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I <br /> . , r,,� <br /> APRLIrAT11.N FOR CONSTRUCI rON PERMIT <br /> 1n�E:e,y,�� everett <br /> CITV OF � <br /> everett � <br /> BUILDIIJG DEPARTMENT <br /> 259-8810 TO BE COMPLETED IN INK—PLEASE PRINT <br /> j( DEMOUTION - COMBINATION -1 BUILDING MECHANICAL PLUMBING SIGN <br /> OWNEB IAhILA0DFE55 Litt ZiP PNpHE <br /> f_�v.z,.ti ff� 1�L�i. � c�. s h� � � C:u..�'�� <br /> � �YIIOLti IAMLAOORE55 CITY �r ZIP PMONE / <br /> S3 /5 <-�lycC2�-,_ u)(-y. _£ L�.v�.Li u1c. �J,('��ZoC- ( j�S�I-��SLS <br /> ARCMREGTONDESIGNER MA�LRDDRESS� �T' ZIP FHONE , <br /> GEI�RRLCONTRACTOR MAILaD�HE55 LITV ZIP PHONE LiLENSE• <br /> ��`� Yl� la �4t LG, ( 14 - i31 Ctx,ti, �I, P_ l3�:t�,•,:.•-:�, `/�'Ocs '�SSyo.�7 Phaeac.J� zs"s4'S' , <br /> �y MECHRNICALCONiRAGTOP MRILRWPE55 CITY ZIP PNONE LIGEHSE� ' � <br /> '4^�H I <br /> '�p H](n PLUMBING CONTRRGtOR MAIL AO�flE55 CITV ZiP PHpNE LiLENSE� <br /> r ^�5��,1 <br /> y `� C1A550FWOFK � <br /> � y� i,.''� NEW C' ADDITION ❑ ALTERATION . i REPAIR jt�EMOLITION _ ! WOODSTOVFIFFPL INSERT l._' BUILOMG RELOCATION � <br /> � He�y� TENANTIMPR09EMENTOPINiEFIORREM00ELON V,1 CON ERSON� \ANDPM �0. ( iI <br /> y �L.Hy LOMflACT PFICE OF WORN: V, r �• Q 1 ��✓ 7 �� yj��/D�, <br /> � O 3 OESCPIOE WOFK AND SOUnRE FODTFGE INVOLVED �'Le�� — S �//} y \ _ , n ,r <br /> yd ��v� � CL.LI. �- �z�� o � i�Lic,�L. �X�. \�1.�4�X-k. �fJ� - �S Z� <br /> �O r,H,� PFOPOSEpU5E0F8UILDING /� / I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> � LT1� L��i-(i i L � APPLICATION AND KNOW THE SAME TO CiE TRUE AND CORRECL ALL ' <br /> LEGRLDESCRIPTIONOFPRGPEHTY�SHOWN9ELOWOflATfACHFOUflCOP1E5� PROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTYPEOF <br /> y H� WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR , <br /> a y� �or eiocK oF NOT. TNE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> H y AUTHORITV TO VIOLATE OF CANCEL THE PROVISIONS OF ANY . <br /> �+ OTHER STATE OF LOCAL LAW REGULATING CONSTRUCTION OR THE � <br /> y <br /> � tl� PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> r <br /> APPLICATION IS MAOE AND I COMPLY WITH THE STATE <br /> Ci7 CONTRACTORS LAW 1827 RCW AND 296.200 WAC. <br /> � Oy SIGNATUREOFCONTFRCTOROqAUTHORIZEDAGENT DFTE <br /> PFOJECTAO�RE55 � VCr7/Y'cJ��'/"\G' `�ir-y,-r W <br /> � o APPUCr1NT5GItYBU51�YE55LILEN5EN0.ANDBU51NES5NAME <br /> � _,5.�/,,f—L {��v�✓t¢iv l.A]c.. �r Q.ri� �(l.. <br /> PLUMBING MECHpNICAL <br /> � NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> � +w WATER CLOSET(TOILET) � NC—FVHNDLG UNITS—H,P. <br /> �� BATHTUB ; FORCED AIR SYSTEMS—B.T.U. M E.A �. <br /> LAVATORY(WASH BASIN) � UNIT HEATEFS-6.T.U. M '', <br /> SHOWER � CLOTHES DRYERS ��. <br /> ��� KITCHEN SINK 8 DISP VENTILATION FAN ��� <br /> �! DISHWASHER RANGE HOOD : <br /> � LAUNDRVTAAV ' � <br /> � WATER HEATEfl � . <br /> f�� � CLOTHES'NASHER i WOOD STOVE ; �� <br /> �� UflINAL METAL FIREPLACE 8 CHIMNEY � � <br /> DRINKING FOUNTAIN FIREPLACE INSERT ; ' <br /> FLOOR DRAIN HEAT PUMP ! <br /> BACKFLOW PREVENTEHS ; GAS PIPING � <br /> �! ROOF DRAINS—RAINLEADERS i EXHAUST FAN � <br /> SINK(SERVICE—BAR,ETCJ � <br /> ����� —T— �I <br /> — � <br /> i <br /> i <br /> ��'i SUBTOTAL 5 SUBTOTAL S i <br /> PERMIT $ � PEFiM1T $ . <br /> TOTAL FEE $ TOTAL FEE S II <br /> � FRONi5ET8ACK REAqSETBACK SIOESETBACK PLANGHECNNOMBEH FEE PECEIPTNO. <br /> USEZONE LOTAREA VRCANTSITE FEES VALUATION FEE ', <br /> ❑ YES .i NO BUILDiNG ' i <br /> iYPEOif.OHSiALLOWA9LE iYPEOiCONSt.ACNAL OCCuvANtv I xOMO'MwxLunnS ' <br /> 4AWP � <br /> PLUMBING <br /> SREOFOIDG. NOAFSTORiEs BaSENENT MECHANICAL i <br /> i I YES ',i NO � I <br /> OCCUPANCV LORD FIqE SPRNNLEPS RE00 H[IGMi LIlAITFTION <br /> OTHER ; i <br /> ..I YES . �. NO STATE BUILDING SUflCHARGE � i�Jll 'I <br /> PEASON FOR SPRiNH�ERS <br /> STATEENERGVSURCHARGE ' <br /> APPLICATION�CC.U'/ PL�NSFPPqOVE00Y CITYOFEVEpETT PUOLICWORKS <br /> LOCAL SALES <br /> TAX CODE IS 3105 TOTAL � ;�rl I <br /> i <br />