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APPLICATII)N FOR CONSTRUCT �t�rN PERMIT <br /> rn,E�re�s�a� ' everett <br /> ��r oF e <br /> everett <br /> BUILDING DFPARTMENT <br /> 259-�'+810 TO BE COMPLETED IN INK—PLEASE PRINT <br /> ' ❑ DEiiA0UT10N O COMBINATIf3N fJ BUILDING �MECHANICAL p PLUMBING ❑ SIGN <br /> r�+�� ��.�rmaiooneSSVLL�L�XJ�S� Ic'�wuc1V1 CYI. C�lJvl-�LJ—I�E�S�—���`E' <br /> "f <br /> TENAHT MAUOORE55 � �i�Y ZIP P�IONE <br /> li7QNVL� �,�� ,�'_ )611�� <br /> �RCNITECTOBDESIGNER MAIL�DDRE55 q�Y ZIP PHONE <br /> VAII`CONTR� TOR . MAIL�ODRESS TY IP � PHONE L16LNSE� <br /> �S �� vA� EN6 � L�. <br /> MECH�NIG0.CONT8ACTOR MIIRADJRE55 QTY ZIP PHONE �ICENS <br /> �-I-!3 <br /> PLUM0INOCONTMCTOF MAILRDDRE55 CITV ZIP PHONE LIC@NSEIr <br /> CIASSOF WORN <br /> � ❑ NEW ❑ ADDITION " ' RATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPLINSEHT ❑ BUILOINGRELOCATION <br /> TENANTIMPROVEMENTORINT ORqEMODELpN��.V^�/ CONTACTPERSONANDPHONENO. <br /> CONTMCTPRICEOfWpqN!_ '�(/� I <br /> TDES�Cfl10E WORK AND AR FOOTAGE INVOLVED <br /> .LI l � <br /> PIqPOSEDUSEOFBURDINO I HEREBY CERTIFY THAT I HAVE READ APJC EXAMINED THIS <br /> APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> lE0AL0E5CRIlIIONOFPqOPERTY�SHOWNBEIOWORATTACNFOUNCOFIES) PROV�SIONSOFLAlYSA1JDORDINANCESGOVERNINGTHISIYPEOF <br /> WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> �or eiocK oF NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTIOPJ.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 /> CONlRACTORS LAW 1827 RCW AND 296..^.00 WAC. <br /> , SIGNATUREOFppNTRACTORORAUTNOR2ED ENT OAIE <br /> PROJECTADDRE55 O� [,/��`I"�y/�/�/� �7�y^\ � �j <br /> �I � DI�.+1 / �r��1 �// � � I� APP�CANTSCITVBUSIN LICENSENO.ANDBUSINESSNAME <br /> PLUMBINO � MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE N0. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) � AIC—A/HNDLG UNITS—H.P. � <br /> BATHTUB ; FORCED AIR SYS?EMS—B.T.U. E.A. � <br /> LAVATOHY(WASH BASIN) � UNIT HEATERS—B.T.U. M ; <br /> � SHOWER � CLOTHES�RYERS � <br /> KITCHEN SINK 8 UISP ; VENTILATION FAN � <br /> DISHWASHER � RANGE HOOD i <br /> LAUNDRV TRAY � WATER HEATER � <br /> CLOTFIES WASHER � WOOD STOVE � <br /> URINAL ' METAI FIREPLACE 8 CHIMNEY � <br /> DRINKINO FOUNTAIN � FIREPLACE INSERT ; <br /> FLOOR DflAIN � HEAT PUMP �— <br /> ' � BACKFLOW PREVENTERS ; GAS PIPING � <br /> � ' ROOF DRAINS—RAINLEADERS � EXHAUST FAN , <br /> � � SINK(SERVICE—BAR,ETC.) � , <br /> � � <br /> i <br /> I. � ' <br /> i � <br /> SUB TOTAL $ ; SUB TOTAL $ � — <br /> PERMI7 $ i PERMIT $ � i — <br /> TOTAL FEE $ ' TOTAL FEE $ ,r� — <br /> FpONTSETB,ICK REAqSETBRCK SIUESETBACK PLANCNECKNUMBEq FEE RECEIPTNO. <br /> USE2IXJE LOTAREA vncaratsrte FEES VALUATION FEE <br /> ❑ YES ❑ NO �— <br /> BUILDINO ' <br /> lYPEOFCONSt.ALIOWABLE TYCEOiCONSf.�tit1AL �>�' xa.doxnuMcuxns � : <br /> cnav , <br /> PLUMBINO i <br /> � SIZEOFBLDO. NO.OFSTOfl1E5 OASEMENT MECHANICAL � <br /> ❑ YES ❑ NO �� � <br /> OCCUPANCYLOAD FIflESPRNKIEBSPEOD NEIONTLIMITATION OTHER � <br /> � <br /> ❑ YES ❑ NO - ' <br /> STATE BUILDING SURCHARGE i <br /> REASON FOR SPRIN1cLEfiS i <br /> �— <br /> STATEENERGYSURCHARGE � <br /> APPUCATIONACC.BY PLANSAPPqOVEDBY CITYOFEVERETT pUBLICWORKS i <br /> � LOCALSALES ' <br /> TAX CODE IS 3105 rorn� G f ; � <br />