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�.4 ,�, <br /> ` APPLICATI ��'� FOR CONSTRUCTYON PERMIT <br /> everett <br /> � fM Erorpreen e � <br /> � CITYOF <br /> everett � <br /> { BUILDING DEPARTMENT � <br /> ; 259-8810 TO BE COMPLETED IN INK—PLEASE PRINT I <br /> � � DEMOLITION ❑ COMBINATION �i BUILDING ❑ MECHANICAL ❑PLUMBING ❑ SIGN i <br /> � OMMEH M�ILADDRESS CITV Z�P PHONE <br /> t <br /> , Gq,+�f a,�� l NYF3hf f�1�FJT5 ?�I Zh Gol,3`f �cvtb F�/�RE'ri' �a7�1 ZGi Z-31?3 I <br /> iENMT MAIL�ODRESS � CITY ZIP I'NONE <br /> y �b�,��� yJ01�v1.N � Co P o. ►aox �oos G.u��Rr��rr °I�?,ob ZriL- 3�'73 I <br /> � ARCNIfECTO11UE61GN M�ILADDRE55 CITY ZIP PHONE <br /> ' ��'�.u+ rw��? F�a � PRcktit�r� 420� ►4orr- av� �✓EKcrT �bml z�-osbg � <br /> � OENEMLCONTRAC� MAILADDRESS GITY � PHONE LICENSE� <br /> � KrISr��=`f - co�E o����rr� P� aox �c s skowM:�►t �a90 ez3-o�- kiRr�-Az-�tF <br /> , <br /> 5 MECHANICALCONTRACTON MMLADDRESS CIT' � ZIP HONE LICENSE� ., <br /> r <br /> N�A <br /> PLUMBINOCONTMLTOfl MMLADDRE55 CITY 21P PNONE LIGENSE� <br /> � N/A <br /> � CUSS OF WORK <br /> ❑ NEW ❑ ADDITION �X ALTERATION I_1 REPAIR ❑ DEMOLITION I I WOODSTOVE/FRPL INSERT IJ BUILDING RELOCATION <br /> � TENANi1MPqOVE4ENTORINTERIORRECMOD^EL�OryN/LV� CANUCTPERWNANDPHONENO. <br /> CONTIUGTPNIGEOFWONN: �[J(�L/ � ��0�� � 25��v�6b <br /> i <br /> ,� DESCRIBEWDRKANDSW�REFOOT�GEINVOLVEO <br /> ' Rc-�o�Pt4o�1 e� - W w - 25 t't, � u. P+� � <br /> �' PROPOSEDUSEO°BUILDINO 1 HEHEBY CEHTIFY THAT I HAVE READ AND EXAMINED THIS � <br /> � d� CV APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> LEOl0.DE6CRIPiION OF PROPERTY(SHOWN BEIOW OR ATT�CH FOUR COPIES) PROVISIONS OF LAWS AND OROINANCES GOVERNING THIS TYPE OF <br /> i WORK WIIL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR � <br /> i �oT aiucK oF NOT. THE GRANTING OF A PEFMIT DOES NOT PRESUME TO GIVE <br /> ' AUTHORITV TO VIOLATE OR CANCEL 7HE PROVISIONS OF ANY <br /> � OTHER STATE Oti LOCAL LAW REGUTATING CONSTRUCTION OR THE <br /> � PERFORMANCE OF CONSTFUCTION.THAT I AM AUThOR12ED BV THE <br /> � OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICAT�ON IS �dADE AND I COMPLY WITH THE STATE <br /> i, CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br /> SIQN�TUREOFCONTR�CTOROR�UiMORIZEOA�ENT DhTE IZ� � - � <br /> 1 A 1 , � 1, <br /> PRO.IECT�DDREbS (�J�Y SGN N�'JIE t llkL.L ARL�IT�JC-YS <br /> �� �qaa Col APPIiCANT5CITYBUINE55LICENSENO.ANOBU51NE55N�ME4 '/�'� /_'L <br /> r1F V� Y� <br /> 1 <br /> � PLUMBINO MECHANICAL - <br /> ,� NO. TYPE OF FI%TURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> 1 WATER CLOSET(TOILE� � A/C—IVHNDLG UNITS—H.P. � � <br /> � BATHTUB ' FOFCED AIR SYSTEMS—B.T.U. M E.A. � <br /> ? LAVATORY�WASH BASIN) i UNIT HEATERS—B.T.U. M i <br /> I SHOWER � CLOTHES DRYEF75 � <br /> � KITCHEN SINK 8 OISP i VENTILATION FAN � <br /> DISHWASHER � RANGE HOOD � � <br /> j LAUNDRYTRAY ; WATER HEATER ' �� <br /> � CLOTHES WASHER i WOOD STOVE � <br /> URINAL ' METAL FIREPLACE 8 CHIMNEY � <br /> � D(�INKING FOUNTAIN i FIR[PLAC[INSERT I <br /> � FLOOR DRAW � HEAT PUMP � <br /> � BACKFLOW PREVENTERS � GAS PIPING ' <br /> � ROOF DRAItiS—RAMLEADERS � EXHAUST fAN � � <br /> , SINK(SERVICE—BAR,ETC.) ; � <br /> � <br /> � � <br /> i � <br /> '. , � <br /> , � <br /> i � <br /> . SUB TOTAL $ ; SUB TOTAL $ ' <br /> ' PERMIT $ � PERMIT $ i <br /> � TOTAL FEE $ ' TOTAL FEE $ ' <br /> � FPONT6Ei8ACN REARSETBACK SIUESETBACK PUNCNECKNUMBER FEE RECEIPTNO. <br /> ,� n <br /> ' USEZDNE LOTAREA vncnnrsitE FEES VALUATION FEE <br /> i ❑ VES C7 NO BUILOIIJG � <br /> 1YPEOFLONST.QLOW�BLE TYVEOFCONSi.AC7UAl oCtuPeNn NOquwEluaolMn6 ��i�n <br /> i �pa� PLUMBING � <br /> i �r— <br /> ' SQEOFBLD3. NO.OFSTORIES BASEMENT MECHANICAL ' � <br /> , � ❑ YES O NO �p <br /> ' OCCUPANCY LORD FIRE SPRNKLEAS REO'D HEIGHT LIMITATION OTHER i p O <br /> �. ❑ YES ❑ NO SiATEBUILDINGSURCHARGE � <br /> NFASON FOR SPRINKlERS <br /> � ' STATEENERGYSURCHARGE i <br /> i <br /> APPLICATIONACC.BV PUNSAPPBOVEDBY CITYOFEVERETi PUBLICWORKS � <br /> �r,1 LOCAL SALES <br /> � w TN(CDDE IS 3105 TOTAL ��3 �,30 <br /> _�.. � _ ,. - - .�, - - - -I' <br />