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i <br /> APPLICATI(:'�v FOR CONSTRUC7 :dN PERMIT <br /> �rre evn reen ' <br /> � ev� <br /> CIiV UF <br /> everett <br /> BUILDING DEPARTMENT <br /> , 259•8810 TO BE COMPLETED IN INK—PLE�A$E PRINT <br /> � ❑ DEMOLITION ❑ COMBINATION CI BUILDING VXMECHANICAL ❑PLUMBING ❑ SIGN <br /> ,' OWNER MP�L�DOf1E5S CIIY ZIP PHONE <br /> �.Q,�J,/�2m Ce. (Yl 29 22 �- �nt' V lQ,i.� f�t 4�i�nn rrt-�' 3 y 1 �oLl 3 <br /> TENANT ,,,,,,,,,,,,,,,,��� QIY ZIP PHONE <br /> , �RCIIIIECT0110ESI(3NEfl MAILADORE55 dIY 21P PIIONE <br /> OENEIIALGONfRACTOR MAIL�ODfiE55 CITY ZIP PHONE LICENSE� <br /> MECIUNIC�LCONfR�CfOR M411��D11E55 CIIY ZIP PNONE LICENS � <br /> �um I.o K 1 Iqlg . � �y Ay ��E I�,in.l�.lamd 9�0.3H 82l •N542�suN�owziy�,T�) <br /> 1 PLUMBINOCONTRl1GiOq MAILII�ORESS CITY ZIP PHONE IICENS / <br /> '� CUSS OF N9RK <br /> , ❑ NEW O ADDITION (XALTERATION ❑ REPAIR f_1 DEMOUTION U WOUDSTOVE/FRPL INSERT ❑ BUILDINO RELOCATION <br /> � TENANT MPOOVEMENT OR MTENqH qEM00El[wlY /�rl GONT�Ci PEBSON nND FIIONE NO. <br /> � CONi11ACT PPICE OF VNRN: I��. (,/v <br /> i �Eu�m�S�W'�'f�iE,,F,O,O�T��,O"E INVOLVED <br /> wss� R.�.N r.�. <br /> PROPOSEDUSEOFBU rtro I HEREBY CEFTIFY THAT I HAVE READ AND EXAMINED THIS <br /> I �� ��' APPLICATION AND KNOW THE SAME TO BE TRUE AND CORFEC?.ALL <br /> � IEO�L0E6CBIPTqNOF P rv�s� BELOW ORA I LNFOU0001'IES� PROVISIONS OF LAWS AND ORDINANCES GOVEFNINO THIS TYPE OF <br /> ' ipT gi�K oF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PEflMIT DOES NOT PRESUME TO QIVE <br /> AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> — OTHER STATE OR LOCAL LAW REGULATINQ CONSTRUCTION OR THE � <br /> PERFORMANCE OF CONSTRUCTION.THAT I 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 /> CONTFACTORS LAW 1827 RCW AND 296200 WAC. <br /> i SIGNATUfiEOFCONTfl�CTOROR�UTHORtZE0A0ENi DATE <br /> x I�.c� 02o3"lz (} /'� ' <br /> .. ►ROJECTADDPE&9 �^,��,^ /�/� IiCA�/VV�. �W , 1�� �C • � _, w",^/ • • <br /> c.r�r►ut, �,�•�� �PFLICANISCIIYBUS�NESSLICENSENO.ANDBUSINESSNMIE � <br /> •i PLUMBINO MECHANICAL } <br /> � . NO. TYPE OF FI%TURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) � NC—NHNDLG UNITS—H.P. , <br /> � � BATHTUB ' FORCED AIR SYSTEMS—B.T.U. M E.A. � <br /> ;! LAVATORY(WA;iH BASIN) � UNIi HEATERS—B.T.U. M ' <br /> SHOWER � CLOTHES DRYE�S � <br /> � KITCHEN SINK d DISP ; VENTII.ATION FAN � <br /> 11 OISHWASHER � qANGE HOOD , <br /> � LAUNORY TRAY ; � WATEfl HEATER � <br /> CLOTHES WASHEH i WpOD STOVE ; <br /> URINAL ' METAL FIREP�ACE 8 CHIMNEY � <br /> DRINKING FOUNIAIN � FIREPLACE INSERT � <br /> FLOOq DRAIN ' <br /> —' HEAT PUMP �— <br /> BACKFLOW PREVENTEHS ; GAS PIPING � <br /> ROOF ORAINS—RAINLEADERS � EXHAUST F�N � <br /> — � <br /> SINK(SERVICE—BAR,ETC.) � — � <br /> � <br /> �—— <br /> � � <br /> --•—— i <br /> i —*— <br /> � <br /> i <br />• I ' ' <br /> —i— <br /> r <br /> I SUB TOTAL S � SUB TOTAL E <br /> PEFMIT $ �i— PERMIT E � � <br /> i <br /> TOTAL FEE $ � TO7AL PEE 3 �O <br /> FROHiSE7BAGK pEMSEtBACK SIDESETOACK PLANCIIECKNUMOEO FEE RECEIPiNO. <br /> USE20NE LOTAHEA VAC�NTSITE FEES VALUATION FEE <br /> i CI YES ❑ NO BUILDIN6 � <br /> TYVEOFLONSi.ALIOWA&f TYPFOifAHSTAttUA( �� rro.avMlunclnns ' ; <br />' � G9pp <br /> PLUMBINQ i <br /> � <br /> B¢EOFBLUO. NO.pFbiOR1E5 B�SEMENT MECH�NICAL �— <br /> O YES ❑ NO � <br /> ' OCCUPANCYLOAD FIRESPfINKLEfi5f1E0D HEqHTUMITA710N OiHEfl � <br /> � U YES U NO STATGBUILDINGSURCHARGE i <br /> FlEASON FOfi 5P1i111KLEfl5 . � <br /> STATE ENERGV SUFCNMGE � <br />� ' APPLICATIONACC.BV P�pNSAPPPOVEDBV CITY OF EVERETT <br /> ' LOCAL SALES PUBLIC WORKS � <br /> TAX CODE IS 31D5 TOTAL ; <br />