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_._�.� <br /> APPLICATI� �OR CONSTRUC�N PERMIT E'�f"e�' <br /> ine eraw�rdn TO BE COMPLETED IN INK—P ASE PRINT � <br /> :IlY OF <br /> everett - — --- � <br /> I HEATING SYSTEM: � GAS U ELFCTFIC U __ _ _ ___ <br /> BUILDING DEPARTMENT � <br /> � � 259-8810 — . <br /> ��� DEMOLITION COMBINATION BUILDING ECHANICAL PLUMBING SIGN <br /> � ENANL � MAIL/�OR�M���Cli� ZIP ���E/�� <br /> ��� � <br /> FPCHITECTORDESIGNER MRILPODRESS CITY ZIP PHONE <br /> � <br /> ��N GENERRL CCNTPACTON MPR ADORE55 CIiV ZIP PHONE LIGENSE N <br /> �# . <br /> ��� � iGRL CONT TOR MNIL P S��/� CIT��' �Z��?z ���,� LICtN �J ��� . <br /> L� '•�//_ <br /> � / /m7/H <br /> �^�y VtUMBINGCONTPFCTOP MAILAWHE55 QTY ZIP PMONE LICENSEM <br /> [V V <br /> Q• Q <br /> N CUSSOFWOflK ��� <br /> y -�� NEW � ADDITION ALTERATION �� REPAIR �. . DEMOLITION �_ �� WOODSTOVE/FRPL INSERT ..�I BUILDING RELOCATION <br /> ��� � CONTACT PEFSON AND PHONE NO. <br /> �N CONTMCTPRICEOFWOPM � ) � . <br /> ~ DESCRIBE WOFK PND ARE F TAGE INVOLVED <br /> ��° �W � 9�Ss3 <br /> � PROPOSE�DU/S�EOFBUILOING I HEFiEBY GERTIFY TI1AT I HAVE READ AND EXAMINED THIS <br /> O!A Sr'�"`-� APPUCATION AND.KNOW THE SAME TO BE TRUE AND CORRECL ALL <br /> �ecn�oescaivnor+oFvaoaearv�sHowHaeiowoanr*ncHvouacoaiesl PROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTYPEOF � <br /> WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> �o* �aK oF NOi THE GRANTING OP A PERMIT DOES NOT PRESUME TO GNE <br /> AUTHORITV TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW RE('iULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTIOM1.THAT I AM AUTHORIZFD BV THE <br /> OWNER OF THIS PROPERTV TO PEPFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I GOMPIY WITH THE STATE <br /> CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br /> SIGNATl1REOFC RACTORORAIITHORR AGEN� <br /> x � , <br /> PRQIEGtADDRE55 n / / / / <br /> . /+�/ /J Q/' _ /� f��y� q �tiQ__, APPLICANTS CITV By ME55 LICENSE N0.FND BUSME55 NRME <br /> 'V/ a /y�cce-i�,!'� c� ,- <br /> PIUMBING MECHANICAL <br /> . NO. TYPE OF FIXTUHE OR ITEM FEE NO. TVPE OF EOUIPMENT FEE <br /> 1I . WATEP CLOSET(TOILET) NC—NHNDLG UNITS—H.P. <br /> � {� i BATHTUB FOFCED Alii S`.'STEMS—B.T.U. M E.A. <br /> 1 LAVATORY(WASH BASIN) UNIT HEA7ERS—B TU M <br /> ��' SHOWER CLOTHES DRYERS <br /> i KITCHEN SINK 8 DISP VENTILATION r.1N <br /> DISHWASHER RANGE HOOD <br /> LAUNDRVTRAV WATERIIEATER <br /> � �� URONA ES WASHEfl MOOD F R6PLACE 8 CHIMNEV <br /> DRWKING FOUNTAIN PIREPLACE INSERT <br /> � � FLOOR DRAIN EAT PUMP <br /> . • � " BACKFLOW PREVENTERS GAS PIPING <br /> � ROOFDRAIN�FAINLEADERS EXHAUSTFAN <br /> . SINK(SERVICE—BAR,ETC.) <br /> { __ — — <br /> � SUBTOTAL $ SUBTOTAL $ ,30; JZJ <br /> .. U� PERMIT $ PERMIT $ /S� <br /> TOTAL FEE $ TOTAL FEE $ S� <br /> F4R OFFICE USE ONLY: <br /> � FRONTSETBACK REARSETBACK SIOESETBACK PLANGHECKNUMBER fEE RECEIPTNO. <br /> usezone �orneen vacnHrsirs FEES VALUA710N FEE <br /> BUILDING <br /> � IYVEOiLONTSRILOWPBIE IYPEOFCONSiP6TpAL acuvpxw xOOr�WFwrvfiuxrt5 - <br />' ' sHouv PLUMBING <br /> SIZEOFBLDG. NO.OFSi0PIE5 BNSEMErvT MECHANICAL �i�(� <br /> OLGUPANCVLOA� FIRESPRNNLERSREOD HEIf.HTLIMIiAiiOrv ADDITIONALPLANCMECK <br /> OTHEF <br /> RERSUN FOR SPRiNKLERS <br /> STATE BUILDING SURCHARGE <br /> INTRKE9V PLANS/PPROVEDBV CITYOFEVERETT PUBUGWORKS <br /> LOCALSALES <br /> TAX CODE IS 3105 rorn� <br />