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� F � ,r. <br />APPLICA'TlG+r�i F�R CONSTRUC7�;.dN PE�tMIT everett <br />�� E�ro�� TO BE COMPLETED IN INK—PLEASE PRINT � <br />citv oF <br />� everett H�ATING SYSTEM: ❑ GAS ❑ ELECTRIC U_ <br />' BUILDING DEPARTMENT <br />259-8810 <br />C7 DEMOLITION f 1 COMBINATION ! J BUILDING I: i MECHANICAL j�LUMBING ❑ SIGN <br />ONTlEfl M�ILADDRESS � LITV ZIP PHON[ <br />� � � lilt(iI i .�s.�J� - <br />. TENAN,�' MRILAO�RE55 CITY ZIP PHONE <br />-t !/ <br />1 ARCNITECT(1SDESIGNER MRILADURE55 CITV 21P PHONE <br />� GFucn�l CaNTa�CTOR _ MAII AD�RE55 � QTY 21P PHONE LICENSE � <br />� ME HIWILALUNlTflACTOR <br />� UYBINGCONTRACTO � <br />' CL/SSOfWOHN <br />❑ NEW L I ADDITION <br />LONTMGi PRICE OF WORK <br />. UESCPIBE WOBK AND SOU�jIF, F� <br />LEG�L OESCRIPTION UF PpOP� <br />lpT BLOCK <br />PRQIECT IIUUNE55 <br />� �t0%C� <br />PLUMBING <br />• N0. TYPE OF <br />/ WATER CLOSET <br />BATHTUB <br />� / LAVATORY(WAS <br />SHOWER <br />KITCHEN SINI( R <br />DISHWASHER <br />� LAUNDRY TRAY <br />CLOTHES WA5H <br />URINAL <br />� DRINKING FOUN <br />FLOOR DRAIN <br />� BACKFLOW PflE <br />� ROOF DRAINS- <br />dTY 21V PHONE <br />f..e.,� LZ�Gi-' J�� <br />rirv ZIP PHONE <br />I <br />LICENSE � <br />I I REPAIR I I DF_MOLITION I I WOODSTOVE/FRPL INSEAT ❑ BUILDING RELOCATION <br />I CON��CT PEf150N ANO MIONE NO. <br />I HEREBV CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND NNGW THE SAME TO BE TRUE ANO COflRECT. ALL <br />BELOW ORATTACHFOUP CAPIES) PROVISIONS OF LANS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />_ oF NOT. THE GRANTING OF A PERMIT DOES NOT FRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AU7HORIZE� BY THE <br />OWNEFi OF THIS PROPERTY TO PERFORM THE W'ORK POR WHICH <br />APPLICATION IS MADE AIJD I �OMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />SIGN�.IURF.OFCONTRACiOflORAUTHOHIZEOAGENT OATE <br />-' �[^�1 �' . �� ^ <br />�./ ' / `-' �� �c ��� � <br />/ � RPPLICANTSCITY�USINESSLICENSENO.ANOBUSINESSNAME <br />MECHpNICAL <br />E OR ITEM FEE NO. TYPE OF EQUIPMENT FEE _ <br />� A/(rA/HNDLG UNITS-H.P. � <br />! FORCED AIR iYSTE1.1S-B.T.U. M E.A. ! <br />UNIT HEATERS-E <br />CLOTHES DRYER! <br />VENTILATION FAN <br />RANGEHOO� <br />WATER HEATER <br />8 CHIMNEY <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN <br />SUB TOTAL $ <br />PERMIT $ <br />TOTAL FEE $ <br />FOR OFFICE USE ONLY: <br />' FRINITSETBACN REARSETOACK <br />USE20NE IOT�BEA <br />TYPEOfCONIS.ALLOWABIE IYPEf1iCON57.4CNR1 <br />SIZEOFBLDO. NO.OFSTORIES <br />� <br />OCCUPANGVLOAD FIRESPRNKLERSIIE( <br />HCASON FOR SPRINKLERS <br />, INTANE6V PIANSAPPfiOVE�BY <br />, � ti�'1 <br />PLANCHECKNUMBER � FEE <br />VACANT SITE <br />BUILDING <br />M[UN.NCV NOOf01HLLINOUNIIS � <br />cnwn PLUMBING <br />OASEME��i MECHANICAL <br />41EIGHTLIMI1R710N ADOITIONA! ALANCHECH <br />OTHER <br />STATE BUILDING SUNCHARGE <br />CITY OF EYERETT PUBLIC WORKS <br />LOCALSALES <br />TAX CODE IS 3105 TOTAL <br />PERMIT 8 <br />TOTAL FEE $ <br />31 <br />