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�' <br />� <br />,;,'� <br />APPLICATION FOR CONSTRUC41��1 PERMIT <br />rn� E��.�� everett <br />�,roF e <br />everett <br />BUILDING DEPARTMENT <br />259-8810 TO BE COMPLETED IN INK—PLEASE PRINT <br />17 DEMOLITION ❑ COMBINATION I I BUILDING ,�MECHANICAL ❑ PLUMBING ❑ SIGN <br />OWNER MAtL�DORE55 CITV 21P PHONE <br />�.hc.�-�e� YYlnnrp. ��in�, F�i.Ierra� I����. C �PrP l4 l��20 J ,25�-19�/ <br />TEN�NT �) MAI�ADD{IE55 CITV ZIP PHONE � <br />�_1(:1Y1C i�.S ����lY\�.� . <br />�RCHITECTdi0E5qNEH M�ILADDRESS CITY ZIP PHONE <br />6 NEflALCONTMCTOR IMILADDHESS }� CITpV '1 ZIP PHONE UCENSE/ , <br />��n� ��.� n�� i� nG �/_AK �n INi�.N�� ����. /'.�nrn�i-� QQ�/l� ✓)CQ_r11Q'1 1��1 1 Yi�L� I C'� 1 1 <br />MECHANICAL <br />CLASS OF WORK <br />❑ NEW ❑ ADDITION <br />MAILADDRESS �� CIiV ZIP PHONE UCENSEI <br />MpILADDRE55 CITV ZIP PIpNE LICENSEI <br />TEPUNT NAPAOVEMENT OR MTE/FI�Ofi <br />CONTP/�CTPRICEOFWORN: j�(r' <br />DESCRIBEWORNMlDSOUANEF I <br />T � 11 \ . �11 <br />❑ REPAIR 0 DEMOLITION LI WOODSTOVEIFRPL INSEHT ❑ BUILDING RELOCATION <br />LE6AL DESCflIPTqN OF PNOPERiV �SMOWN BELOW OR �TTACH FWR CAPIES) <br />LOT BLOCIC OF <br />rnaect �oa+ess <br />'7_LI A �_ <br />TYPE OF <br />WATER CLOSET <br />SHOWEH <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />UIUNDRY TRAY <br />CLOTHES WASHER <br />UflINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />ROOF DRAINS—RAINLEAC <br />FRONTSETBACK <br />USE20NE <br />fYPE Of CONST. ALI OW.IBLE <br />SIZE OF BLIXi. <br />� OCCUPANCYIOAD <br />HEASON FOR SPRINKLEflS <br />APPLIC�TION RCC. BY <br />SUB TOTAL <br />PERMIT <br />TOTALFEE <br />REANSETBACK <br />LOT AREA <br />TYPE OF CONSL ACTUAL <br />NO. OF STOflIES <br />FIPE SPRNKLERS REO'D <br />❑ YES U NO <br />PLANS APPROVED BV <br />FEE <br />CONTACT PERSON M10 PHONE NO. <br />1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS � <br />APPUCATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL � <br />PROVISIONS OF LAWS AND ORDINAIJCES GOVERNINO THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTINO OF A PERMIT DOES NOT PRESUME TO OIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONStFiUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BV THE '��� <br />OWNER OF THIS PROPERTV TO PERFORM THE WORK FOR WHICH � <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 1827 RCW AND 296200 WAC. y <br />SIGNANHEOFCONTRACTORORAUfHOqREDAOENT D�TE 'f <br />d <br />,� <br />��.�k r>>� � � rla�l'� /��'�� <br />RMa1NTS CITY BUSINE55 LILENSE NO. AND BUSINE AME <br />MECNANICAL 4 <br />r <br />NO. TYPE OF EQUIPMENT FEE t <br />A/C—A/HNDLG UNITS—H.P. � ; <br />FOPCED AIR SYSTEMS—B.T.� �. M E.A. � ' <br />UNIT HEATERS—B.T.U. M i i <br />CLOTHES DRYERS � . <br />VENTILATION FAN ; 1 <br />---.__ __..__ � <br />WOOD STOVE, � <br />METAL FIREPLACE 8 CHIMNEY � � <br />FIREPLACE INSERT ; <br />HEAT PUMP � <br />GAS PIPING ' <br />EXHAUSTFAN � �. <br />� � <br />� � <br />� <br />SIOESETBACK PLANCHECKNUMOER FEE <br />VACANT SITE FEES <br />❑ YES ❑ NO BUILDING . <br />ocaru�cr xoamv[wx�uxrts <br />GNOUP <br />PLUMBING <br />BASEMENi MECHANICAL <br />❑ YES ❑ NO <br />HEIGHTLIMITA710N OTHER <br />STATE BUILDING SUHCHARGE <br />STATEENERGVSURCHARGE <br />CITY OF EYEflETT RUBLIC WORKS <br />LOCALSALES <br />TAX COUE IS 3105 TOTAL <br />SUBTOTAL S �',_ <br />PERMIT S � �� <br />TOTAL FEE a 3 ' � <br />RECEIPT NO. <br />VALUATION FEE ' <br />i <br />i <br />i <br />I <br />i <br />i � <br />� <br />i <br />:� <br />