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r'." <br /> 6�tr'� <br /> APPLICATIti�l FOR CONSTRUC7ti+bN PERMIT <br /> everett <br /> � �E���� e <br /> � CITV OF <br /> ; everett <br /> BUILDING DEPARTMENT TO BE COMPLETED IN INK—PLEASF.PRINT <br /> 259-8810 <br /> ❑ DEMOLITION I I COMBINATION �BUILDING I I MECHANICAL I I PLUMBING ❑ SIGN <br /> OWNER MAllA00RE55 diV ZIP ) PHONE i2S� �,l�Z <br /> ✓- .1� // �l' / /F/ 'ti <br /> -7%r�,a I^Y�,�.�.a- Q c� u 9 /,��f S 7� ,�<-« ,,�� I � c <br /> T NI1NT MAILAOURES�— CIT ZIP PHONE <br /> T�,� � /t27,� / F s.e ;���z, ��.�t��s � l r,- 2s��-QS/ <br /> �RCHITECTORDESIG H MAILADORESS f7T— C�t Zf'`/n P110NE <br /> f�K'-��J C{..!��,q�/— /7703 `��l�l �� �-F�TI�B,d Q� - <br /> f .ERAL iRACTOB ��A�ADORESS ITY ZIP PHONE LICENS O�/�.�II(��c <br /> � � ��li Z � �Z ��l�L <br /> MFCN IC�LCONTRA 70R MAIIAODRE55 CITY ZIP PHONE UCENSEI <br /> VLUMBINaC TPACTOR MAILPD�RESS CITY 21P PHONE LICENSE/ <br /> �. <br /> CLASS OF WOflK <br /> ❑ NEW I 1 ADDITION f�'ALTERATION I I REPAIF I I DEMOLITION I ! WOODSTOVEIFRPL INSERT I 1 BUILDINO RELOCATION <br /> TEN�NT IMPROVEI.IENI OR MTERIOB REMOOEL ONLY �4� �_.[/7... COMACT PEfi50N�ND PIIONF.NO � �J <br /> � c� <br /> GONTMCTPHICEOFWORK: 7L. S'l � >�t-� _S - 7- Z <br /> DESCNIBE ORNANDSOl1ARF/FOO EINVOLVEO h 4„ <br /> PROPO EOUSEOFBUIID G / � I HEREBY CERTIFV TNAT I HAVE READ AND EXAMINED THIS <br /> �,� fP ,�y' � APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECL ALL <br /> / �"�-------�"""� PROVISIONS Or LAWS ANU ORDINANCES GOVERNINO THIS TYPE OF <br /> tea�uoescmrrwNOF�noremv�s��Neeiowonnrucnrouncories� yyORK WILL BE COMPLETFU WITH WHETHER SPECIFIED HEREIN OR <br /> �oT flLOCK oF ' _ NOT. TFIE CRANiING OF A PERMIT DOES NOT PRESUME TO CIVE <br /> AUTHORITY TO�VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTh1EFl STATE OR LOCA!_LAW REGULATING CONSTRUCTION OR THE <br /> -- PEFlFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BV THE <br /> OWNEFi OF TFi15 PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 1827 RCW AND 296.200 WAC. 5/�y��O <br /> SIGN�TUf1EOPCONfR4CTO110fiAUIHORIZEDAGENT OATE <br /> v""� J � �E��������1/'^�� <br /> PXOJECTAUDRE55 IU��[ �t A _ �PPLICAMSf,ILYP1151NF5511GF.N5ENO.Ab BUSINESSNAME <br /> ✓ v <br /> PWMBINQ � MECHANICAL <br /> NO. 7"PE OF FIXTURE OR ITEM FEE NO. TYPE OF E�UIPMENT FEE <br /> WATER.LOSET(TOILET) � A/C—A/HNDLG UNITS—H.P. � <br /> � <br /> BATHTUB ' FORCED AIR SYSTEMS—B.T.U. M E.A. ' <br /> , UNIT HEAT[RS—B.T.U. M � <br /> LAVATORY(WASH BASIN) __ � <br /> —� <br /> SHOWER ' CLOTHES ORYERS �_ <br /> KITCHEN SINK 8 DISP ; VENTILATION FAN � <br /> DISHWASHER � RANGE HOOD ' <br /> WATER HEATEA � <br /> LAUNDRYTRAV � � <br /> � CLOTHFS WASHEfl � WOOD STOVE � <br /> UPINAL ' METAL FIREPLACE&CHIMNEY ' <br /> i <br /> DRINKING FOUNTAIN � FIREPLACE INSERT �_ <br /> FLOOR DRAIN —r— HEAT PUMP � <br /> BACKFLOW PREVENTERS ; GAS PIPING <br /> ROOF DRAINS—RAINLEADERS EXHAUST FAN ' <br /> i <br /> SINK(SERVICE—BAR,ETC.) � � <br /> � ' <br /> � <br /> —— � <br /> � <br /> �— —' , <br /> T� I <br /> � SUB T01A1 5 ' _____ SUB TOTAL $ ' <br /> PEPMIT $ � PERMIT $ � <br /> TOTAL FEE $ ' TOTAL FEE $ ' <br /> _i_ <br /> FRONTSETBACK REAOSETBALK SIOESE7fi�CN PI�NCHECHNUMAER i .�EE '� 'YD RECEIPTNO. <br /> �ST�JCs — <'o ��f 7/ 3 � 6. sa <br /> usezori _ � LOTAREA Vr1CAM5nE FEES VALUATI N °EE <br /> I I YES �NO BUILDW� ��h 2 i ,3 U <br /> rccurexcr xnnroN4wxr.uxus 7j °t� �""�''�� <br /> 7YPEOfCONSI.RILOWABIE TYPEOFCONSCPCIIIAL q%�� � iy ,�'f. 7[� � i <br /> TI'_� I PLUMBIN r � _ <br /> .J� N _ � <br /> SIZEOFBLDG. NOOFS70111ES P�SEMEM MECIIANICAI. � <br /> 2od� �� I I VES �NO — — ' <br /> OCCUPANCYLOAO f SPRNNLEflSfiEOD IIEIG11fLIh11TNI0N OTHER � <br /> �ES I I NO �— _ � <br /> SIAiE BUILDING SUfiC11�RGE y � � <br /> —_—___ — i <br /> REASON FOf15PRINNLEf1S � <br /> S1NE ENFRGV SUfiCllAfiGE <br /> i <br /> PPPUCRTIONACC.BY PLr1N54PPR0�'E�OV CITYOFEVEflETT PUBLICWORKS i <br /> ;j LOCAL SALES �� � 8v <br /> /y�� TAX CODE IS 3105 7U7AL <br />