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,""' r-�. <br /> ti <br /> APPLICATI�N FOR CONSTRUCTION PERMfT everett <br /> — LEASE PRINT - n <br /> rnoe�•e rce� TO BE COMPLETED IN INK P J <br /> � /� i,� 1=� � <br /> CITV OF <br /> everett HEATINGSYSTEM: ❑GAS ELECIRIC U <br /> 6UILDING LcPARTMENT <br /> 259-8810 <br /> D OLITION ! COMBINATION BUILDING �MECHANICAL �,: PLUMBlNG '-! SIGN <br /> O ER � Mp /ADRESS CITY `I��O� PHONE � � � <br /> TENRNT MAIL�OORE55 CITV ZIP PHO�E <br /> `� l l �� (� I( <br /> ARCHITEGT O D IGN � MML AD RESS �/� � CITV ZIP PNONE �� ! � �O lA <br /> ' � t/� <br /> � <br /> GE E LCONTR�CTOR • MAILA D�SS .1i O � CITV ��t �y� ZIPI` � PHONE �L�COENSE� � . „ I���) <br /> t� � J ���� ii'��J <br /> MGCNANICALCO iRACTOR MAILAUDRESS LITY 21P PHONE LI�ENSER <br /> PLUMBINGCONTFACTOF MNLAD�RESS CITV ZIP PHONE UCENSE� <br /> CLA�SJ]F WORK . . _ . <br /> f7L N I � ADDITION ' ALTERATION � REPAIR �' DEMOLITION - WOODSTOVE/FF?L INSERT '._i BUILDING RELOCATION <br /> 0o CONTACT P6RSON AND P 6 c.� � _ ��g 3 <br /> CONTPALT PRICE OF WORK <br /> OES BE W 1 ND SOUARE FOOTAGE INVOLVED � <br /> Paoeos SEOF ILDING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> `� APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> IEWLDES iIPT10NOFPROPERTY�540WNBELOWOPATTA o acoa :sr� l ^ PROVISIONS OF LAWS P.ND ORDINANCES GOVERNING THIS TYPE OF <br /> V WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> �oT�_ e�ocK oF NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANV <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION GR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM MUTHORIZED BY THE <br /> OWNER OF THIS ROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION I MADE AND I COMPLY WITH THE STATE <br /> CONT ACT RS 18.27 RCW AND 296.200 WAC. <br /> SIGNA7 OF T TORORAUTHOR2EDAGENT OATE <br /> �, X l � <br /> PPQIECfADDRESS <br /> APPLICAN qN 9USINE55 LICENSE NO.AND BUSINE55 NFME <br /> D <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE N0. TY�E OF EOUIPMENT FEE <br /> WATER CLOSET(TOILE� � A/C-AIHNDLG UNITS-H.P. � <br /> BATHTUB ; FORCED AIP SYSTEMS-B.T.U. M E.A. <br /> LAVATORY(WASH BASIN) � UNIT HEA1 ERS-B.T.U. M � <br /> SHOWER Z CLOTHES DRYERS <br /> KITCHEN SINK&DISP � � VENTILATION FAN <br /> DISHWASHER RANGE HOOD � <br /> LAUNDRYTRAV ; WATER HEATER ' <br /> CLOTHES WASHER � WOODSTOVE <br /> URItJAI ' METAL FIREPLACE 8 CHIMNEY <br /> DRINKING FOUNTAIN i FIREPLACE INSERT i <br /> � FLOOR DRAIN � HEAT PUMP � <br /> BACKFLOW PREVENTERS GAS PIPING � <br /> ROOF DRAINS-RAINIEADERS � EXHAUST FAN � <br /> SINK(SERVICE-BAfl,ETC.) ; <br /> i � <br /> � <br /> � <br /> SUB TOTAL 5 ' SUB TOTAL S " ' �'. <br /> PERMIT 5 � PERMIT 5 � I <br /> TOTAL FEE 5 ; TOTAL FEE S ' i <br /> FOR OFFICE USE ONLY: I, <br /> FRONT SETBACK REAR SETBACK SIDE SEiBACN PLAN GHECK NU fIEB FEE REC IP NO I <br /> 20 ' 2a� 5 � �ri-�Gyo°I .�7.� �S(.P � � <br /> USE2/Cpy+E LOTA�R-EAp r VAGANTSRE FEES VALUATION FEE i <br /> `n"�- � �✓� 0 �J DUILDING �Z17 ;j3(o• � �� I <br /> TVFEOFCONiS.ALLOWA9LE -r �VPEO°CONST.ACIDAL acurAM;r x�arcNRliHcumis .�`_ <br /> � GA�� � pWM81NG i <br /> 5R[OF OLDp NO.OF STOOIES OASEMENT �.�ECHANICAL ' II <br /> Z,,o Sf f 2 N� a do , <br /> 6ZG SF 4A,?_ <br /> OCGUPANCY LOAD FIRE SPPIINLERS REO'D NEIGMT LIMITOATION ADDITIONAL PLAN CHECK <br /> N �{ /��� �+ ' OTHER � <br /> HEASON FOR$PRINNLCR$ <br /> STATE BUILDING SURCHARGE �is ) . <br /> i <br /> R,Ilnh[OY PIANS APPRO`.ED OY CITY OF EVERETT PUBLIC WORKS � � <br /> /,�,� LOCAL SALES <br /> 7 �' i$�` TAX COOE IS 3105 TOTAL ; 7� <br /> i <br />