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APPLICATI��:� FOR CONSTRUC1.aN PERMIT <br /> ma E�,�,�„ everett <br /> CITV OF e <br /> everett <br /> BUILDING DEPARTMF�NT <br /> 259-8810 TO BE COMPLETED IN INK—PLEA$E PRINT - <br /> O DEMOLITION LI COMBINATION f J BUILDING '�CHANICAL ❑PLUMBING C] SIGN <br /> OWNF� U V11�J�OPI �.Y�7 ��ES�J / ! ' 1 `�IOh (�CIT� C IQZIUK.. �/'CJI�{�, EV�� � J��� <br /> � <br /> TEN4Nt MpRAOp E55 CIIY =IP PHONE <br /> �RCNItECTORDESIGNEP M�ILADDRESS CITV Zip pHONE <br /> GENEflRICONTR�CTON MAILADDRESS CITY =IP PHONE 4CENSE/ <br /> � � MEGIIA��q��Ti��MAIGiDRE$S ��� 1 ' ��and qYo3�1 �Z�E'� �S�UCENSE'���T�'Q� <br /> / V l_M1U 1 f W L lJ 1. <br /> p y VWM9�NGCENITN�CIOR M�IL/OORE55 LITY =IP pNONE LICENSE/ �� � <br /> x <br /> q�j�.y t~a cuss u•wonK <br /> j.a � N CJ NEW ❑ ADDITION ALTEFATION I_1 REPAIR f I DEMOUTION f�.l WOODSTOVE/FRPL INSERT ❑ BUILDING PELOCATION <br /> he � TEN�NTIMPPOVEMENTORINTEHIORREMODELON/I�V CONTpCiPER50NRNDPHONENO. <br /> O � � CONiRRCiPPICEOFWORK: ,"� 1 <br /> yy� DESCRIBEWOR�DSOU�REFOOTAGEINVOIVE� ,I <br /> c•n. <br /> z�i. <br /> 'S"Y. PROPOSEDUSEOFBUILOMa I HEREBY CERTIFV THAT I HAVE READ ANO E%AMINED THIS � <br /> [il <br /> d APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECL ALL : <br /> O H �E(UL�ESCRIPTIONOFVR ERTY�S BELOW ON�T HFOUHCOPIES) PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF � <br /> WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR ! <br /> p� n �or eiocn oF NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE � <br /> z H� � /„O � I AUTHOFITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY � <br /> y ,3 _lU OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE . <br /> C� PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BV THE <br /> �� y OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> F,.� APPLICATION IS MADE AN� I COMPLV WITH THE STATE <br /> �!�(q CONTRACTORS LAW 18.27 RCW AND 296200 WAC. ; <br /> �7 SIGNRtUflE CONTRACTOHOPAUTNOR2EOAGENT DQE <br /> � � X �;c -� o z D3�-2 � <br /> � er+aEcr�ooness C <br /> . � RPPLICRNTSLITYBUSINESSIILENSENO.�NDO INESSNAME � i <br /> PLUMBINO MECHANICAL I <br /> NO. TVPE OF FIXTURE OR ITEM FEE NO. TYPE OF EOUIPMENi fEE � <br /> WATER CLOSET(TOILET) � A/C—A/HNDLG UNITS—H.P. i <br /> p � BATHTUB ' FORCED AIR SYSTEMS—B.T.U. M E.A. � <br /> f ■ ��. LAVATORY(WASH BASIN) � UNIT HEATERS—B.LU. M ; i- <br /> � � SHOWER � : <br /> � _. CLOTHESDRYERS � <br /> _ KITCHEN SINK 6 DISP VENTILATION FAN ; <br /> ! DISHWASHER � RANGE HOOD i � <br /> I �� L'IUNDRVTflAV ; WATERHEATER ' �, <br /> CLOTHES WASHER i WOOD STOVE � <br /> URINAL METAL FIREPLACE 8 CHIMNEY � <br /> i DRINKINQ POUNTAIN FIREPLACE INSERT ; <br /> �� ' FLOORDRAIN � HEATPUMP � � <br /> BACKFLOW PREVENTERS ; GAS PIPING ; <br /> ROOF DRAINS—RAINLEADERS � EXHAUST FAN i <br /> ' SINK(SERVICE—BAR,ETC.) ; <br /> 1 � <br /> � <br /> ` <br /> � � <br /> � � <br /> 1 <br /> '� SUB TOTAL S ; _ SUB TOTAL 5 ' <br /> I�. PERMIT S PEFMIT 5 <br /> ' TOTAL FEE S TOTAL FEE $ �(� <br /> . fPONTSETe�CN REAPSETBRCK SIOESEtBRCK PUNCNECK�Ny}1B[q.� FEE HECEIPTNO. � <br /> D d <br /> VSE20NE LOTARER vac.wTsire FEES YALUATION FEE <br /> I 1 YES L I NO BUILDING i <br /> iYPEOfCONSi.ALIOWl�BLE lYPEOitON51Q.111AL ���r NowDwFiuxGUM��S <br /> enao pLUMBING ' <br /> i <br /> SIZEOFBLDG. NOAFS70RIE5 9ASEMENT � <br /> MECHANICAL i <br /> ❑ YES I:7 NO � <br /> � <br /> � OCCUPANCYLO�O FIRESPPNNLERSNEOD MEIGHiUMITATION 07HER � <br /> � <br /> . C I yE3 �.I NO S7ATE BUILDING SURCHARGE � <br /> PFASONFORSPRINNlEFS • � <br /> �— <br /> STATEENERGYSURCHARGE ; <br /> APPIICATIONRCC.BY GUNSAPPROVEDBY CITYOFEVERETT PUBLICWORK$ ' <br /> LOCAL SALES ' <br /> TAX CODEIS 3105 TOTAL 1 <br />