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l`Vl'fPll <br /> AP�PLICATIO�J FOR CONSTRUCTj.JN PERMIT � <br /> TO BE COMPLETED IN INK—PLEASE PRINT <br /> rne F����groon <br /> CITY Gf <br /> everett HEPTIN3 SYSTEM: U GAS ❑ELECTRIC ❑ — <br /> BUILDING DEPARTMENT <br /> 259-8810 <br /> DEMOLITION COMBINATION BUILDING � MECHANICAL [7 PLUMBING SIGN <br /> \Yn[ / MAILADDRESS CITY ZiP PHONE ��S � Y�.� <br /> ]��2uc` 7e,'v, ��09 /�uX'��n�3���Edere/� >.G'�o3 <br /> {� TEN�NT �/ ` M�RIL A'D'D/RESS �.J CITY ZIP PHONE <br /> � E b ! i �/U t lt+0I�7 O/hiP C,��d / �� ���OG ��� �� 7 .S� �'�— <br /> ��� y ARCHITECTOR�ESIGNER MAILR��RESS <br /> CITY ZIP PHONE <br /> i0 A P7 <br /> � � y GITY IIP PNONE LICENSE/ <br /> GENERRLCONTPAGTOR MRILADDRESS ��0�� �j�< � O/ �O�/ <br /> y " ,f'�i/rnnl� /ll�ch �/7/� CG,>� e,cu��s� �t/� ,!�? •,.. _ <br /> ���, PNONE UCENS.I <br /> O CC O MEC ANIC�LCONTRRpOR MA11.AO�RESS �/�JO�' ZIP <br /> � N H <br /> ��n, Z�p P'IONE LICENSE+1 <br /> •7 _ . � PLUMBINGGONTnAGTOR M�ILPOORE55 <br /> C Z <br /> ro o <br /> O N L1A550FWORN . ; <br /> M Gn0 � . NEW .-I ADDITION �.-. ALTEFATION . . REPAIR �..i DEMOLITION . 1 WOODSTOVE�FRPL INSERT ❑ BUILDING FELOCATION <br /> � ` — � CONTACiPE�50NANpPHONENO. <br /> � y GONTRRCT PRICE OF WORN <br /> H <br /> N y D� E WO N NID SOUARE FOOUGE� O��EO <br /> � � y ,t� P c . Auce /eL <br /> � y pnovoseouseoFewt �" I HEREBY CEflTIFY THAT I HAVE READ AND EXAMINED THIS <br /> � APPLICATION AND KNOW THE SAME TO BE TRUE kND CORRECT.ALL <br /> y q PFiOVISIONS OF LAWS AND ORDINANCES GOVERNING THIS NPE OF <br /> O y IEGAlpESCRIPT10Y0FPROPENN�SNOWNBELOWONATTRCH`OUHGOPIES) yyORK WILL BE COMPLETED WITH WI�ETHER SFLCIFIED HEREIN OR <br /> �or oiccK oF NOT. THE GRANTING OF A PERMIT DUES NOT PRESUME TO GIVE <br /> AUTHORITV TO VIOLATE OR CANCEL THE PROVISIC�NS OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHOfiIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> ppPLICATION IS MADE AND I COMPLY WITH THE S�fATE <br /> CONTRACTORS LAW 18.27 RCW AND 296200 W��C. <br /> SiGNRTUREOFCONTRACTORORAUTHOR2EDRGENT DAiE <br /> �7%s/ �o�/��Ezv �.— �,� �. X <br /> PPQIECTAD�RE55 � <br /> APPLICANTS CITY BUSiNE55lIGENSE NO ANO BUSINE55 NRME <br /> MECHANICAL <br /> I�-� � .\ PLUMBING TYPEOFEQUIPMENT FEE <br /> NO. TYPE OF F17(TURE OR ITEM FEE N�' aC—NHNDLG UNITS—H.P. ' <br /> �� WATER CLOSET(TOILET) <br /> • BATHTUB / FORCED AIR S`!STE�'S—B.T.U. M E.A. <br /> 1 ' LAVATORY(WASH BASIN) UNIT HEATERS—B.T.U. M <br /> CLOTHES DR1'ERS <br /> i '��I KITOCHEN SINK 8 DISP VENTILATION FAN - - <br /> DISHWASHER RANGE HOOD <br /> LAUNDRV TRAY WATER HEATER <br /> � '�� CLOTHES WASHER WOOD S10VE � <br /> , I �� URINAL METAL FlFEPLACE 8 CHIMNEY 1 <br /> CFINKING FOUNTAIN FIREPLACE INSERT <br /> � FLOOR DRAIN HEAT PUMP � <br /> BACKFLOW PREVENTERS GAS PIPING �— <br /> i I a'�' ROOF DRAINS—flAINLEADERS EXHAUST FAN <br /> I SINK(SERVICE—BAR,ETC.) � <br /> i <br /> 1 <br /> i <br /> r� , <br /> SUB TOTAL $ SUB TOTAL $ U� <br /> � PERMIT S PERMIT 5 �S <br /> '� TOTAL FEE 5 1' TOTAL FEE $ ,i_ <br /> 1�1 FOR OFFICE USE ONLY: nEce�rr No. <br /> FROi4SETBI.CH RERRSEiBACN SIDESETpALN Pl1NCHECNNUMB[R FEE <br /> USE20NE LOTAREA <br /> VACANTSITE FEES VALUATION J� ^FEt <br /> dUIIDING — <br /> iYP[OitONiS.ALlOWABIF fYPEOfLONSi.ACiUAI ocwreucr xoa0w[wr�4unn5 � <br /> i <br /> tnouv p�UMBING � _ <br /> EREOFOLDG. M�.OFSTORIES OFSEMENT MECHANICAL �S � <br /> ADDITIONAL PLAN CHECK <br /> � <br /> Ot:CUPANCYL0A0 iIPESPRNNLER5RE0'D NEIGNTLIMITRTION � <br /> OTHER <br /> RGSON FOR SPi11NNl!i95 � <br /> SiATE BUILDING SURCHARGE ' <br /> i��7pK�py PLANSRPPROVEOBY CITYOFEVERETT PUDLICWORNS <br /> LOCALSALES <br /> TAX CODEIS 3105 TOTAL <br />