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_ �. � <br /> . <br /> � <br /> APPLICATION FOR CONSTRUCTIVN PERMIT QVe�Ptt <br /> ��E�re��� TO BE COMPLETED IN INK—PLEASE PRINT � <br /> GTV OF <br /> everett HEATING SYSTEM: GAS U ELECTRIC U <br /> BUILDING DEPARTMENT <br /> 259-8810 � <br /> I-1 DEMOLITION 1_� COMBINATION IJ BUILDING Ii7AAECHANICAL Cl PLUMBING I7 SIGN <br /> OWNER M�RADOHESS CITY 21P PHONE <br /> A).,.,.,���G �pYA►�► �� 1��RT�ST. S.W.#10(a �vERETr 9R�vy 7�13-55G,� <br /> TENMlT MAILAUDHE55 CITY ZIP PHONE � <br /> ARCHITECTORDESIGNER MARADORESS CITY ZIP PHONE <br /> GENER�LCONTR�GTOH MAILPODRE55 CIIY ZIP PIIONE L�CENSEI <br /> (��ntk�nNHkl?CIAL PD [�r�,r�42 l,vuNl�2zY� lilA 9��04� 7743�J-13 <br /> MECHANICQCONTRACTOR MAILADDRE55 —� CITY � ZIP PHUNE LICENSER <br /> Qj�SMPICMC-C�IAIJILAL Pnl',r� ��2L1.��)u'�o�t�l (a �1B0�/(o `J7y-�3B�-11 C1,YMP}1r170�1 <br /> PLIMIBIN6GONTfl�CTOR MAILADDRE55 CIIY ZIP PIIONF LICENSEI <br /> C OF WORK . <br /> _ NEW I I ADDITION f J ALTERATION i J REPAIR I I DEMOLITION I I WOODSTOVE/FRPL INSERT ❑ BUILDING RELOCATION <br /> CONTqCT PEHSON AND PHONE NO. <br /> � CONTMCTPRICEOFWOHK O �p =4LN eRA�r-oRf] 77�} - R�,�) � <br /> DESCR6E WORK IJdD SIXIARE FOOT�GE INVOLVED <br /> 5• F <br /> PROPOSEDUSEOFBUILDINO I HEREBY CERTIFY THAT I HAVE READ AND E%AMINED THIS <br /> – ,��jt� APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> LEGAL DESCRIPTION OF PROPERTY(SNOWq BELOW OR�TfRCH FWN CAPIES� PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> WORK WILL BE COMPLETED WITH WHETHER SPECIFIED fiEREIN OR <br /> ior eiocK oF NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AUTHORITY TO VIOLATE OR CANCEL THE PROVISIO�lS OF ANY <br /> }} OTHER STATE OR LOCAL U1W FEGULATING 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 1827 RCW AND 2 200 WAC. - <br /> SIONATURE OF CONTR�CTOR OR�UTHORIZED A . <br /> _ - R6E X <br /> PROJECTAOURESS <br /> APPI,IC�NTS I BUSINESSLICENSE .M:DBUS NMIE � <br /> PLUM IN6 MECHANICAI <br /> NO. TYPE OF FIIfTURE OR ITEM FEE NO. TYPE OF E�UIPMENT FEE <br /> WATER CLOS[T(TOILET) � A/C—AIHNDLG UNITS--H.P. � <br /> BATHTUB ; FORCED AIR S`!STEMS—B.T.U. M E.A. � <br /> LAVATORY(WASH BASIN)� � UNIT HEATERS—B.T.U. M ; <br /> SHOWER ' CLOTHES DRYERS � <br /> KITCHEN SINK 6 DISP � VENTILATION FAN ; <br /> DISHWASHER � RANGE HOOD � <br /> LAUNDRY TRAY ; WATER HEATER ' <br /> CLOTHES WASHER � WOOD STOVE � <br /> URINAL ' METAL FIREPLAGE&CHIMNEY � <br /> DRINKING FOUNTAIN � FIREPLACE INSERT ; <br /> FLOOR DRAIN � HEAT PUMP � <br /> BACKFLOW PREVENTERS i GAS PIPING ; <br /> ROOF ORAINS—flAINLEADERS � EXHAUST FAN � <br /> SINK(SERVICE—BAR,ETC.) ; � ` <br /> � i <br /> i � <br /> SUB TOTAL S ; SUB TOTAL S ' � <br /> PERMIT S � PERMIT $ � � <br /> TOTAL FEE E ' TOTAL FEE $ ' � <br /> FOR OFFICE USE ONLY: <br /> FflONT SETB�CN REAfl SETBACK SIDE SETBACK PLAN CHECN NUMBER FEE RECEIPT NO. <br /> USEIONE LOT�PEA VAG/NTSITE FEES VALUATION FE� <br /> BUILDING i <br /> tYVFOiLONiS.�LIOWRPIF lYVEOiCONSt.ACNAt octuv�xcr rmorrt,vuux6uxn5 i <br /> cnao pLUMBING � <br /> SIZEOFBlIX3. NO.OFSTORIES BASEMENI MECHANICAI � — <br /> 1_ <br /> i <br /> ADDITIONAL PLAN CIIECK � <br /> OCCUPANCYlOAO FIRESPRNKLEHSPEOD HEIGHTLIMITATION � <br /> _ <br /> I OTIiER ' <br /> — � <br /> REASON FOF SPRINKIERS �--� <br /> STATE DUILOING SURCHARGE i <br /> INTAKE9Y PUNSAPPf10VE[)OY CITYOFEVERETT PUBLICWORKS � <br /> LOCAL SALES � <br /> _ _ TAX CODE IS 3105 rorn�— C��'�� <br /> �_ <br />