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1 <br /> APPLICATIC���� FOR CONSTRUC'i .''JN PERMIT = <br /> , everett . <br /> rne E�reroreen � ; <br /> cirv oF ' <br /> everett <br /> BUILDING DEPARTMENT <br /> 259-8810 TO BE COMPLETED IN INK—PL�E�A E PRINT <br /> p DEMOLITION ❑ COMBINATION 17 BUILDING V�'N�ECHANICAL ❑PLUMBING ❑ SIGN '' <br /> �"E�.� noYu��o2q�� ��- �'T���.. Z'�v��t' `i`b2o3 3� •45�5 'LS' , <br /> 7ENANf � 1�00RESS CITV ZIP PFIONE <br /> ARCHI7ECTORDESIONER MAILAOORE55 CIIY =IP PIIONE <br /> OENEMLCONTMCTOR M�RADDf1E5S CITY ZIP PNONE LICENSE/ <br /> MEGIIANIC�LCONTR�Cf011 M�IL�UORESS CIIY, iIP PHONE LIGENS � <br /> �um I..o K I 1�I15 . i �4 P�v NE K�n,K.lamd q$Q3H 82� •W5y SUNlow714{�,T�)� <br /> pLUMOMOCW�TH�CTUH MAILAODRE55 CITY ZIP �NONE UCEN t • <br /> •CUSS OF WORK V <br /> ❑ NEW ❑ ADDITION 4!X ALTERATION ❑ REPAIR U DEMOLITION CI WOODSTOVEIFRPL INSERT ❑ BUILDINd RELOCATION <br /> TENu71 IMPPOVEMENT OR INTERqli PEMODEI ONCLY' 'l CONUCT PERSON�NO PHONE NO. <br /> CONTOACT PPIGE OF WqiN: � D�� 'DV <br /> � DESCRREWOfIK�NDSlW,�'R�E,F.O�0T^�0^EINVOIVED <br /> �I IS""u �'�`-'�' <br /> i P OPOSEDUSEOFBUI�INO� I HEREBY CERTIFY THAT I HAVE READ AND E%AMINED THIS <br /> �,� QlYYIJ" APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> I LE(Ul0E5CRIPTqNOFP n�s BELOWOFlA CHFWRCOPIES� PROVISIONSOFLAWSANDOHDINANCESGOVERNINGTHISTYPEOF <br /> � WORK WILL BE COMPIETED WITH WHETHER SPECIFIED HEREIN OR <br /> �' �or e�ocK aF NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO QIVE ' <br /> AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY , <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> — PEHFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BV THE <br /> OWNEH OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLV WITH THE STATE � <br /> � CONTRACTORS LAW 1827 RCW AND 298200 WAC. <br /> i516N/1TUREOFCONif1�Ci0POfl11UTNORIZEDAOENT OAiE <br /> , X b,,cc� o�o3�z <br /> ! surntioK. 4nc . �.� �(1a�arn <br /> ���••. �ROJECiADOPE89 �� � �M �/� <br /> I �•. (J(�� APPIIC�lITSCITVBUSMESSIICEN9ENO.ANOBUSINESSNMIE :,', <br /> PLUM81N0 MECHANICAL � <br /> �'I NO. TYPE Of FII(TURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATERCLOSET(TOILET) � N�AIHNDLOUNITS—H.P. � <br /> �•1 � BATHTUB ' FORCED AIR SYS?EMS—B.T.U. M E.A. ' <br /> 'I i � LAVATORY(WASH BASIN) � UNIT HEATERS—B.T.U. M � <br /> SHOWER ' CLOTHES DfiYEHS � <br /> KITCHEN SINK 8 DISP i VEN?ILATION FAN i <br /> ��'• ' DISHWASHER � RANGE HOOD � <br /> � � LAUNDRYTRAY ; � WATERHEATER ' <br /> CLOTHES WASHER � WOOD STOVE � <br /> i� URINAL ' METAL FIREPLACE 6 CHIMNEY ' <br /> ,' i � DRINKINO FOUNTAIN � FIREPLACE I ERT � <br /> FLOOR DRAIN ' HEAT PUMP ' <br /> BACKFLOW PREVENTERS � GAS PIPING � <br /> ROOF DRAINS—RAINLEADERS � E%liAUST FAN � <br /> � <br /> SINK(SERVICE—BAR,ETC.) i � <br /> �� . i <br /> i � <br /> � � <br /> ,� � � <br /> . i � � <br /> � SUBTOTAL 3 � SUBTOTAL S O <br /> I � <br /> PERMIT S i PERMIT E I � <br /> � TOTAL FEE S ' TOTAL FEE S ' <br /> , FRONfSETOACK PEAq5E18�C1( 516ESETBACK PIANCHECKNUMOER iEE RECEIPTNO. � <br /> I1SE20NE LOfARE� YACNITSIfE FEES VALUATION FEE <br /> O YES ❑ NO BUILDINO . ' <br /> TYPEOFCONST./�LLOWABLF TYPEOiCONSLALIU�I a[uvuicv MoaoMlliMGUMis <br /> i <br /> ' ��� PlUM81NG i <br /> S�ZEOFBLW. NO.OFSTOf1iES ORSEMENT � <br /> MECH�NICAL ' <br /> � ❑ YES ❑ NO � <br /> OCCUPANCYLO�D FIOESPPNRLEASRE00 NEIGIITUMIiA1�ON OTHER � <br /> ❑ YES U NO � <br /> STA7E BUII�ING SURCHARGE � <br /> REASONiORSPflINKLEP9 • <br /> STATE ENEfiGY SURCHARGE i <br /> i <br /> APPIICATIONACC.BY rw�snrenoveoer CITYOFEVERETT PUBLICWOiiKS ; <br /> ; LOCAL SALES , <br /> TAX COOEIS 3105 rora� � <br /> .I <br /> � <br />