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; � pppLICATI�':J FOR CONSTRUCT:+JN PERMIT <br />'•i• , everett <br />;'. : IheErerpreen e ..�� <br />• cmoF <br />,;, everett <br />" BUILDING DEPARTMENT <br />.�'. TO BE COMPLETED IN INK—PLEA E PRINT <br /> 259-8810 <br />�' �' O DEMOLITION O COMBINATION l] BUILDING V ECHANICAL ❑PLUMBING L SI(3N ' <br /> Ep MIIILADOOE55 LtlY 21P PHONE <br /> � (�aQ. �h�,-t�('i� 2825 �-cn�-h �`�lir �-ti �c�.�.e�t' q B2p� 3��� o�0.5 <br />," <br /> ' 7EN�Ni M�II�OD(1E95 CITY 2�P PHONE <br /> MCH�1ECtOR�E510NER M�ILADD(IESS CITY ZIP PIIONE ' <br /> OENER�ICONfMCTON M�ILAODRE55 CITY ZIP PNONE LIGENSE� <br /> 11 CONIMCTOR AI�IL��Ut1ESS CIIY, 2i� �HONE UCENS � <br /> MEC /JIICAL <br /> W �' <br /> G`b 2 •N5 <br /> SUNIo II4b� <br /> �wn I.o K 1 Iq 15 • � �y 1�� titi W�-I�.lamd 0.3H 8 � 'f ) <br /> PLUMBINOGONTRACTOB M�I1A000E5S QIY ZIP PHONC LIGENS � <br /> l <br /> .CUSS OF WORK <br /> i� ❑ NEW O ADDITION �XALTERATION LI REPAIR I� I DEMOLITION I_.I WOODSTOVEIFRPLINSERT � BUILOINaRELOCATION <br /> �' GONMCT PEIi50N AND PIIONE NO. <br /> TENANT IMPROVEMENi OH INTERIOi/I�f1EM(O�D/�EL ONIO� <br /> ��'��. CONTRACTPRICEOFWOi1N• [_�-I�J <br /> DESCRIBE WORN AND SWARE FOOT�6E INVOIVED <br /> �' B�c h�Q- <br /> ouseoFeu wo � I HEREBY CERTIFY THAT I HAVE HEAD AND EXAMINED THIS <br /> ��' ���� .�Q,Jyy�,�A,�/ APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> ��� PROVISIONS OF LAWS AND OAOINANCES GOVERNING THIS TYPE OF <br /> •�I LEU�LOESCNIPTIONOFPR rv1sN BELOW OtlAI CNFOURCOPIES) yyORK WILL BE CC �PLETED WITH WHETHER SPECIFIED HEREIN OR <br /> ��I tor BLOLN �F NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO OIVE <br /> ��i AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANV � <br /> .��� OTFIER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> — PEFlFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> �ii �: APPLICATION IS MADE AND I COMPLY WITH THE STATE , <br /> �'�I CONTRACTORS U\W 18.27 RCW AND 296.200 WAC. <br /> 1'i � 5�6NATUBEOFCONTRIICTORORAUINURIZEUAGENT OATE <br /> ; � I�.�� 02-03-I2� <br /> � X sum I�oK. 4nc �� -�(1a�oo'n <br /> f • 'PIIOJEGTADDRES9 �� n^ n NM �n <br /> � � ��. APfLICANTSCITYBU5�NE55lIGENSENO./JlDBUSINESSN�ME <br /> (A/J (d',IGtJ t/�, <br /> '�i I PLUMBINU MF:CHANICAL <br /> '� NO. TYPE OF FIXTURE OR ITEM FEE N0. TYPE OF EOUIPMENT FEE <br /> '•'I WATER CLOSET(TOILET) � � NC—A/HNOL6 UNITS—H.P. � <br /> ��� BATHTUB ' FORCED AIR SYSTEMS—B.T.U. M E.A. � <br /> •�I IAVATORY(WASH BASIN) � __ UNIT HEATERS—B.LU. M _T_ <br /> � SHOWER � CLOTHES DRYERS , � <br /> �,� KITCHEN SINK d DISP ; VENTILATION FAN ___� <br /> ��; <br /> - DISHWASHER � fiANGE HOOD <br /> �� LAUNORYTRAY ' � W�TERHEATER <br /> ��� CLOTHES WASHER � WOOD STOVE ' <br /> S. ' i METAL FIREPLACE 8 CHIMNEY T— <br /> URINAL � <br /> DRINKINd FOUNTAIN i F�PEPLACE INSERT �T_ <br /> FLOOR DRAIN � HEAT PUMP � <br /> BACKFLOW PREVENTERS ; _ GAS PIPING <br /> ROOF DRAINS—RAINLEAOERS � EXHAUST FAN ' <br /> i <br /> � �� SINK(SEflVICE—BAR,ETG) ' <br /> 0 <br /> � i <br /> i <br /> � � _—�— � <br /> . � <br /> �J ' __ i <br /> � � <br /> i <br /> � <br /> f 1 <br /> SUB TOTAL E ; SUB TOTAL S <br /> ' PERMIT E �— � PERMIT S � <br /> • TOTAL FEE E ' TOTAL FEE E ' <br /> : FflONTSEfBRK REMSETOACK SIOESEieRCK fYANCHECkNUMOEB FEE IIECE�PTNO. <br /> '� . usezor+e IOTAREA VACANTSITE fEES VALUATION FEE <br /> i <br /> '� ❑ YES ❑ NO aWLOwO . ' <br /> ttvcorcoHsr.uiowrsie ttrtacoxsi.�ctua acwµa waa ��xa�mns � <br /> � 4R0u° pLUMBINO � <br /> � <br /> � <br /> 6REOFBlDO. NOAFST0t11E5 BASEMENT MECH�NICAL � <br /> � ❑ YES 17 NO � <br /> •� OCGUPANCYLOAO FIRESPRNNLE�SREOD IIEIGIITIIMITATION OTfIER � <br /> U YES U NO � <br /> . STATE BUILOIN6 SURCNARGE i <br /> � RE�SONFORSPflINKLERS ' � <br /> � SiATEENERGVSURCHARGE � <br /> � <br /> APFLICATIONACC.BY PIANS�PPROVEDBY CITYOFEVERETT PUBLICWO�KS i <br /> LOCAL SALES � <br /> TAX COOEIS 3105 TOTAL ' <br />