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i <br /> ' APPLICAT14:i;?I FOR CONSTRUCT,';�N PERMIT <br /> '`' maE„,�„a„ ' everett <br /> :.:: . �,T�oF e <br /> �,;, everett � <br /> ;; BUILDING DEPARTMENT <br /> `i 259-8810 TO BE COMPLETED IN INK—PLEA�E PRINT <br /> ��I ❑ DEMOLITION ❑ COMBINATION C] BUILDING pa'IArECHANICAL ❑PLUMBING ❑ SIGN <br /> �WNER MrILAU011E5S CI�Y ZIP PIIONE <br /> Q,� f�l�.ilm�nm 27 p1 �(hon�V (��, ��#' ��s2 � '�3 •4q�Sz <br />. tsrurQ� unwnooness arv zir r�wr+e <br /> f, � �IICHITECTORDESIONEfl MAILA�DI7E55 CIN ZIP PIIONE <br /> I}! 6ENE11ALCONfMCTOf1 MAllAO�R[55 CIIY ZIP PNONE LICENSE� <br /> ti.' MECNANICALCONiR4CTOR AUILADURE55 CIIY ZIP PIIOHE LICENS 1 <br /> • �um I.:o K I Iq t� . � 2N R✓ N<r I'�n.l4to�md q�0.3H 82l •N54 suN�owiiyy,7�) <br /> 4 � <br /> i1�1 PLUMBINOCONTO�GTOR MAILA�OqESS CITY 21P PHONE �ICENS / <br /> �'� CUSSOFW011K <br />�i.�� O NEW ❑ ADDITION �XALTERATION CI FlEPAIR f.l DEMOLITION 17 WOODSTOVE/FRPI INSERT ❑ BUILDINO RELOCATION <br /> �.� <br /> = TENANTIMPROVEMENTOAINTEflpRREMODELM�IYG(^j� /\ CONI�CTPERSONAHOPNONENO. <br />:��� CONTMCT PRICE OF WOi1N: � (J;J�'O(„J _ <br />: !jl DESCRI17EW011RAND$'p'UM1'E.F.�OOT�110EINVq9ED <br /> �1 /�✓� �T"��U � <br /> ,;+'I r rnoroseo use oF eui�wo'— <br /> �, • I HEREBY CERTIPY THAT I HAYE READ AND EXAMINED THIS '�. <br /> �I O1YYlJ� APPLICATION AND KNOW THE SAME TO BE 7RUE AND CORRECT ALL <br />�'��I LEOALDE6CRiPTqNpFPR rv�sN BELOWORA CHFOURCOPIES� PROVISIONSOFLAWSANDORDINANCESGOVERNINOTHISTYPEOF . <br /> �� WORK WILL BE COMPLETED WITH WHE7HER SPECIFIED HEREIN OR <br />�r�J ior eiocu oF NOT. THE GRANTING OF A PEHMIT DOES NOT PRESUME TO OIVE �� <br /> ��� AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> �' OTHER STATE OR LOCAL LAW RE6ULATING CONSTRUCiION OR THE <br /> �'� PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORI2ED BY THE ' <br />" j! ; OWNER OF THIS PROPERTY TO PEPFORM THE WORK FOR WHICH <br /> ?,� � APPLICATION IS MADE AND I COMPLV WI?H THE STATE <br /> �•� I�� CONTHACTORS lAW 18.27 RCW AND 298200 WAC. <br /> ���I � SIONAIUREOFLW1Te�G10RORAUINORIZEDAOENT DATE � <br /> ;'I ' I�.c.� 02.0 3�z <br /> �� /�/� /7N/�7 �Q x S�rr�I.ok 4nc . � -�(1,�an <br /> ��'� •'. PRO.IECTADDRE59 <br /> '" SaJmQi tJ��J {.+�.IVVIJ` APPLICANfSC17Y9USINE55LqEN5ENO.ANDBU51NE55NIVAE <br />���I ' ' PLUMBINO MECHANICAL <br /> ';i <br /> i.�:I NO. TYPE OF FI%TURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> . WATER CLOSET(TOILET) � NC—A/HNDLG UNITS—H.P. � <br /> i.�: <br /> �; BATHTUB ; FORCED AIR SYSTEMS—B.T.U. M E.A. � <br /> ' LAVATORY(WASH BASIN) � UNIT HEATERS—B.T.U. M � <br /> �;,j I � SHOWER � CLOTHES DRYERS � <br />� •1•. KITCHEN SINK 8 DISP ' � <br /> �I I � DISHWASHER � VENTILATION FAN <br /> RANGEHOOD � <br /> �:,j . LAUNDRY TRAY ; ' WATER HEATER � �� <br /> CLOTHES WASHER � WOODSTOVE i <br />. i,;I � URINAL � <br /> METAL F�REPLACE&CHIMNEY � <br /> II��'�� � DRINKING FOUNTAIN � FIREPUICE INSERT ; ' <br /> �� . <br /> FLOOR DRAIN � HEAT PUMP i � <br /> ;:�� � BACKFLOW PREVENTERS ; GAS PIPING ' <br /> '�� � ROOF ORAINS—RAINLEADEPS —�— EXHAUST FAN � <br /> j�i � SINK(SERVICE—BAR,ETCJ ' <br /> � ' <br /> �. i i ' — � <br /> �' � i <br /> ..i � — —r— <br /> '�'• r <br /> i <br /> '�j . i i <br /> �'I f 1 � q <br /> �'� SUBTOTAL 3 ; SUBTOTAL S <br /> ��� ; PERMIT $ �— PERMIT S I � <br /> TOTAL FEE S � TOTAL FEE S ' <br /> - FRON(SETBACN REAi15ETBACK SIDESETBACK PWICHECNNUA10Eq FEE PECEIPTNO. <br /> ��I i <br /> .•� I ; USEZONE LOiMEA VACANTSITE FEES VALUATION FEE <br /> 41 ; ' <br /> �� � , ❑ YES U NO BUIL�IN6 . � <br /> :,, i irr�acoxsteuowuie nrcovcoxscncrou ��* �aamurmuMis � <br /> PLUMBIN6 ' <br /> i <br /> `f . S¢E OF BLDO. Np.OF STORIES BASEMENi —i— <br /> ❑ YES O NO MECHANICAL � <br /> !� i � <br /> � OCGIIPANCYl0�0 FIRESPBNKLEflSf1EOD NEIGIITLIIAIU7ION 0711Ef1 � <br /> , i <br /> U YES ❑ NO STATEDUILDINOSURCHARGE � <br /> � REASONF0t15PRINNLERS • <br /> i <br /> �� , STA1E ENEtt�Y Sl1RCHAtiGE i <br /> � . APPLICA710NACC.BV PUNSAFPf10VE0BY CITYOFEVERETT PUOLICWORHS � <br /> :� ' '• LOCAL SALES <br /> � , TAX CODE IS 3105 TOTAL ; <br /> ti <br /> ,�. <br /> i; ' <br />