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APPLICATII�N FOR CONS�"�RI�C? ityN PERMIT <br /> �E��� � everett <br /> atv oF � <br /> ever�tt . . <br /> BUILDING DEPARTMENT <br /> 259-8810 TO BE COMPLETED IN INK—PLEASE PRINT <br /> O DEMOLITION ❑ COMBINATION ❑ BUILDING �MECHANICAL L7 PLUMBING ❑ SIGN <br /> ��R MA�LADURES CI IP PIIONE <br /> -�trmi. -�SI 9 uJ. �ict,uem c�,. � c'�s�--�F5$� _ <br /> TEN�NT MAIL�DDPE55 CITV 21P PMONE <br />� �NV�2 (,�A� ��}lSl1� <br /> Ai1CNITECTOqpESIGNEfl M�ILADDRE55 CITY 21P PHONE <br /> VAII CONTRR T�' MAILADDRESS TV IP � PHONE� . f ����NN� � Li- <br /> S �T V!1 <br /> n <br /> MELHINICM.CONTHACiOR MAILADDRE55 CITY ZIP PHONE LICENS <br /> �-I-13 <br /> PLUAIBINOCONTMCTOR MAILADORESS CITV ZIP PHONE LICENSE <br /> CU5$OF WORK <br /> ❑ NEW ❑ ADDITION RATION O REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL INSERT ❑ BUILDING RELOCATION <br /> TENiWTIMPRpyEMENTORINT qpEMODE LV CONTACTPER:AN�NDPHONCNO. <br /> CONTMCT PRICE OF WOAK!` '��� I <br /> �� ANO AR FoouC�rrva�o � � 'n ^^ '/ <br /> TUi►� <br /> raoroseouseoFevaoiHa ' I HEREB.' CERTIFY THAT I HAVE READ AI.D EXAMINED THIS <br /> APPLICATION AND KNOW THE SAME TO BE TRU_AND CORRECT.ALL <br /> lE0Al0ESCPIPTIONOFPROPERTV�SHOWNBELOVJORATTAGHFOURCOPIES) PflOVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TVPE OF <br /> WOHK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> �oT B�oc�c o� 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 REGUTATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BV THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOH WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTHACTORS LAW 18.27 RCW AND 996.200 WAC. <br /> SqNATUREOFCONiRACTORORAUTHORIZEU ENT OATE <br /> � PROJECTADORE35 �J�/'� `I��y^M �T( ry^, A / �j <br /> �I � DI G / ���+�/1 1 �" I� APPL CANTS CITV BUSIN LICENSE NO.AND BU51NE55 NMIE <br /> � PLUMBINO ' MECHANICAL <br /> NO. TYPE OF fl%TURE OR REM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILEn � NC--A/HNDLCa UNITS—H.P. , <br /> �— <br /> BATHTUB ; FORCED AIR SYSTEMS—B.T.U. E.A. � <br /> � LAVATORY(WASH BASIN) � UNIT HEATERS—B.T.U. M ; <br /> � � SHOWER � CLOTHES DHYERS � <br /> KITCHEN SINK d DISP ; VENTILATION FAN ; <br /> DISHWASHER � RANGEHOOD � <br /> UUNDRYTRAY ; WATERHEATER � <br /> CIOTHES WASHER � WOOD STOVE ; <br /> URINAI. ' METAL FIREPLi10E 8 CHIMNEY � <br /> DRINKIN3 FOUNTAIN � FIREPLACE INSERT ; <br /> FLOOR DqAIN � HEA7 PUMP � <br /> ' '� BACKFLOW PHEVENTERS ; GAS PIPING ' <br /> ROO��DRAINS—RAINLEADERS � EXHAUST FAN � <br /> � SINK(SERVICE—BAR,ETC.) ; � <br /> � � <br /> i i <br /> � � <br /> SUB TOTAL 3 ; SUB TOTAL S ' — <br /> PERMIT $ � PERMIT S �� '— <br /> TOTAL FEE 3 ' TOTAL FEE S � — <br /> FRONTSETBACN REAqSETBACK SIDESETBACK PLANCHECKNUMBER FEE HECEIPiNO. <br /> USEZONE LOTAREA VAG�NTSITE FEES VAIUATION FEE <br /> O YES ❑ NO BUILDING . i <br /> TYPEOFCONSCALLOWABIE TYPEOFCONST.ACTU�L �� xoaow[Wxauxi�s <br /> �a� PLUMBING � <br /> j SQEOFBLDO. NO.OFSTOflIES BASEMENT MECNANICAL �'r i � <br />� ❑ YES ❑ NO , <br /> OCCUPANCVLOAD FIflESPRNKLEfiSREO'D HEIOMTLIMITATION OTHER � <br /> ❑ YES ❑ NO STATE BUILDING SURCHAFGE i <br /> REASON FOR SPRINKLEflS <br /> i <br /> STATEENERGVSURCHARGE � <br /> APPLIC�TIONACC.BV PUNS�PPROVEDBV CITYOFEYEHETT PUBLICWORKS i <br /> LOCAL SALES <br /> 7AX CODE IS 3105 rorn� G f ; � <br />