEADERS � EXHAUST FAN � <br /> �i SINK(SEflVICE—BAR,ETC.) ; ' <br /> — , , <br /> — � i <br /> � <br /> i � <br /> i � <br /> . SUB TOTAL E ; SUl3 TOTAL S '— <br /> PERMIT S � PERMIT $ i—' <br /> TOTALfEE 3 ' TOTALFEE $ �� <br /> FRONT6ETBACK REARSETBAGK SIDESETHFCN PUNCIIECNINMBER FE[ AECEIPTNO. <br /> ueEzw+e LOTAPEA WCANTSITE FEES VALUATION FEE <br /> ❑ YES ❑ NO BUILDINO � <br /> TYPEOiCONST.�LIOWABIE TYPEOFCUNST.�CIUAL ���+ �-a�luxEuxrtt � <br /> onao pLUM81N0 � <br /> eQEOFBiDIi. NO.OFSNRIES BASEMENi MECHANICAL � , <br /> ❑ YES O NO � <br /> OCCUPMlCYLOAD FINESPRNKLERSflEO'D HEIOHTUMIUTION OTHER i <br /> ❑ YES ❑ NO STATE BUILDING SURCHARGE � <br /> REAfiON FOR bPflINNLEflS <br /> STATEENERGVSURCHARGE i <br /> APPLICAiIONACC.BY PUNSAPPROVEUBY CITYOFEVERETT PUBLICWORKS � <br /> LOCALSALES —�— <br /> TAX CODE IS 3105 TOTAL rj'`-j'— <br /> I <br /> ,_, .._. ....-_..,, -- � : <br /> ,.r-._.;._�e_u-:�ttme8:a:.:'1'T!➢ii,�h•Y..i1: . n••n. .r�� •.�c• <br /> -:� .:....--._ , <br /> ... <br />