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APPLICATION FOR CONSTRUCTIvN PERMIT <br /> everett <br /> the Ere�green <br /> GITY OF � <br /> everett <br /> BUILDING DEPARTMENT <br /> 259-8810 TO BE COMPLETED IN INK—PLEASE PRINT <br /> fzl DEMOLITION lJ COMBINATION I I BUILDING 1 IMECHANICAL iJPLUM8ING I I SIGN <br /> OWHER M�M1MDPESS CITY ZIP P11WJE <br /> John �. H�ghes, D.D.S. , I'.S. 3430 Colby Avo. , LWerett, NA 982U1 259-0125 <br /> TENANT MAILAUDOE55 CITY 21P PHONE <br /> APC111TELTONDESIGNER MAIA�DRE55 CITY N PNONE <br /> Falken Forshaw, 1510 12th Street, Everett, NA, 96201 252-9471 <br /> GENERILLGONTRACTOR MMIADDflE55 CITY ZIP PNONE LIGENSE• <br /> .1)r.�ner <br /> MECNMIILAL CONTRI1CTOfl MAIL 11UDRE55 QTY ZIP PNDNE LICENSG I <br /> PLUMBINGCONTRACTOP M�ILWDflGSS CIIV ZIP PMONE LILENSEI <br /> CLASS OF WOFK <br /> I 1 NEW (-1 AUDITION Cl ALTERATION I I flEPAIft L%I DEMOLITION I I WOODSTOVE/FRPL�NSERT C 1 BUILOING RELOCATION <br /> TENANT IMPROVEMENT Oq:NTERIOB REMOD@L ONIY CANTACT PE1R�SON AINO PHONE NO. ) (� /� <br /> CONTR�CTPRh;EOF1VORH: �O�I��f���) p�S7 �(/�t2S <br /> DESGRIOE WORK�NO SOII�PE FOOTAGE IYVdYED <br /> Demolisl� t�io frame structures� 1F300 sq. ft. <br /> rnorosenuseaewtmN� � I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> APPLICATION AND I<NOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> LEG�IDESCRIPTtONOFPROPEPTY�SHOWNBELOWORATTACNFWRWI'IES� PROVISIONSOFLAWSANDORDINANCESGOVERNINGTH�STYPEOF <br /> ��18�19�� i�K 8Z3 oF Plat of fWerett WORK WILL BE COMPLE7ED WITIi WHETHER SPECIFIED HEREIN OR <br /> �o� 4 ;JOT. THE GRANTING OF A PERMIT DO[S NOT PRESUME TO GIVE <br /> AUTIIOR�TY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> D1VSsiOf1 A OTHER STP.TE OR LOCAL LAW FEGULATING CONSTRUCTION OR TNE <br /> / PERFORMANCE OF CONSTRUCTION.TIiAT I AM AUTHORIZED BY 7HE <br /> ✓�Zp'I CC1I�Ol��� I r OWNER OF THIS PROPERTY TO PERFORM THE WORK POR WHICH <br /> 2 , APPLICATION IS MADE AND 1 COMPLY WITH THE STATE <br /> p CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br /> a{'�a �� ZO 3 Z CVIu. SIGNAIUIiEDFCOII7RACiORORAUT110fl17G0�GLNT D�7E� ,Y �, <br /> �� � �[ '�'+ts4dq i'M•i��r/ Ix�.Ml e�.ii <br /> 9 :�7as �.� (I)1 <br /> '��� �jC� C'G�Cl�% `�� X , � �rL�i L�. //�.y.c..., Uu�.l <br /> vaa cr�yo�oar�.s-s7 X 'd/J `�� L <br /> F_�L l��I � �$'T ���.% A�'�LICANISCIiY0U511lESSLIC[NSENU PND3USINESSNAME _ <br /> PLUMBIN6 � MECHANICAL <br /> NO. TYPE OF FU(TURE OR ITEM FEE NO. TYPE OF E�UIPMENT FEE <br /> WATER CLOSET(TOIIET) � A/C—A/HNDLG UNITS—H.P. � <br /> �— <br /> BATHTUB � FORCED AIR SYSTEMS—B.T.U. M E.A. <br /> LAVATORY(WASH BASIN) —�— UNIT HEATERS—B.T.U. M � <br /> —•— <br /> � SHOWER ' CLOTHESDRYERS � <br /> KITCHEN SINK B DISP ; VENTILATION FAN ; <br /> DISHWASHER � RANGF I100D � <br /> — � <br /> LAUNDRY TRAY ; WATER 11EATER ; <br /> CLOTHES WASHER � WOOD STOVE � <br /> UR�NAL ' METAL FIREPLACE 8 CHIMNEY � <br /> DR�NKING FOJNTAIN i fIREPLACE INSERT i <br /> T <br /> FLOOR DRAIN � HEAT PUMP � <br /> BACKFLOW PREVENTERS i GAS PIPING j _ <br /> ROOF DRAINS—RAINLEADERS —� EXHAUST FAN � <br /> � <br /> SINK(SEFVICE—BAR,ETC.) ; ; _ <br /> � <br /> � --�— <br /> _ _ <br /> i— — <br /> ; <br /> i <br /> � <br /> � i <br /> SUBTOTAL $ ; SUBTOTAL $ ' <br /> PERMIT $ � PERMIT $ � <br /> TOTAL FEE S ' TOTAL FEE f ' <br /> FflONTSEIBACK O[ARSEIORGN SIDESETOALK PlAHQ1�CNNlItAOEfl �EE NECEIPTNO. <br /> ._.- -NA - �t � z� 3 - <br /> usetorv(�` / iornqen vncnr+rsuc FEES VALUATION FEE <br /> �� �j I I YES I 1 NO pUiLDirvG � <br /> TVPEOftON57.RtLOWABIE lIPEOftON51.�C70A1 acurwn xadmnwxGuunS � <br /> �pWP PLUMOING i <br /> SIZEOfBIOG. NO.OFSTOflIES ORSGMGNT MECHANICAL --r— <br /> I I YES 1 I NO i <br /> OCCUPANCVLOAD fIRESPRNKLENSpEOD IIEIGIRLIMIIRTION OTHER i <br /> I 1 YES I I NO STATE OUILUING SURCHAR�E � <br /> NE�SON FOfi SPfiINKIERS — �-- <br /> SiAfE EIJERGV SURCIiARGE i <br /> APPLIC�TIONACG 13Y PLAN51^PIIOVE�OY CITY OF EVEHETT PWLIC WOIiKS � <br /> LOCAL SALES <br /> TAX COOEIS3105 70TAL � <br />