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',i <br /> � : APPLICATif:�;�l FOR CONSTRUCT��+�N PERMIT <br />:�:�, <br /> � rn�E��,�� ' everett <br />:�.'� � cinoF � <br />�;;: � everett � <br />,; BUILDING DEPARTMENT <br />'� 259-8810 TO BE COMPLETED IN INK—PLE�A E PRINT <br />;�� O DEMOLITION ❑ COMBINATION O BUILDING V.YIfAECHANICAL ❑PLUMBING U SIGN <br />: ER MAIIADDRE55 CITY ZIP PNONE <br /> < ���.� I�a.ilmncam 21 p1 �(hn��'Vtaur fJ�. �u�a#' ��s2U3 353•4q�SZ <br />'� �� IENAt�U MAILAOORESS CITY ZIP PFIONE <br /> J <br /> 11flCHIiECiOflOESIONER MAILAODNE55 CITY ZIP PHONE <br />�I; OENERALpONiN�CT011 IMILAO�RESS CIfY 21P PNONE UGENSEI <br />��, �wi11 o�Kfl I Ia113Ess12y. I�� Nrc. c�TW�n,141amZc� G4'i0.3►-�P�821 •�-I5�4�5uNlowll4b:i�� <br />'� i VLUMBINOLONTPACTOR MAILII0DPE55 CITY 21P PHONE IICENS / <br />!:i <br />;'� CLASS OF YYONN ' <br /> i.�' ❑ NEW CI ADDITION �ALTERATION CI REPAIR f.l DEMOLI710N I.J WOODSTOVE/FRPL INSERT ❑ BUILDINO pELOCATION <br />��i <br />=,� TEWWTIMPROVEMENTORINTEPqflREMODElM1LY���•M1� CON��CTPEfl50NANOPHONENO. <br /> 1 <br />}�I� CONiP�CTPRILEOFWORN: { V <br />!�I DESGPIAE WOIMf AND S�IX�IA�H�E�FOOT/��UE 1NVOWED <br /> I � R""U r.."`-'�' � <br />%� rrroroseouseaeu r+u I HEHEBY CERTIFY THAT � HAVE READ AND EXAMINED THIS <br />;i <br />;,I �{,( Q1YYU� APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> � lEMl0E6CRIPTpNOFPP rv�s BElOW011A CNFO'JRGOPIES) PROVISIONS OF LAWS AND ORDINANCES GUVERNINO THIS TYPE OF <br /> i�� ' WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />�';I tot e�aac oF NOT. THE 6RANTING OF A PERMIT DOES NOT PRESUME TO OIVE <br />��' AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />''' OTHER STATE OR LOCAL LAW REOULATING CONSTRUCTION OR THE <br />:� — PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BV THE <br />;�. ; OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> t; !, APPUCATION IS MADE AND I COMPLY WITH THE STATE <br />;; �. CONTRACTORS LAW 1827 RCW AND 298200 WAC. <br />(i1 1. SKiNAIUNEOFCONTR�CTOiIORAUTIqi1REDA0ENT OATE � <br /> ' Ivi.G� OZ.03"12� <br />:��, X <br />��...� 5urn I�ok 9-nc . � -�U�oorn <br /> , ; "��T„°��' Sama, w� c�oU2 <br />�: �•� APPLICANISCITYBUSINESSLICENSENO./�NDBUSINE59NMIE <br /> 1• �''. <br /> r�I ' PWMBINO MECHANICAL <br />: I <br />��I �. �. NO. TYPE OF FIXTUHE OR REM FEE NO. TYPE OF E�UIF�AENT FEE i <br />�t; ' WATER CLOSET(TOILET) � AIC--AMNDL6 UNITS—H.P. , <br /> R7I � BATHTUB ' FORCED AIR SYSTEMS—B.LU. M E.A. � <br /> ' LAVATORY(WASH BASIN) i UNIT HEATERS—B.T.U. M ; <br />;;11JJ SHOWER � CLOTHES ORYERS � <br />;y i . ' KITCHEN SINK 8 DISP ; VENTIlATION FAN ' <br />� ' I <br />'•I DISHWASHER � RANGEHOOD � <br />'���; : UIUNDRYTHAY ; � WATERHEATER � ��, <br />"�� ` CLOTHES WASHER i WOOD STOVE � � <br />���� URINAL ' METAL FIRfiPLACE 8 CHIMNEY � <br />�;l� � — • <br /> DRINKINO FOUNTAIN , FIREPLACE INSERT ' � <br /> r� � � <br />'�f•' � FLOORDRAIN � HEATPUMP i <br />�.j� ' � BACKFLOW PREVENTERS ; OAS PIPIN6 ' <br />'� � ROOF DRAINS—RAINLEA�ERS '� EXHAUST FAN � <br /> i�i ;� SINK(SERVICE—BAR,ETC.) ; � <br /> � <br /> f�.!j I �. ' � <br /> oi , � <br />�•. I : <br />:'�� i;: ; i <br />}� I . � � <br />''�'I � SUB TOTAL S � SUB TOTAL S <br />�C'��� ' PERMIT t � PERMIT S � i <br /> ly i I � TOTAL FEE t ' TOTAL FEE S � <br /> I . <br /> � FRONTSET&lCN REMSE7BACN SIOESETB�CK PUNCHECKNOMBER FEE RECEWTNO. <br />;1t <br />�. � ; USE20NE LOTMEA VAGWiSiTE FEES VALUATION FEE <br />,� i ❑ YES ❑ NO � <br /> i BUILDINO � <br /> I lYPEOiLONSCMlOWABIE lYPEOFtONST.ACtU�L ���+ Mo.aowtLLmalm�s � <br /> � <br />'Ri � � �n0� PLUM91N0 � <br />� . <br />�i : ; BQEOFBLDO. NO.OF9TORIES BASEMENT MECHANICAL i <br /> ; U YES o No ; <br />�� � OLCUPANCYLOAD FIRESnRNNLER511E0'D HEICIITUMIiATION OTHER i <br />"% �' ❑ YES U NO ' <br /> . STATE BUILDINO SURCHARGE � <br /> � REASONFORSPNINRLERS • <br />•� ' STATEENEfiOVSURL'HAROE � <br /> f� . � <br /> �, . 6P1'UCATIONACC.BY PUNS�PPROVEDBY CITYOFEVERETT PUBLICWORKS � <br />�' � � LOCAL SALES ' <br /> 1� i � TAX CODE IS 3105 TaTa � <br />',i <br />;�. <br /> i; <br />