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� <br /> .+i �_. <br /> APPLiCATIG.� FOR CONSTRUCT�JN PERMIT <br /> e,�e.,.o.,,,,� everett ' <br /> arv or � <br /> ever�tt <br /> BUILDING DEPARTMENT <br /> 259-8810 TO BE COMPLETED IN INK—PLcASE PRINT <br /> DEMOLITION i= COMBINATION BUILDING _ MECHANICAL PLUMBING SIGN <br /> �y t'YNER IAAILAD�RFS �ITY ZiP P1pNE <br /> � � �,r. ( y�s 3W13- C.�'ol'b,, A�c �.,r �j�20� 25`y -1$yT <br /> p � � �' N�� W�LLADIXiE55� CT' ZIP �XdiE <br /> � y y <br /> �y <ivUMECTORDESIGNER MAM1ADDRESS C�TY IIP PHDNE <br /> y H(� <br /> K y "- GENEFALCONiR�CTOR 1.UILdODRE55 CITV ZIP PIqNE LILENSE• <br /> b H b <br /> (A F� <br /> o � r t'.CCHANiCAICONTHRG OR MAILApDHE55 CITY IIP P1qryE LIGENSE� <br /> 6 1v. +�/. W�,���,,-�c,-Si� 3uo_/�iu iivP �;ur S�io� 255-�33/ ��'�wN /37,f'I <br /> M w ^ �l UMBMG GONTBAGTOR MpR p�DNE55 CITY ZiP PNpNE LICENSE� <br /> n • R <br /> � � CLASSOFWORK <br /> H <br /> "� �4JEW '-�. ADDITION � ALTERATION �: REPAIR L.. DEMOLITION , WOODSTOVEFRPL INSERT .I BUILDING RELOCATION <br /> � ~ y TENANT�IAPROVEMENTORMiEFlqRq�E�,BNLY CONTACtFERSONANOPMONENO. <br /> y <br /> M <br /> p y CONTRACT PRiCE OF WORK: <br /> ��q � r DESCRiBE WORN RNO SOUARE FOD AGE INVOLVED <br /> y H y - ( <br /> � SEPUSEOFeWiDIN 1 HEREBY CEFTIFY THAT I HAVE PEAD AND EXAMINED THIS <br /> � � �I APPLICATtON AND KNOW THE SAMF TO BE TRUE AND CORFECL ALL <br /> i[craoe ai norroFpa aenn�sH BEIOWOP�tULHfWflCOPIES� PROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTVPEOF <br /> WORK WILL BE CJMPLETED WITH WHETHER SPECIFIED HEFEIN OR <br /> inr BIOCN ov NOT. THE GRANTING OF A PERId1T DOES NOT PRESUME TO GIVE <br /> AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANV <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OH THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHOFIZED BY TH[ <br /> OWNEP OF THIS Pi70PERN TO PERFORM THE WORK FOR WHICH <br /> APPUCATION IS MADE AND I COMPLY W'ITH THE STATE <br /> CONTRAGTORS LAW 18?7 ACW AND 296.2C0 WAC. <br /> SiGNA1t1REOVG011iRACTOPOfiAUTHORIZE�AGENT DAiE <br /> —L ld'�'`�l C� <br /> vAaEcr nooness ., <br /> � 3y�3� ��„(� APPUUHSQtT8U5!N .SL4ENSE1:0AIlp�p9ME5SNAIA <br /> I C� PWMBING MECHANICAL <br /> � � ; NO. TVPE OF FIXTURE OR ITEM FEE NO. TVPE OF EOUIPMENT FEE <br /> WATER CLOSET�TOILET) NC—AHNDLG UNITS—H.P. <br /> � 1�� BATHTUB FORCED AIR SYSTEMS—B.T.U. M E.A. <br /> �� LAVATORY�WASN BASIN) UNIT HEATERS—B.T.U. M <br /> � • SHOWER CLOTHES DRYERS �— <br /> KITCHLN SINK 8 DISP VENTILATION FAN � <br /> DISHWASHER RANGE HOOD <br /> i 1� LAUNDRV TRAV WATER HEATER <br /> CIOTHES WASHER � WOOD STOVE <br /> URINAL METAL FIREPLACE 6 CHIMNEY <br /> ' DRINKING FOUNTAIN <br /> � � FlREPLACE INSEflT <br /> ,�' 1 � FLOOR DRAIN HEAT PUMP <br /> DACKFLOW PREVEIJTEPS GAS PIPING <br /> ROOF DRAINS—RAINLEADERS —�— EXHAUST PAN <br /> + SINK(SERVICE—BAR,ETC.1 i — <br /> _� ' <br /> � T <br /> I _� <br /> � <br /> I �,_ �— <br /> =1 �, — SUB TOTAL S _ SL18 TOTAL $ (fa <br /> � PERMIi $ PERMIT 5 �� I— <br /> - TOTAL FEE 5 TOTAL FEE 5 SJ'� — <br /> FRONTSETB�CK pEANSETBACK Si0E5EipACK PI,qNGHECKNUMOER f[E RECE�PTNO <br />� ucezor�e ioreaEn vncntrtsire FEES VAWATION FEE <br />' ��� . VES NO BUILDItdG <br /> � LYFEWCOr13IAtLOWABIE lYPEOLWNsI.�ciupl �-u��•vv. xoaun[.uxc�Mns <br /> • ; .� . cp���� PLUM�RJG — -- <br /> � �'� SIZEOFBLW. q20FSTOflIES BASEMCNT �— <br /> � MECNANICAL � r� — <br /> V� .�. YES i_. NO <br /> � ,� OLCUPRNCVlOAO fIqESPPNKlER5RE40 M[IGNTLIMITATIOH OTHER i <br /> � <br /> _�{q IJ YES . I NO STAlEBUILDINGSURCHpqGE <br /> PEASONFOHSPRINKLERS <br />- _ r �— <br /> ��1�:�5d ' 9iATEENERGVSUIiCI1AflG[ <br /> �PPLICRt10NACC.�Y PIANSAPPR0VE00Y CIiYOFEVEflETT pU�LICWpRN$ <br /> LOCALSALES <br /> TAX CO�E IS 31D5 TaTA� S J– ' <br />