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APPL�CATIO��. FaIR CON�TRUCTI�IN �ERMIT e�e'e'� <br /> ina Eve�p�ee� TO BE COMPLETED IN INI!—PLEASE PRINT � " <br /> CITY Of <br /> everett HEATING SYSTEM: !]GAS ❑ELECTRIC ❑ � <br /> BUILDING DEPARTMENT <br /> 259•8810 <br /> ❑ DEMOIII'ION f7 COMBINATION -: BUILDING G MECHANICAL i�LUMBING i:] SIGN <br /> OWN�R MRILFDOqE55 CITV ZIP PHONE <br /> N l e,'L,c nti^ �.�� �C I fi s �"�,G•-dG.' r�l� • Sl��/��2 � _ <br /> � � TENANi � OD�ES� CITY 21P PHONL <br /> �!.'/.�,.����d n �i,�F� </....s ��F 76�`i <br /> � � �� � T citv ziv a�ror�e <br /> ARCMRECTORD SIiNS M� AO�RE55 � <br /> �',�y �=�t�a Mu �!„ S�.,m,= 3y3-�3vd' � <br /> F,,, GENERA�CONTRPCTOR A�LA RESS QTV ZiP PHONE 4CENSEI <br /> I <br /> �J'� <br /> tC � — — <br /> MECHANIC4LCONTqqCiOfl MRILAD�RE55 LITY � Zip PHONE IILENSE/ <br /> ,�� ,� //OU 'YII,c� S5� <br /> L1 PLU,M�Z/INGCO�N�Tfl'ACTOfl IA�ILAOORESS CITV pZIP PIIONE LICENSE� <br /> �x � 1YCd�t� � /7'JPi� � r �E7�?Tc.� g0/U� 7u"L-7�2-� J�Lo2T r-(MS iS(�+ <br /> CUSS OF WORK <br /> O H �� ❑ NEW C ADDITION �LTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOOOSTOVE/FRPL INSERT ❑ BUILDING FEICCAl'ION <br /> ��� n O� CONTACTPERSONAN�PHONENO. �^� <br /> H� �Cy+ CONTHGCTPRICEOf WOfiK� '/�VUV r � -� 6 � —^ 7 ]1 n <br /> � ,3� DESCR/IqFWOFNANU50UAREF00TAGEINVCLVEO <br /> _4.//l <br /> �~ PPOPOS' U: OFBUIL01!!G I HEREBY CERTIFY THAT I HAVE READ AND EXpMINED THIS <br /> r �� ��� APPLIC 1TION AND KNOW THE SAME TO BE TRUE AND CORAECT.ALL <br /> LEGAIDESCfiIPTIONO:PqOPEfltt�SHOWNBELOW OR ATTAGH FOOPCOPIES� PROVISIONS OF LAWS AND OFDINANCES GOVERNING THIS TVPE OF <br /> WORK WILI 6E COMPLETED WITH WHETHER SPECIFIED HEAEIN OR <br /> �or p�ocK oF NOT. THE GRANTING OF A PEHMIT OOES NOT PRESUME TO GIVE <br /> y��"7�� AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTNER STATE OR LOCAI.LAW FEGULATING CONSTRUCTION OP THE <br /> � PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFOHM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 1827 RCW AND 296.200 WAC. <br /> SIGNATUREOFCONTPACTOflOFAUTHOF2EDAGNT DATE/�� /�/ <br /> � <br /> ' PROJEGTAD�PE55 /�� -- <br /> � ���� LJ�r�eti. �/`� �_ APP�I NTSCITY iN SUCE IIO.ANDBUSINESSNNME <br /> �� \r PLUMBING MECHANICAL <br /> I �� NO. TYPE OF FI%TURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> , � �i y WATER CLOSET(TOILE� p � - NC-AIHNDLG UNITS-H.P. ' I <br /> � BATHTUB ; FORCED AIR S`.'STEMS-B.T.U. M E.A. <br /> 'f/ LAVATORY(WASH BASIN). /(J i - UNIT HEATERS-B:f.U. M i <br /> 1� I��I SHOWER � CLOTHESDRVERS � <br /> �� � i <br /> KITCHEN SINK 8 DISP i VENTILATION FAN <br /> / DISHWASHER ,�-!� - RANGEHOOD <br /> i LAUNDRYTRAY ' - WATER HEATER <br /> ' I CLOTHES WASHER l� - WCOD STOVE ; I <br /> � ��� URINAL NETAL FIREPLAC'c 8 CHIMNEY �_ <br /> � DRINKING FOUNTAIN FIREPLACE INSERT i i <br /> � � FLOOR DRAIN � HEAT PUMP <br /> � I <br /> I �'�� BACXFLOVJ PREVENTERS i GAS PIPING I ' <br /> e ROOF DRAINS-RAINLEADERS � EXHAUST FAN � <br /> � SINK(SERVICE-BAR,ETC.) ; <br /> � <br /> � !,�� � <br /> --r <br /> � <br /> � SUBTOTAL $ � - SUBTOTAL $ ' <br /> °ERMIT $ p � - R°RMIT 5 i <br /> �s� TOTAL FEE $ j'� T�TAL FEE $ <br /> - FQR OFFICE USE ONLY: <br /> FHGJTSETUACN PEARSETBACR SIOESET�ACK PlA1JCHECHNUh1BER FEE RELEtPTNO. <br /> USEZONE �OTFREA VACANTSITE FEES VALUATION FEE <br /> ouuoiNc <br /> 7YF[OFCONTS.ALLOWABLE 1YPEOiC@ISCALIOAL occuP.wa xoovmv[wxGuxns i <br /> Gfl0°P PLUMBING i �" <br /> SREOFOL�G. NO.OFSTORIES BASEMENT MECHANICAL ' I <br /> i <br /> OCCUPANCYLOAU FlRESPRNKLEFSFEOD HEIGHTUMITATION A�DITIONALPLANCHECK i � <br /> i <br /> OTHER � <br /> REASONFORSPflINNLEflS <br /> STATE Bl11LDING SURCHARGE i <br /> INTAKEBY PLANSAPPNOVEDBY CITYOFEVEflE7T PUBLICWORKS <br /> LOCALSALES � <br /> TAX CODEIS 5105 TOTAL � � <br />