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r, ,,w� <br /> APPLIC�►TION FOR CQ�NSTRUCTION <br /> PERMIT <br /> fhs Everyreen <br /> CITV OF <br /> everett <br /> everett e <br /> BUILDING DEPARTMENT <br /> 259•88to TO BE COMPLETED IN INK— PLEASE PRINT <br /> OWNER MAILr1DORE55 CItY'�^ , ZIP PNONE <br /> TEN�N�� B��AILAODR��� ��� CIT�i 1�W� PM���_ I II� <br /> •pCHITECTOR0ES14NER MAILr1�ONESS CITY ZIP PHONE <br /> �Ei.ER�LGONTRAGTOfl MAILFDDRESS CITY ZIP PHONE LICENSE♦ <br /> `f.o.�c2� � i�una ��l• (,iu�rr r��+� N�rue�crinP� <br /> MECHANICALCONTHRCTOR M�ILADDFE55 !n■ e CIT �y ZIP PHONE LIGENSE+ <br /> ` �ViJ F. � �M� <br /> PLUMBINOCONTMCTOH MFILAD�IIE 5 ilP PHONE �ICENSE� <br /> �•� <br /> C,�IA/SS OF WONN �y�p — <br /> LN NEJY ❑ ADDITION L�f ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FFPL INSERT ❑ BUILDING R'cLOCATICN <br /> IENANT IMPRpVEMENT OR INTERIOR REMO�EL ONLY ('qNTAGT PEflSON AND PHONE NO <br /> CONTMCT PRICE OF WORK <br /> � C <br /> DESCRIBE WORK�ND SOUARE FOOTr1GE INVOWED <br /> i n�ta.l.2. �.cm i+ ��-C� r,?5�a4'�/ <br /> a+oroseo use or evaoiNa � <br /> �, _ __�� IHEREBVCEqTIFV?HATIHAVEREPDANDEXAMINEDTHISAPPLICATIOIJAND <br /> (�}�r� KNOW THE SAME TO BE TRUE AND CORRECT.ALL PROVISIONS OF UWS AND <br /> LE(L�LUESCRIPTIONOFPROPERTY'SHOWN6eLOWORATTACHFOURCOPIES) ORDINANCESGOVERNINGTHISNPEOFWORKWILLBECOMPLETEDWITH <br /> � WHEfHER SPECIFIED HEFEIN OR NOT.THE GRANTING OF A PERMIT DOES NOT <br /> PHESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br /> �oi BLOCK oF ANYOTHERSTATEORLOCALLAWREGULATINGCONSTFUCTION09THEPER- <br /> FORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE OWNER OF <br /> � THIS PROPERTV TO PERFORM THE WORK FOR\NHICH APPLICATIOM IS MADE <br /> AND I COMPLY WITH THE STATE CONTRACTORS LAW 1827 RCW 1ND <br /> . 296200 WAC. <br /> SIGNRTUREOFCONTRACTORORAUTMOFI]EDAGEYT DATE <br /> PROJECfADOPE35 --/-`-'-"��-�1� �'�/� LO <br /> RPP4CANTS CITY BUS NESS LICENSE NO NND BUSINE55 NAME <br /> � <br /> PLUMBINQ MECHANICAL <br /> NO. TYPE OF FO(TURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) A/C—A/HNDLG UNITS—H.P. <br /> BATHTUB FORCED AIR SYSTEMS—6T.0 <br /> LAVATORY(WASH BASIN) � UNIT HEATERS—&T.U. M <br /> SHOWER CLOTHESDRYERS <br /> KITCHEN SINKB DISP. VENTILATION FAN <br /> DISHWASHER RANGEHOOD <br /> LAUNDRYTRAY _ WATEFHEATER <br /> CLOTHES WASHER WOOD STOVE <br /> URINAL METAL FIREPLACEB CHIMNEY <br /> DRINKINO FOUNTAIN FIREPLACEINSERT <br /> FLOOR DFAIN HEAT PUMP <br /> BACKfLOW PREVENTERS GAS PIFING <br /> ROOF DRAINS—RAINIEADERS EXHAUST FAN <br /> SINK�SERVICE—BAR,ETC.) <br /> SUBTOTAL $ SUBTOTAL 5 J � <br /> PERMIT $ PEqM1T S / <br /> TOTAL FEE $ T(�7qL FEE $ ,3U � <br /> FPONTSET&1CK PEAqSETBACK SIOESETBACK PLANGNECRNUMBER FEE qECEIPTNO. <br /> useior+e LOTAFEA VFCFNTSRE FEES VALUATION FEE <br /> ❑YES ❑ NO <br /> IYPEOFCANS? OCCUPFNCYGROUP NO.OFDWELLINGUNITS BUILDING <br /> ALLOW�BIE/ACTUAL <br /> PLUMBING <br /> 91ZEOFBLDG. NO.OFSTORIES BSM1IT. OCGLORD <br /> ❑� MECHAPiICAL <br /> ❑ N — <br /> HEiGHTLIMITATION OTHER <br /> FIRESPRINNLERS REOUIRED ❑YES ❑ NO STATE BUILDING SURCHARGE <br /> STATE ENERGV SURCHARGE <br /> APPLICRTIONACGBY PLANSr1PPR.BY <br /> PUBLIC WORKS <br /> TOTAL <br />