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, APPLICA7 .ON FOR CONSTRU�:�t10N PERMIT <br />, <br /> everett <br /> ICITYOFreen � <br />��i everett <br /> ' BUILDING DEPARTMENT <br /> 259-8810 TO BE COMPLETED IN INK—PLEASE PRINT <br /> I_I DEMOUTION I I COMBINATION I 1 BUILDING �MECHANICAL i I PLUMBING I l SIGN <br /> OWNER MAILADUfiESS pTY ZIP PMONE <br /> j�•.�, R��eru,H� 4Vzy- �er � ��✓r 2S5_ yy�� <br /> TENANT MAL�DDRESS dTY ZIP PNONE <br /> AHCHITEGTOflDESIGNEFi MAILADDRESS LITY ZIP PIIONE <br />� GENER�L CONTRALTOR MAIL�DORE55 CITY 21P F110NE LIGP.SE 1 <br /> 4ECHNIIGAL CONT ACTp R MMl ADDRESS CITY 21P PIIONE LICENSE� <br /> �.. Li Gb.�,,d.uf�nc� 3110-F��� �'t/C �uf SS�Lo� 2S5•sd'ii �l/UY�wh l3'1 K r _ <br />' PLUMBINGCONTPACIDR MAI�ADUflE55 CITY 21P PHONE lICR15°1 <br /> CLASS OF WORK <br /> I-1 NEW I.I ADDITION �ALTERATION I I REPAIR (_I DEMOUTION I I WOODSTOVE/FRPL INSERT ❑ BUIIDINI;RELOCATION <br /> t <br /> � TEN�NTIMPROVEMENTORINTERIORREMODELONLY � I1 «� IJNTFCTPERSONANDPHONENO. <br /> a CONTMLT PBICE OF WOBK: . SII{L�. S ✓�� JV _ <br /> DESCRIBE V:ORN/J1D SOUANE FOOT�GE INVOI.VEO <br /> !� <br /> �� PROPOSE SEOFBUILOING � <br /> 9y� � � . I HEREBY CEflTIFY THAT I NAVE READ AND EXAMINED THIS <br /> 5 APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> �een�p�� iorroFrnorean�s M�OEIOWORARRCMFOURLOPIES) PROVISIONSOFLAWSANDOF7INANCESGOVERNINGTHISTYPEOF <br /> WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> �or BLOCN oF NOT. THE GRANTING OF A PERMIT DOES NOT PRESUMF 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 CONSTRUCTION.TI1AT 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 /> CONTRACTORS LAW 18.27 RCW AND 296?00 WAC. <br /> SIGNAIDRE OF CONTflACTOf:N AUTIIORIZEO AGEN I O�TE <br /> I X OC -�v+`h� f/ <br /> PPQlECTADDRESS <br /> ��.ay �J S�l �PPUGANiSCIIYBUSINESS ICENSENOANDBUSINE55NAME <br /> � � <br /> PIUMBING MECHANICAL <br /> NO. TVPE OF FlXTURE OR ITEM FEE NO. TVPE OF EQUIPMENT FEE <br /> WATER CLOSET(TOILEn � A/C—A/I INDLG UNITS—H.P. � <br /> BATHTUB ; FORCED AIR SYSTEMS—B.T.U. M E.A. ' <br /> LAVATORY(WASH BASIN) � UNIT HEATERS—B.T.U. M � <br /> —� <br /> SHOWER ' CLOTHES DRYERS _ ' <br /> KITCHEN SINK 8 DISP i VENTILATIOP!FAN � <br /> DISHWASHER � RANGE HOOD � <br /> _ �AUNORYTRAY _ _ �_ �_ WAT�RIfEATER ' <br /> CLOTIIES WASHER � WOOD STOVE � <br /> URINAL ' METAL FIREPLACE 8 CHIMNEY ' <br /> DRINK�NG FOUNTAIN i FIREPLACE INSERT �_ <br /> FLOOR DRAIN � HEAT PUMP ' <br /> BACKFLOW PREVENTERS ; GAS PIPING ' <br /> ROOF DRAINS—RAINLEADERS � EXHAUST FAN �- <br /> � <br /> SINK(SERVICE—BAR,ETC.) � � <br /> — , <br /> i � <br /> —T— <br /> i <br /> � — ' <br /> i �— <br /> i � <br /> ��i SUB TOTAL $ ' SUB TOTAL $ / ' — <br /> I <br /> PERMIT $ � PEFMIT S //� � — <br /> I'i <br /> TOTAL FEE $ TOTAL FEE $ � J ' � <br /> FRONTSETBRCN AERHSETOACK SIOLSEIORCN PLr1NGMECKNUM�Ef1 FEE RECEIPTNO. <br /> USEZONE LOTAflEA Vr1CANT5ITE FEES VALUATION FEE <br /> T <br /> 1 I YES I I NO BUILOMG � <br /> IYPEOFCONS7.RlLONAOIE TYPEOFCQIISi.ALIOAI �P�r NoaPnuuHcuNiiS -- i <br /> ' �aW� PLUMBING i <br /> ��- <br /> SREOFBLDG. NO.OFSTORIES ORSEMENT � <br /> MECHANICAL ' <br /> I 1 YES I I NO � — <br /> � <br /> OGCUPANCY LORD FIRE SPRNKLEPS PEO'0 11EIG11T LIMITATION �TI IER � _ <br /> [1 YES lJ NO STATE BUILDING SURCHARGE � <br /> FiEA50N FOR SPNNKLERS �- <br /> STATEENERGYSURCHARGE � <br /> APPLIChT10NPGC.OV PLANSAPPROVEDOY CITYOFEVERE7T PUBLICWORKS � <br /> LOCALSALES , <br /> TAX CODE IS 3105 TOTAL � <br />