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CITY OF <br />everett <br />BUILDING DEPARTMENT <br />259-MID <br />APPLI&TION FOR CONSTRUCTION <br />PERMIT <br />TO BE COMPLETED IN INK— PLEASE PRINT <br />ARCNRECTO"DESZIER MAIL ADDRESS CITY OF PHONE <br />i <br />rrtuvuu rnummMllilmkt PHONE LICENSES <br />❑ NEW ❑ ADDITION L7 ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WGODSTOVEJFRPL INSERT Cl BUILDING RELOCATION <br />TOMY, IM%gVEMEM OR INTERIOR REMODEL ONLY <br />CONTRACTP1110EOp WORIt <br />CONiACi PER'vON AHO PNOAF NO <br />C V <br />DESCRIBE BORN ANOBOUMEpoorAOE INVOLVE. <br />1 IIIUn(A�tll <br />IHEREBY OWTHE SAME TO THAAND <br />TRUE READ ANECT. AL PR VISIONSHIS ICATIONOF LAWS <br />KNOWTHESAMETO NITRUEANDCORRECT.ALL PROVISIONSOFLAWS AND <br />ORDI ED WITH <br />SGOVED HEREIN THIS TYPE OFWRANTINORK WOFA ILL BE PERMITCOMPLDOES NOT <br />WHETHER <br />WHETHER TO GIVE LTH ERMRDOERNOT <br />VIOLA FOR CANCEL <br />PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCELTHEPROVISIONS OF <br />STATE CON LOCAL LAW REGULATING CONSTRUCTION ORTHE PER <br />THISFORMANCEOFCONSTRUCTION. THAT IAMAUTHORIZED LI THE OWNER OF <br />THIS I CON) TY TO PERFORM THE WORK FORWHICHAPPLICATION 18, 7 RISMADE <br />AND I (AMPLY WITH THE STATE CONTRACTORS LAW lB2T RCW AND <br />296.200 WAG <br />61GNAiURF OF CONTRACTOR LIR PMnpiIIE•JAGEHI DATE <br />V <br />X <br />LEGAL prroN OF SNLNRIV ID—IIELOM.RArIALNFOVRL.PIFN <br />Lor___BLOCN__—of <br />NM)JFCr ADDRE56 ���q� <br />AFFTUCANIS CIYYDU61NEEa'LICENSE NO. AN. BU61HEf666 NAME <br />PLUMBING <br />MECHANICAL <br />N0. <br />TYPE OF FIXTURE OR REM <br />FEE <br />NO. TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />NC— AIHNDLG UNITS— H.P. <br />. <br />BATHTUB <br />I <br />FORCED AIR SYSTEMS — BTU. MEA <br />_ <br />LAVATORY (WASH BASIN) <br />UNITHEATERS—BTU, M IOQ DOD <br />SHOWER <br />CLOTHES DRYERS <br />KITCHEN SINK s DISP. <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRYTRAY <br />) <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE d CHIMNEY <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />MEAT PUMP <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />ROOF DRAINS — RAINLEADERS <br />EXHAUST FAN <br />SINK (SERVICE— BAR. ETC) <br />SUBTOTAL <br />S <br />SUBTOTAL S <br />PERMIT <br />S <br />PERMIT S <br />TOTAL FEE <br />S <br />TOTAL FEE S <br />FRONT 6ETB.ALA <br />REAR6ETMCN <br />SIUESEIBMIK <br />NAM CN[CK xUMNR <br />i[[ <br />MC[IRMD. <br />USE zoxE <br />LOI AREA <br />VACANT srtE <br />D YES o No <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />TYPE Of LOx[i. <br />'MLawxOACluu <br />Of.CUpM1CYOROUP <br />MO.OF bNELLIMG UH115 <br />PLUMBING <br />— <br />NNE OF ELCO <br />NOOf s1ORlEs <br />oYE <br />.N <br />CCC LOAD <br />MECHANICAL <br />30 <br />OTHER <br />FIRE SPRINKLERS REWIRED OYES ONo <br />NFaxI LIMrtAtaN <br />STATE BUILDING SURCHARGE <br />APNIurroNAcc Br MANS ApvN BY <br />STATE ENERGY SURCHARGE <br />PUBLICIVORKS <br />TOTAL <br />