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APPLICATIt�N FOR CONSTRUCI ;�ON PERMIT <br /> everett <br /> rn.E�.y,ean � <br /> CITV OF <br /> ever�tt <br /> PUILDiNG DEPARTME�JT <br /> � 259-8810 TO BE COMPLETED IN IRIC—PLEASE PRINT , <br /> ❑ DEMOLITION ❑ COM6INATION ❑ BUILDING �'MECHANICAL ❑PLUMBING ❑ SIGN <br /> pyyNEq AUILAODRE55 LITY ZIP PNONE <br /> Il�c�+.w� A -1 l.or .��. Li d.v � 1i101 C'o .+ krrc��.�S, �vcrC.tl WA 9$2G3 353-38y�{ ' <br /> TEHANT MAILADDRE55 CITV 21P PMONE <br /> ARCHITECTORDESIGNEq MAILADDRESS CITY ZIP PHONE . . � . <br /> GENERALCONTflALTOR M�I�ADDRE55 CITY ZIP PMONE LICENSE� <br /> MECWW�C�LCONTRACTOfl MAILADOPESu CITV ZIP PHONE LICENSE/ WW 5;��y�DL. <br /> Wc�ods+�„rc, Su.y4n�t��u� ��c. 1T01 P7I':JOC�.II}Ll L��� . 9�26f 252-zSly <br /> pI�MBWOOpNTqALTOR MAILADDRESS � �CITY ZIP r PHONE LILENSEI � <br /> CLA55 OF M/ONN <br /> ❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR � ❑ DEMOLITION I�WOODSTOVE/FPPL INSERT ❑ BUILDING RELOCATION <br /> TEIUNT MiPRGJEMENT OR INiERIOR REMODEL ONLY CONTACT PERSON AND PHONE NO. � <br /> canw�cr w��ce oF w«ix: � Lo r +�a L i wJ.�e .� w k . 33�-�-1 O'7`t <br /> DE6CR9E WOAN AND SOUARE FOOTA�E INVOIVEU �H�a�/�«jto��- <br /> Pt IICj1' �FLY'L ���'C�aIQ C2 -I- N��-!� <br /> vnoroseouseoFevaoir+a I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS . <br /> p a_ , _�,c�,�� ' APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL . <br /> —�'� PROVISIONS OF LAWS AND ORDINANCES GOVERNIN6 THIS TYPE OF <br /> LE6ILL DESCRIP710N OF PflOPERTY(SMONRI BELOW OR ATTACN FWR COPIES) <br /> WORK WILI BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR' • <br /> �or � t I I e�ouc I I oF 1 f�r¢.�tkr NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO dIVE ' <br /> AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY � <br /> , �� OTHER STATE OR LOCAL LAW PEGULATING CONSTRUCTION OR THE � <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE � <br /> OWNER OF THIS PROP[RTY TO PERFORM THE WORK FOR WHICH , <br /> APPLICATION IS MADE AND 1 COMPLY WITH THE STATE � <br /> CONTRAC'.OP,3 LAW 18.27 RCW l.ND 29620D WA0. � <br /> SIGN�IDREOFCONTRACTORORAUTHOPI2FOAGENT DAiE ��_2� . fl.� � <br /> — � I <br /> PIpJECTADDRESS ,/� �n "' `� � <br /> CIIGI CO.��w-�'-�'� �V�f C'� �1"� APPLICANTSCINBIISINESSLICENSENO.ANDPUSINE5SNMIE <br /> PLUMBINfi MECHANICAL <br /> NO, TYPE OF FIXTURE OH ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) � NC—A/HNDLG UNITS—H.P. � 3 <br /> BATHTUB ; FORCED AIR SYSTEMS—B.T.U. M E.A. � � <br /> LAVATORY(WASH BASIN) � UNIT HEATERS—B.T.U. M � � <br /> SHOWER ' CLOTHESDRYERS � •� <br /> KITCHEN SINK 8 DISP i VENTILATION FAN ; ' <br /> DISHWASHER � RANGE HOOD � I <br /> LAUNDRYTRAY ; WATERHEATER ' i <br /> CIOTHES WASHER � WOOUSTOVE � I <br /> URINAL ' METAL FIREPLACE 8 CHIMNEY � I <br /> DRINKING FOUNTAIN i � FIREPLACE INSERT i , <br /> FLOOR DRAIN � HEAT PUMP � � <br /> BACKFLOW PREV@NTERS ; GAS PIPING ; <br /> ROOF DRAINS—RAINLEADERS � EXHAUST FAN � <br /> � SINK(SERVICE—BAR,ETC.) ; � <br /> � <br /> � � <br /> � � <br /> � ' i <br /> � I <br /> SUB TOTAL 5 ; SUB TOTAL S ' <br /> PERMIT $ � PERMIT S � <br /> TOTALFEE S ' TOTALFEE $ � <br /> FRONTSETB�CK flEANSETBALK SIDESETBACK PIANCMEGKNUMBER FEE RECEIPTNO. <br /> USE20NE LOTAREA VACANTSITE FEES VALUA710N FEE <br /> ❑ YES O NO BUILDING � <br /> TYPEOfCOHST.lIIOWABIE TVPEOFCONSi.ACNAI �� ��aowEuuwuHrts � <br /> �p�P PIUMBING � <br /> SIZCOFBL06. NO.OFSTORIES BASEAIENT MECHANICAL , <br /> O YES ❑ NO � <br /> OCGUPANCVLO�O FIRESPRNKLERSPEO'0 HEIGMTLIMITATION OTHER i <br /> ❑ YES ❑ NO � <br /> STATE BUILOING SURCHARGE � <br /> REASON FOR SPRINNLEflS <br /> STATEENERGYSURCHARGE i <br /> APPLICA710NALC.BY PUNSAPPROVEOOY CITYOFEVERETT PU�LICWORKS � <br /> LOCAI SALES , ' <br /> TAX CODE IS 3105 rorn� <br />