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APPLICATION FOR CONSTRUCTIa)N PERMIT <br /> evereu <br /> ina e�e.,,ee� e <br /> CITV OF <br /> everett <br /> BUILDING DEPARTMENT TO BE COMPLETED IN INK—PLEASE PRINT <br /> 259-8810 <br /> Ixl DEMOLITION I 1 COMBINATION I I BUILDING 1 I MECliANICAL � I PLUMBING I I SIGN <br /> ONTlER MnIL ADDAE55 ��TY 21P P1104E <br /> John E. Nughes, D.D.S. , Y.5. 3430 Colby Avo. , l'veratt, NA 98201 259-o1z5 <br /> TENRNT Mnil AODBESS CIiY ZIP PIiONE <br /> APCH1iEGTOPDESIGN[N M�ILAODRESS pTY 21P PHONE <br /> Falken ForshaH, 1510 i2th Street, hberel.t, WA, 96201 252-94�1 <br /> GEN[RALCONTAAGTOR M�R ADOA[55 CITY ZIP PIIDNE L�GENSE� <br /> (�� inrr <br /> MECHRNICN.LON7N�CTOR MRIL AU�P[55 dTV 21P PIIONE UGHNSE■ <br /> PIUMBINGCONiHAGIOR MA0.AD�flE55 CITY ZIP PMONE LICENSE/ <br /> CUSS OF WORN <br /> I �I NEW I. I ADDITION f 1 ALTERATION I I REPAIR IXi DEMOLITION I I WOODSTOVE/FRPL INSERT I 1 tiJILDING RELOCATION <br /> TEN/NT MIPROVEMENT OR INTEPIOR REIAOD[L ONIY CANi�RCT��P�E��R5�011 A1N1D PIIONE NO. / /� <br /> GONTR�CTfH�CEOiWORN: �/�J.(]—�j.U�� �� OJ7 �DI�Z.S <br /> —' <br /> DESCRiBE WORK PNO SOU�f1E fOOTAGE INVIXVFD <br /> Uemolish Luo frame structures� 1�0 sq. ft. _ <br /> Pnoroseouseweuaoinc � I H[REOY CERTIFV THAT I HAVE READ AND EXAMINED THIS <br /> APPLICATION AND KNOW THE SAME TO BE THUE AND CORRECT.ALL <br /> LEWLD[SCNIPTIONOFPROPERTY�SHOWNOCIOWOq�T7AQIPOUPCOPIES� PROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTYPEOF <br /> 1'lat of LWez'ett WORK WILI BE COMPLETED WITH WHETHER SPECIFIED HEREIN OH <br /> �o��r18.19�2�iocK 8�3 oF NOT. THE GRANTING OF A PERMIT DOES NOT PRESUlAE TO GIVE <br /> AUTHOF7ITY TO VIOLATE OF CANCEL TNE PROVISIOIJS OF ANY <br /> DiVSSlo� A OTHEF STATE OR LOCAL LAW REGULATING CONSTRUCTION OR TNE <br /> — PERfORMANCL OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> 3�ZF'I C ' I�i ' �� �PPLICATIONISSRMADB ANDPI pC0 P Y WITOH KTHER STATE <br /> `, CONTRACTORS LAW 7827 RCW AND 2962D0 WAC. <br /> aKl/� 3� �s 2,IZL CVI�y1 SIGNR111RFOPGONiRPCTORORFUT11DRiZCUAG[NT DATEZ ,y y/ <br /> O'1 l� � ' _/ <br /> \/�,� c,�L__/,j,� 0�1 �vG4cl� i=K�N�, T�GNit atu <br /> '��� �jo cc;�L�9 g� X �� �"� �,+�.,. ['. //,.,.�_. u�,.✓, <br /> rRa creoonEss <br /> /a yi z �' <br /> .r'�L�%��l l.�f�- � � m�rucn��tsurvnusn+[ssucti+scuo nr+oousm�sse+Ar: <br /> �:ri <br /> PLUMBING MECHANICAL _ <br /> NO. TYPE OF FI%TURE OH ITEM FEE N0. TYPE OF EDUIPMENT FEE _ <br /> WA7EF CLOSET(TOILEn _ � A/C—A�HNDLG UNITS—H.P. �_ <br /> BATHTUB ; FORCED AIR SYSTEMS—B.T.U. M E.A. ; <br /> IAVAIORY(WASH BASIN) � _ UNIT HCATERS—B.T.U. M �_ <br /> SHOWER � CLOTH[SDRYERS � _ <br /> KITCHEN SINN 8 DISP ' VENTILATION FAN _�__ <br /> � <br /> DISHWASHER � RANGE HOOD ' <br /> LAUNDRYTRAY _;_ WATERIIEATER � <br /> CLOTHES WASHER � WOOD STOVE �_ <br /> URINAL ' METAL FIREALACE 8 CHIMNEY � <br /> ORIIJKING FOUNTAIN � FIREPLACE INSERT __7_ <br /> FLOOR ORAIN __�__ H[AT PUMP _ ' <br /> BACKFLOW PREVENTERS ___i_ GAS PIPING � <br /> ROOF DRAINS—RAINLEADERS � EXHAUST FAN ' <br /> ---`— <br /> SINK(SERVICE—BAR,ETC.) � _ , <br /> � _ --;— <br /> — � <br /> — — � <br /> . . i . . . .. . . _. _. _. . . . ..�. <br /> , <br /> � —T <br /> _ � � � <br /> SUO TOTAL S ' SUB TOTAL 5 ' <br /> PERMIT $ —�_ PERMIT S _�_ <br /> TOTALf[E $ ' TOTALFE[ S <br /> FRONTSETORCK BEARSEi9AGN 510[SETOpCK PIANCH�CNNIIMOER FEE PEG[IPit10 <br /> .-.--—.-/J _-- � 7(n 3 _i. <br /> usezori@r>_ � iotnnu VALANTSIIL FEES VALUATION FEE <br /> �� I I YES 1 I NO BUIlOiraG ' <br /> tvr[orcoNsra�awmie ttvcofCoxst.a:tur,t oaurara+ xamvmwr�cimnc - -- � <br /> �"0� PLUM�ING � <br /> �— <br /> � <br /> SIEEOFBLDG. NO.OFSTOHIES O�SEMENT �dECHANICAL � <br /> I l YES I.I NO ; <br /> OCCUPN1CVlO�D FlRESPIiNNLERSREOD IIEIGIITLIMITAIION OTHER � _ <br /> I I YES I I NO STATE BUILDING�1:RCHAHGE � <br /> --�— <br /> REASON FO(I SPPINNLEfiS � <br /> S7A7EENERGVSURCHAHGE <br /> _ � <br /> pPPIILAIIONPCGUY PLRNSAPPROVEODY CITYOFEVERETT PUBLICWORKS � <br /> LOCAL SALES � <br /> TAX COUE IS 3105 TOTAL ' <br />