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L Y <br /> �y� APPLICATI� FOF� CONSTRUC `�� N PERMIT `� <br /> � , �E�� everett <br /> � '�. CITV OF � <br /> , �everett <br /> 1 BUILDING DEPARTMENT <br /> � 259-8810 TO BE COMPLETED IN INK—PLEASE PRINT <br /> � ❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑MECHANICAL ❑ PLUMBING ❑ SIGN <br /> � p MAILADDRESS C�iV 21P PHONE i <br /> t ��.° /�//•�.Y/�7f �lfn a I Dn(m,�rp- �-Y/c.�i — cl�?r/3_ 2��Zf2-2� I <br /> '� 7EN/JI{ IMIL�DDRESS CITV ZIP PMONE ' � , � <br /> � ARCNITECTORDE510NEfl MML�DDRE55 CITV 21P PHONE I <br /> R <br /> ` OENEMLCONiHACTOR M�ILADDRESS CITV 21P PXONE LICENSE• <br /> q �nP/ <br /> '� MECHM/IC/�LCONTRACTOR MAILN'DRESS CITV ZIP PHONE LICENSE� <br /> � PLUMBINOCONttUCTOR MMLADDRESS CITV 21P PHONE LICENSE� <br /> � <br /> ,1 CU880F WORN <br /> � NEW O ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL INSERT ❑ BUILDINO RELOCATION <br /> C TEWWTMPROVEMENTORINTERIOflRiMODELONLY )PJC[ �> ML !. CON7ACTPEP50N�HDPHONENO. � <br /> � CONTMCTPRICEO�WONNt C�1 � )a Y <br /> ; � pEBCqIBE WORN AND 60UARE FOOTAOE INVOLVED <br /> .��- 6Go sf <br /> vnonoseousEUFew�onw I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> .� � ('�,� �Q�T APPUCATION AND KNOW THE SAME TO BE THUE AND CORRECL ALL <br /> ? lE(NI.DE9CFIPTqN OF PROPENTV(6XOWN BELOW OR ATTACN FOUR COPIES) PROVISIONS OF LAWS AND ORDINANCES OOVERNIN6 THIS TYPE OF <br /> �'� WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> `.s wr e�ocK oF NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO OIVE <br /> AUTHOfiITV TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> ") �^�� ��I IS �G /7 0`- N /O�D'P �f-[� BIOC � OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> ' ? � � PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> ;:j OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> /' APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> �{ CONTHACTORS LAW 18.27 RCW AND 296.200 WAC. <br /> SIONANREOFCONTR�CTORORAUTNORREDAOENT DATE <br /> � <br /> ' X G/?�l� ��/,�_ <br /> 9 �RQIECTADDRE55 2 9dxg � <br /> APPLIGINTS CIiV BUSI�S LICENSE NO.AND BUSIN SS NAME <br /> ��� PLUMBINO MECHANICAL <br /> �J � N0. TYPE OF flXTURE OR ITEM FEE N0. TYPE OF E�UIPMENT FEE <br /> �V WATEH CLUSET(TOILET) � AIC—A/HN�LG 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 /> � SHOWER ' CLOTHESDRYERS � <br /> �y . KITCHEN SINK&DISP ; VENTILATION FAN ; <br /> � DISHWASHER � RANGE HOOD � <br /> �j � LAUNDRY TRAY ; WATER HEATER ' <br /> � CLOTHES WASHER � WOOD STOVE � <br /> � �� URINAL ' METAL FIREPLACE&CHIMNEY � <br /> � ' �- DFiINKING FOUNTAIN � FIREPLACE INSERT � <br /> FLOOR DRAIN � HEAT PUMP � <br /> � BACKFLOW PREVENTERS ; GAS PIPING ' <br /> � ROOF DRAINS—fiAINLEADERS � EXHAUST FAN � <br /> � SINK(SEHVICE—BAR,ETCJ ; ' <br /> i <br /> 7 � i <br /> i � ' <br /> � i � <br /> i � <br /> ,� ' ' <br /> I <br /> � . SUBTOTAL S � SUBTOTAL $ ' <br /> � ' PERMIT S � PERMIT $ � <br /> j TOTAL FEE $ ' TOTAL FEE $ � <br /> � � FFONTSEiBACK REARSETBACK SIDESETBACN PUNCMECKNUMBER FEE �� 3�r RECEIPTNO. <br /> ; 2c� n� co• K �o• ,�ua,w►a.�6� — aGG <br /> � U&EZONE LOTAflEA VACANTSITE EES VALUATION FEE <br /> � + 1 � ❑ YES NO m lea� P�o� cA�n � <br /> j l � � BUILDING • � 8y� <br /> 1 lYPEOFCONST.AIIOWABIE TYPEOFCONST.�CTU�L �Wow MaaDNt�UNGuxit6 � ' � <br /> � , J PLUMBINO � <br /> � BIZEOFBLDG.' NO.OF6TORIES BASEMENT MECHANICAL � <br /> � <br /> � ' 6� � ❑.YES 6d NO � <br /> . OCCUPANCY LOAD FIRE SPRNNLERS Re0'D HEIGMT LIMITATION OTHER � <br /> i <br /> i �/ <br /> ❑ YES QQ NO � STATE BUILDING SURCHARGE '7 i S <br /> � REA60N FOfl SPRINNLERS <br /> i ' STATE ENERGY SURCHARGE i <br /> � MPLICATIDN�CC.BV PWISAPPROVEDBV CITYOFEYERETf PUBLICWORHS i I� <br /> ' %,i /1� LOCALSALES i <br /> ! �/!q 'T TAX CODE IS 3105 ror�� �(p <br /> i � <br /> i , �-... ._ .__ . , , . ,., ,. . ,: . <br /> . .: . , . . , ,;., ,,,..... <br />