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APPLICATIt.��l FOR CONSTRUCI':�ON PERMIT <br /> n„E,,,,p,�„ � everett <br /> CITV'OF � <br /> everett <br /> BUILDING DEPARTMENT <br /> 259•8610 TO BE COMPLETED IN INK—PLEASE.PRINT <br /> ❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑MECH�INICAL 4�'i PLUMBING O SIGN <br /> ONTIEfl MAIL MDRESS GTY ZIP PNOHE ' <br /> K�� �-�C+ r �.i.� �v 2�"�' � �S� � 0 3 2/ <br /> TENANT MAILADOqESS LITV ZW PNONE <br /> 4 7 � 1 Co��.� l�u � <br /> �fiCNffECTqiDE51GNER /M0.AODRE55 LfTY ZIP VHONE <br /> GENERALCANTRACTOR MAILADDRC55 CITY LP PHONE IICENSE■ ' <br /> 4ELN�HIC�LGONTRACTOR MARADDPE55 GITY ZIP PNONE I�LENSE� <br /> PlUA18W6CO\NTRAGTO.^. MARM�RESS CITY 21P PMONE LILENSEI <br /> �6aT2.Cbr]C ��U\��c.nn S�n � � - �4a� 5�. �� - M-��t4 �P��U�� ��Z4C�G.. <br /> QASSOF WORK � <br /> O NEW rJ P.ODITION ❑ ALT'cRATION ❑ qEPAIR ❑ DEMOLITION ❑ WOODSTOVFJfRPL INSERT ❑ BUILDING RELOCATION <br /> �[TEN�IITMAP110VEMki!*CAINTER REAIO�ELONLY . CONTACiPEN50NANDPMONENO. � <br /> ,�.ONTMCiPR�CEOFwonK: � �j J� . i <br /> DESCRIBE M/JRN MIQ 6IX1APE FOOTAGE INVOI 0 ' <br /> � 1 <br /> —G eous oF uwomo 1 HEREBY CEHTIFY TNAT I HAVE PEAD AND EXAMINED THIS <br /> cJ APPLICATION AND KNOW THE SAME TO BE TRUE AND CORflECT.ALL <br /> lEf31�LDEECRIPTKKIOFPNOPENTY�SMOWNBELOWOflqTACHFWRC01`IES� PROVISIONSOFLAWSANDOfiDINANCESGOVERNINGTHISTYPEOF <br /> WORK WILL BE COMPLETED WITH WHETHEfl SPECIFIED HEREIN OR <br /> �°T &'ocK oF _ NOT. THF. GflANTINO OF A PERMIT DOES NOT PRESUME TO 41VE <br /> AUTHORITY TO VIOLATE OH CANCEL THE PHOVISIONS OF ANY <br /> � OTfiER STATE OR LOCAL lAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHOHIZED BY THE <br /> OWNEfl OF THIS PROPERTY TO PERFORM THE WOHK FOR WHICY, <br /> APPLICATION IS MADE A�D I COMPLY WITH THE STATE <br /> CONTRACTORS IAW 7827 RCW AND 296.200 WAC. <br /> SIGNATUF�FCONTRACTOROp�UTHONIZEU�6ENT DATE �, <br /> �Rq1E�T��REsS X .� 1 — 4 — �,G <br /> 7 � J�V APP CITV ICENSE NO AND Bl151NES5 N�ME <br /> PLUMlINO CMANICAL <br /> N0. TYPE OF FlXTURE OR ITEM FEE NO. TYPE OP EOUIPMENT FEE <br /> WATEH CLOSET(TOILEn � A/C—A/HNDLG UNITS—H.P. i <br /> BATHTUB ; FORCED AIR SYSTEMS—B.T.U. M E.A. � <br /> LAVATORV(WASH BASIN) i UNIT HEATERS—B.T.U. M ; <br /> SHOWER � CLOTIiES DRYERS � <br /> KITCHEN SINK 8 DISP � VENTILATION FAN � <br /> DiSHWASHER � RANGE HO00 � <br /> ,UUNDRV TRAV � WATER HEATER - � <br /> CLOTHES WASHER � WOOD STOVE ; <br /> URINAL � METAL FlFEPLACE 6 CHIMNEY � <br /> DRINKING FOUNTAIN i FIREPLACE INSEPT ' <br /> FLOOR ORAIN � HEAT PUMP � <br /> BACKFLOW PREVENTERS � GAS PIPING ' <br /> ROOF GRAINS—pA1NLEADERS � EXHAUST FAN � <br /> SINK(SERVICE—BAR,ETC.) ; ~— <br /> � ; <br /> � , <br /> i , <br /> i , <br /> � r <br /> SUBTOTAL S ; SUBTOTAL E ' <br /> PERMIT E � PERMIT E � <br /> TOTAL FEE S ' TOTAL FEE E � <br /> FRONTSETBACB REARSETBRGK SIDESEiH�CK PLANCHECKNUTABER FEE RECEIPTNO. <br /> USE2plE IOTAREA v�cu+Tsiie FEES VALUATION FEE <br /> ❑ YES ❑ NO BUILDINO . i <br /> TYPE Of CONSL ALIOWABLf TYVE OF fANSI.ACTUAL �Y �p�Tu�NGuxrt6 <br /> GMpW � <br /> PLUMBINQ ' <br /> SREOFBLDO. NO.OFSTORIES BASEMENT � <br /> MECHANICAL � <br /> ❑ YES ❑ NO , <br /> OCCUPANCYl0�0 FIRESVPNKLERSREOD HEIOHTLIMITATIOH OT11ER j <br /> ❑ YES O NO STATE Bl11LDIN0 SURCMARGE � <br /> � <br /> REASON iOq SPflINKIERS —j� <br /> STATE ENERGY SURCHARGE i <br /> APPUC�TIONACC.BY PUN5APPfl0YEDBV CITYOFEVERETT PUBLICWORKS � - <br /> LOCAI SALES ' <br /> TAX CODE IS 3105 TOTAL I <br />