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� i <br /> APPLICATII..�I FOR CONS�TRUCT �ON PERIVIIT Ii ; <br /> everett � <br /> Ihe Erergreen �' � <br /> CITV OF I <br /> everett � <br /> BUILDING DEPARTMENT TO BE COMPLETED IN INK—PLEASE PRINT <br /> 259-8810 <br /> „ DEMOLITION ' COMBINATION BUILDING �CMECHANICAL PLUMBING SIGN <br /> ow A unanooeess . ci ziv vHor+e i <br /> 1��C�br ecK 2925 �-aleat���.,�' ��+,i,u.� �� q�2�°3 355• 835Z <br /> TENANi MAILApDRE55 CITY ZiP PHONE <br /> ARCNITECTORDESIGNEF MFILqDDREES CITY ZiP PHONE <br /> CI7Y ZiP PHONE lICE1lSE/ I � <br /> ��� GEN[IIALCONTRRCTOR M�ILAO�RE55 -- I <br /> � CIiY IIP PMONE LICENSE� <br /> ah3 MECIIRNICALCONTRAGT P I.IAILAO�RE55 SUI`�LO1�1�7J6 . <br /> [�'H SwnQ.o I� �nC. � IqlS • i2�1 Av K.ut Ic1 cu�d q�o3�1 �Z� �U54� �'��.c�e�� . � <br /> a y y PLUMBRIG CONTF�CIOR MFIL�DOPESS CITY ZiP �MONE 4CENSE� <br /> � CLASSOFWORN <br /> O �O � ' NEW � �. ADDITION ALTERATION .. � REPAIR . DEMOLITION . . WOODSTOVE/FRPL INSERT � DUILDING FELOCATION <br /> �C �"�� TENANT IMPHOVEAIENT OR INTERIOR1FlEMODEL ONLY ;� CONTACT PERSON AND PMONE N0. <br /> Ij �� CONTHACTPRICEOFIYORH: ! O�• �v �� <br /> z DESCRIOE WORK 4tID SOUARE FOLO7AGE INVOLVED <br /> � HO � l� -- i . <br /> PROPOSEOWEOFBUIL��NG I HEREBY CERTIFY THAT I HAVE REAO ANp EXAMINED THIS <br /> r�.1 [�i�g APPLICATION AND KNOW THE SAME TO BE TRUS AND CORRECT.ALL <br /> 4�� C� PROVISIONS OF LAWS AND ORDINANCES GOV`=RNING THIS TVPE OF <br /> zN LEW�DESCliiPTIONOPPROPERttISNOWN towoanrtnc���ouacoaiet� y�ORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> 9 H� ioT o�ocK oF NOT. THE GRANTING OF A PERMIT DOES �i07 PRESUME TO GIVE <br /> t"� �' /�� AUTHORITY TO VIOLATE OR CANCEL THE PROV!SIONS OF ANY <br /> C7 VJ H T � �QO3� ' O � �l�/ OTHER STATE OR LOCAL LAW REGULATIN��CONSTRUCTION OH THE <br /> p PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> C] l7 y OWNER OF THIS PROPERTY TO PERFGRM THE WORK FOR WHICH <br /> � �ty APPLICATION IS MADE AND I CJMPLY NITH THE STATE <br /> [s] CONTRACTORS LAW 1827 RCW AND 236200 WAC. <br /> $ Ij VJ S�G4ATUREOPGONTR�GtORORAUiNORiZEDPSENT OAtE <br /> H O fn <br /> N.�:C . �' 020312- <br /> X �wn,�.o�c. 0n� • �zs� `�(�l,�.l��'n <br /> PRQIEGTAODPE55 <br /> p� T„,'__-1a- � APPLiCANTSCITVBUSiNE55lIC[NSENO -•NO�USiNE55NRldE <br /> �lMt•VL <br /> i <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EOIiIPME <br /> `�' � WATER CLOSET(TOILET) A�C—NHN�LG UNITS—H.P. <br /> !! BATHTUB FORCED AIR SYSTE�dS—B.T.U. M E.A. <br /> LAVATORY(WASH BASIN) UNIT HEATERS—B.7.U. M <br /> a <br /> SHOWER CLOTHES DRYERS <br /> � ' KITCHEN SINK 8 DISP VENTILATION FPN <br /> w� DISHWASHER RANGE HOOD <br /> LAUNORV TRAY WATER HEAT�_R <br /> �' � CLOTHES WASHER WOOD STOI E <br /> O� URINAL METAL FIR�PLACE 8 CHIMNEY <br /> DRINKING FOUNTAIN FIREPLAGE INSERT _T <br /> FLOOR DRAIN HEAT PUh1P � <br /> I' � BACKFLOWPREVEN;ERS GASPIPING <br /> fi00F DRAINS—RAINLEADERS EXHF,UST FAN <br /> SINK ISEFVICE—BAR,ETC.) � — <br /> �'`� <br /> SUBTOTAL 5 ; O <br /> � I ' SUBTOTAL 5 PFRMIT S { �Q <br /> PERMIT 5 <br /> TOTALFEE 5 TOTALFEE S <br /> � F�ONiSETBACK �EARSETOACK SiDE5ET8ACK �LANGHECKNUMB_R fEE PECE�PiNO <br /> �+ <br /> useza+e ioinnen vacnr+isrte FEES VALUATION FEE <br /> � YES NO BWl01NG <br /> irFEOiCON5T0.lPXABIE TYPEOttONSiALIU�t aarvsa+ nooirouo•acnis <br /> tqppe pLUMBING <br /> Si2[OFBIDG. NO.OFSTORIES BASEMENT MECNANICAL <br /> �. ! VES - �. �i0 <br /> OCGUP�NLYLWD FIRESPRNNIERSREOD MEIGIIiLIAULRION OTHER <br /> '. : VES . NO STATE BUILDING SURCHARGE <br /> n[n50N fOR SPRINRLENS �— <br /> STATEENERGYSURCHPRGE <br /> pPVIiC�TION�CC.BY PLANSRPPROYEOPY CITYOFEVERETT PUUlIC1YORK5 <br /> LOCALSALES <br /> TAX COOEIS 3105 TOTA� <br />