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_ , - <br /> �� APPLICATIOIr FOR CANSTRUCTI�N PERNlIT �'`'`'`�" <br /> K �m,�t,.�,,:•<•�-� TO BE COMPLETED IN INK—PLEASE PRINT <br /> arvoF <br /> everett HEATING SYSTEM: ❑GAS ❑ELECTRIC ❑ — l <br /> BUILDING DEPARTMENT � <br /> 259-8810 <br /> DEMOLITION COMBINATION BUILDING XMECHANICAL PLUMBING SIGN <br /> ������ER IJAILADDRE55 GIN �IP PMONE / <br /> � ���n i��.:.-:• �.�,I i� �_ . _ .�/ `IS� ��..� ;7,': �- �y7?� <br /> I,�1!.�,,I�NII ����;f���, a�,� , ; ,r,� � , , .,� <br /> � � IiJiANT <br /> MAIL RD�RE55 CITY 21P PHGNE <br /> � � � PHONE <br /> b nRC��rtEGTORUE5IGNEB MAILAODPES$ ��T� Z�P <br /> t' � y _ <br /> i,i_N[RRLGONTRAGTO MAIIA�DRESS CITY ZIP PHONEC 'LI�ENSE� T <br /> � � � �7 - � , : - 1 - .�D 5°i-� ��U rA1(' 153L1 <br /> A'EC�UWC CONTRRCIOR MhILADOFE55 Cltt IIP PNONE LICEI:SE� <br /> hp H �+G <br /> .a y ~ ��n, Z�p PHONE IICENSE� <br /> 'ly .,o� � PLUMBINGCONTMGTOR MMLAOOAESS <br /> � y � <br /> � CLASS OF WOPN <br /> H � '. � NEW _ ADDITION �ALTEFATION . ' REPAIR DEMOLITION . WOODSTOVE/FAPL INSERT BUILDING RELOCATION <br /> � ♦ CANTACT PERSON AND PNONE N0. <br /> r H COHTRRCT PFiLE OF WORI(Y� l <br /> y OESCFIBE W09K AN�SOU�RE fOOTAGE INVOLVED <br /> � o m ' �f' �l <br />� � p vRoaoseoweoFeuaoiNc I HEREBY CERTIFY THAT I HAVE REAU AND E%AMINED THIS <br /> y � ' � APPLICATION AND KNOW THE SAME TO BE TRUE AND GORRECT.ALL <br /> � LEG�LDESCRIPTIONOFPROPERTVISMOWNBEIOWOflATTACNFOURCOPIES� PROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTYPEOF <br /> WORK WIIL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> �pT BLOCi. OF NOT. THE GRANTING OF A PER1d1T DOES NOT PFESUME TO GIVE <br /> AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANV <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />� PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZ[D BY TNE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATIOIJ IS MADF. AND I COMPLY WITH 7HE STATE <br /> CONTRACTORS LAW 1P27 NCW AND 296200 WAC. <br /> SiGYRiUREOFCONTRACTORORAl1iHOR4E�AGENi DATE <br /> I r / ' /,/' � / /l/� � <br /> �`.�i �11l � !Gl' � �.%..r'r�[�i� �;r���J <br /> PROJELTADDRESa f �1 qPVL6ANT5CRYBU5INESSLIGENSENOAN0�U5iNE55NAM11[ .�' <br /> l- . 1 . •; l .`_., i <br /> ��� PLUMBING MECHANICAL <br /> i � <br /> I ��' NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) A�C—AIHNDLG UNITS—H.P. <br /> ' ' BATHTUD � FORCED AIR SYSTEMS—B.T.0 M E.A. <br /> 1 LAVATORY(WASH BASIN) UNIT HEATERS—B.T.U. M <br /> , '�� SHOWER CLOTHES DRYERS <br /> ��� KITCHEN SINK 8 DISP VENTILATION FAN <br /> �. � DISHWASHER � RANGE HOOD <br /> LAUNDFYTRAY WATER HEATER <br /> �� CLOTHES WASHEfl � WOOD STOVE <br /> � I !o� � URINAL 1 METAL FIREPLACE 8 CHIMNEY <br /> DRINKING FOUNTFIN i FIREPLACE INSEflT <br /> FLOOR�RAIN HEAT PUMP ' <br /> �� BACKFLOW PREVENTERS GAS PIPING � <br /> � �, I ROOF DRAINS—RAINLEADERS EXHAUST FAN <br /> � SINK(SERVICE—BAF,ETC.) � <br /> • <br /> � <br /> ��' . <br /> SUBTOTAL 5 SUBTOTAL 'S — <br /> � PERMIT S /h �— <br /> t TOTAL1PEE S TOTALFEE S '� ' — <br /> ��. <br /> FOR OFFICE USE ONLY: <br /> ifi0NT5EiBACK �EARS[iBACK SIDESETB/CN PLANCnECNNUM�ER FE[ �ECE��TNO. <br /> useior+t LOTARER vncaNrsre FEES VALUATION FEE <br /> dUILDING <br /> ivPtOFCONIS.RILOWABIE n'PEOiC01.5iAG111F. oapanc+ NOo�mnw+�rc5 <br /> PWh101NG <br /> �1 <br /> SiZEOFBLDG. NO.OFSTORiES BASEMENT MECHANICAL ��� <br /> p 1NCYLOAD F�AESPRNKLER5REOD NEIGNTLIMILATION ADDITIONAI.p�pNCHECK <br /> OTHER <br /> (1EASON FOR SPRINKLEPS � <br /> � STATE DUILDING SUFCHARGE <br /> i <br /> INTRKE�V PLANS�PPROVF.00Y CITYOFEVERETT PUBLICWORK$ i <br /> LOCAL SALES <br /> TAX COUE IS 3105 TOTAL �!�5 �� I <br /> � <br />