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� APPLICATILN FOR CONSTRUC7 tibN / � IT <br /> G� ��0 everet[ <br /> «E��rea� A�G 0 dC <br /> cm oF <br /> everett ���� � � ,9 <br /> BUILDING DEPARTMENT TO BE COMPLETED IN INK—PLEASE PRINT puT y'�F...,,, `9O <br /> 259•8810 6/i Fl�•.. .. <br /> ❑ DEMOLITION f 1 COMBINATION I l BUILDING XMECHANICAL I f�!'qJ,��RGj�'T•�•. ❑ SIGN <br /> MRILADORESS f CITY ZIP PMONE p� <br /> �R��� �cti a$f�7fu�'✓�c�3�/izctl C�1/c�ls.� I.�Zn3�y.�-��yy <br /> TEN�NT � MAILAUDRE55 CIfY ZIP PHONE <br /> ARCHITECTORDE I�N� MAILADOOESS CIfY 21P PIIONE <br /> GENERP�CONTRAGTOR MRILADOPE55 GIIY 21P P��ONE UCENSEI <br /> ti�l � '`'/�' �z�lr'�.�1�, I� " ' �V `i'f'c'3y 5�..3 -yys/.k�•�le���/v�1J�, <br /> MECHANIC�LCON ACTON MRIIRDDRE55 CIIV ZIP P110NE ��CENSEI <br /> PLUMBINOCONiP�CTOA All11LA0DiiESS CITY ZIP PIIONE LICENSE• <br /> CUSS OF WORK <br /> ❑ NEW L7 ADDITION LTERATION I�I REPAIR I�.I DEMOLITION I I WOODSTOVE/FRPL INSERT fl BUILOING RELOCATION <br /> TEN/�NTIMPHOVEMENiORINTERIOflREMODELONLY Ry� CONTACiPE050NANDPNONENO. <br /> �/'Yr1/�uy <br /> CONTRACT VRILE OF WORK' c.,v�/ <br /> DESCNIB WORN AND SOU�RE�FOOTAGE INVO VED ,,/ <br /> � � <br /> Ppp�ou�uaow� Lfi� ! c�'c � t1d/1y � <br /> � „ I HEREBY CERTIFY THAT I HAVE READ AND EKAMINED THIS <br /> L: , ��� APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECL ALL <br /> 1T1 PROVISIONS OF LAWS AND OROINANCES GOVERNING THIS TYPE OF <br /> LEMLO CNIPT OFPNOPER (SIIOWNBELOWORATTACIIFOURCOPIES� <br /> WORK Will BE COMPLETED W�TH WHETHER SPECIFIED HEREIN OR <br /> ipT BLOCN ov NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �UTFIORITY TO VIOLATE OR CANCEL THE PROV�SIONS OF ANY <br /> `�iL�C.��D,77—�II�J "�II '"�() OTHER STATE OR LOCAI LAW REGULATING CONSTRUCTION OH THE <br /> �-----�— PERFORMANCE OF CONSTflUCTiON.THAT 1 AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br /> SIGNALUIIEOFCONTMCi000f1AU7HOR�2ED�CENT DAiE <br /> � ��e.�'h J� 3 1 L .7 � <br /> : / / � ��/�� ! ��/////�/ <br /> �� PRQIECTADDRESS �L�'�'LCIG��TE • �L�U/��(-�`wG'✓�"'�^ <br /> � /)O �/� APPIIC�NTS CIIV USINE55 L�CENSE NO.ANO BUSINE55 N�ME <br /> O�(J G � <br /> 'j PLUMBINO MECHANICAL <br /> 'i NO. TVPE OF FI%TURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> � WATER CLOSET(TOILET) � AIC—lUHNDLG UNITS—H.P. i <br /> � BATHTUB ; FORCED AIR SYSTEMS—B.T.U. M E.A. SU.' �D <br /> j LAVATORY(WASH BASIN) � UNIT HEATERS—B.T.U. M � <br /> I SHOWER ' CLOTHES DRYERS � <br /> � KITCHEN SINK 8 DISP i VENTILATION FAN i <br /> " DISHWASHER � RANGE HOOD � <br /> '� LAUNDRYTRAY ; WATERHEATER ' <br /> �� CLOTHES WASHER � WOOD STOVE � � <br /> �� URINAL ' METAI FIREPLACE 8 CHIMNEY � <br /> � DRINKING FOUNTAIN � FIREPLACE INSERT � <br /> � FLOOR DRAIN ' HEAT PUMP ' <br /> BACKFLOW PRF?VENTEFS � GAS PIPING � <br /> ROOF DRAINS—RAINLEADERS � E%HAUST FAN � <br /> SINK(SERVICE—BAR,ETC.) � � <br /> 1 ' <br /> i � <br /> � � <br /> � � <br /> � � <br /> � � <br /> j SUB TOTAL $ � SUB TOTAL $ ' <br /> i PERMIT $ PERMIT S � � <br /> i <br /> TOTAL FEE S ' TOTAL FEE 5 ,'� <br /> � FRONTSETBACK �EAflSETBRCN S�OESETBACK PlANC11ECKNUMBER FEE RECEIPTNO. <br /> i <br /> ! USE20NE LOTAAEA VACANTSttE FEES VALUATION FEE <br /> ' <br /> � I I YES �-� N� BUILDING � <br /> � lYPEOFtOHST.�lLOW18LE 7YPEOf[ONSIRC1Up� aaravcr NOIXVN[lIiYGOHi15 <br /> � <br /> cnwv p�UMBING i <br /> � SREOFBLOG. NO.OFSTOI7IE5 BASEMEN7 � <br /> MECHANICAL � <br /> I I YES I I NO � <br /> OCCUPMlCYLOR� FIPESPf1NKLEB5PE0'0 MEIGHTLIMITATION OTHER i <br /> I 1 VES I I NO STAT[BUILDINGSURCHAf1GE ; <br /> REASON fOfl SPiiINHLERS �—_ <br /> STAiEENERGVSURCHppGE i <br /> i <br /> APPLICRTIONACC.BY PUNSRPPROVEODY CITYOFEVERETT PUBLICWORKS � <br /> LOCAL SALES , <br /> TA1I CODE IS 3105 TOTAL � <br /> ',.,� - , <br />