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;?'n;E- , >.. ,:: <br /> '^:;,:,.. , .. c-ol1" 'i,Y4 <br /> APPLICAT�N FOR CONSTRU �`° ON PERIIAIT <br /> everett <br /> � rha Eroro�^ � <br /> CITY OF <br /> qqq� everett � <br /> � BUILDING DEPARTMENT TO BE COMPLETED IN INK—PLEASE PRINT <br /> �259-8610 <br /> � ❑ DEMOUT��N ❑ COMBINATION ❑ BUILDING ❑MECHANiCA HONE PLUMBING ❑ SIGN <br /> (�r AOOHE55 rCITY /�q � <br /> a � OWNER� � G��� 70�5 �ObG7 <br /> �f'- i <br /> MAlLAO�RESS CIN 2�P PMOIIE , <br /> `' � wq ��� gaany <br /> i /�..,c � loa o 3 �vEQc,a� <br /> �.i CITY ZIP PHONE <br /> � ppCpITECTOROESIONER MA�LADORE55 <br /> 1 L �Q t ��T, Z�p PHONE LICENSER <br /> �� OENEMLCONTMCTOF7 A:AlLAODFESS �1,' y.393 _ <br /> �� S�r�� �� CITY ZIP PHONE LICENSEII <br /> MECIUNIC/�LGONTR�CTOR AUILAUDRE55 <br /> �� CIiV 21P PXONE LICENSE/ <br /> vWMBINO MAILADOPESS as` �' �'���� S'r�FIVIMG <br /> � �•ny�g nA � � AL� �013� •Gea f�FJU7D� �_ <br /> � p�9, WOPK <br /> j � ❑ ADDITION ❑ ALTERATION ❑ REPAIR G ^EUO'-!710N ❑ WOODSTOVElFRPL INSERT ❑ BUILDING RELOCATION <br /> � CONTAGT PERSON M10 PHONE NO. <br /> .� ����Mp�TER�ORREMO�EIONLY <br /> ,� �pliMCT PFICE OF WORK: <br /> . OEfiCFIBE WOiiK AND SWARE FOOTADE INYOWED <br /> 1 vporoseousEOFam�oieo I NEREBY CERTIF� THAT 1 HAVE READ AND EXAMINED THIS <br /> + APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> { � PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> . !E(Y1LDE6CflIPT10HOFPpOPERN(SXOWNBE�OWOflATTACHFWHCOPIES) yyORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> _: �T B��K oF NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME 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 AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> � CONTRACTORS LAW 1B.27 RCW AND 296.200 WAC. <br /> � SIGNATUREOFCONT ORIZEDA6ENT O�TE <br /> I � � � <br /> j I��a� <br /> y <br /> � pqpJECTAOPRESS � APPL CITVBU3INESSL�CEN .MIDBUSMESSNNAE <br /> ��y�,� J � <br /> � �P�Q MECHANICAL FEE <br /> p�p, 7YpE OF FI:(TURE OR ITEM FEE NO. TYPE OF EOUIPMENT <br /> WATER CLOSET(TOILEn � A/C—A/HNDLG UNITS—H.P. ' <br /> � FORCED AIR SYSTEMS—B.T.U. M E.A. ' <br /> � , BATHTUB � UNIT HEATERS—B:LU. M ' <br /> LAYATORY(WASH BASIN) ' <br /> ^' ' � CLOTHES DRYEfiS � <br /> ' -' — � SHOWEfl � VENTIIATION FAN ' <br /> KITCHEN SINK&DISP � RANGE HOOD � <br /> �:��" DISHWASHEF � WATER HEATER � <br /> ' LAUNDRYTRAY ' � <br /> WOOD STOVE ' <br /> �� CLOTHES WASHER � <br /> r � METAL FIREPLACE&CHIMNEY � <br /> URINAL � FIREPLACE INSERT ' <br /> .� DRINKING FOUNTA�N � HEAT PUMP � <br /> FLOOR DRAIN � GAS PIPING y— <br /> � BACKFLOW PREVENTERS ' <br /> , EXNAUSTFAN � <br /> �'i ROOF DRAINS—RAINLEADERS � <br /> � ' SINK(SERVICE—BAR,ETC.) � ' <br /> , ' <br /> ' y S � <br /> � <br /> — � <br /> 1 � � <br /> � � � <br /> a � � <br /> ' SUB TOTAL $ . ' SUB TOTAL $ <br /> ' � PERMIT S ' <br /> �! PERMIT 5 � TOTAL FEE S ' <br /> 1 TOTALFEE S pECEIPTNO. <br /> �� PIANCNECKNUMBER FEE <br /> j FRONT6EiBACK REAflSETBACK SIOESETBACK <br /> � FEES VALUATION FEE <br /> �} �OTAREA VACANTSITE � <br /> � , U&EZONE � <br /> � ❑ YES ❑ NO BUIL�ING . <br /> � ' acuw,xcr xo.aow�uixou+ns �D � <br /> � TYPEOFCONST.ALIOWNBIE TYPEOFCONST.ACiURL pqq�p p�UMBING <br /> 1 61ZEOFBL00• NO.OFSiOPIES BRSEMENT MECHANICAL �I � <br /> I ❑.YES ❑ NO � <br /> a OTHER � <br /> OCCUPANCYLOAD FIRESPRNHLERSflEO'0 HEI�HTIIMITATION i <br /> y ❑ YES ❑ NO STATE BUIIDING SURCHARGE � <br /> i <br /> REASONFORSPFINNLERS STATEENERGYSURCHARGE ' <br /> � <br /> i <br /> Y APPLICATIONACC.BY PUINSAPPPOVEDBY CITYOFEVERETf PUBLICWORKS ' <br /> � \^n n� LOCAL SALES ;G� <br /> i <br /> �`��i'�' ` TAX CODE IS 3105 toTa� <br /> ' .r:.. .p� r:: .L ':i ., .- ..-�, .:.r. . ....,.. .. :. � ' . . . � � - �. -.. . .�.. . .':.n <br />