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APPLICATIOI��OR CONSTRUCTIO��1 PERMIT everett <br /> llro Eve�g�een TO BE COMPLETED IN INK—PLEASE PRINT � <br /> CITV OF <br /> � everett HEATING SYSTEM: ❑GAS 0 ELECTRIC ❑ <br /> BUILDING DEPARTMENT <br /> 259-8810 � <br /> i DEMOLITION i_l COMBINATION i`�BUILDING C 1 MECHANICAL ❑PLUMBING ❑ SIGN <br /> YttJER M�ILpOD{7E55 CI Y Z�P FMONE <br /> ` Pi�FU �c� ���1�(n� r�� � F��,>��f lc��, F✓�rP�1 C��A- �i�av3 3 �,3 ���r� <br /> . I[N�NI MAIL�DDRE55 CITY Z�P PMONE <br /> l <br /> � �R�j��OROES�GNER MAILADDRESS CIiY ZIP PHONE <br /> ��J <br /> —LY� <br /> '- GG Ff�ALG F�CTO(1 MRIlA00RE55 CITY 21P PHONE LICENSEI <br /> ��4; �e � <br /> MEGHANICALCONiR�CTOR MAILADDRESS CIIY ZIP PHONE LICENSE/ <br /> PWMOINGCONIR�G70R MAILAD�RESS LIIV ZIP PIIONE LICENSEI <br />_-� q <br />'�: � — <br /> CUSS Of N'ORK <br /> ;- I � I NEW LI ADDITION IJ ALTERATION I RFPAIR IJ DEMOLITION LI WOODSTOVE/FRPLINSERT ❑ BUILDINGRELOCATION <br /> � � C �CTPEflSON PNONENO. <br /> ' ��}/y.� /� J� A N e /� c <br /> CONTRIICT PRICE OF WORK "' �� (y���[1� L`Y� � Ul.`t I� �✓�' ���� <br /> .i <br /> � OESCPIDE WORK AND S��E FOOTAGE INVOlVEO <br /> J��C�) ��t, <br /> - � PROPOSEOUSEOfBU1LDING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />�,y�- : APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECt ALL <br /> ' LEC�LffSCRIPTIGNOFPqGPERTV�SHOWNBELOWOf1AiT4CHFOURCOPIES� PROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTYPEOF <br />�� -� ( WOPK WILL BE COMPLETED WITH WHGTHER SPECIFIED HEREIN OR <br /> ti { �or eiocK or NOT. THE GRANTING OF A PEfiM1T DOES NOT PRESUME TO GIVE <br /> ...,_, �� AUTHORI"Y TO VIOLATE ON CANCEL THE PROVISIONS OF ANY <br /> � 4 OTHER ST�\TE OR LOCAL L1:i'HEGUUITING CONSTRUCTION OR THE <br /> , , ' — PERFORMANCE OF CONSTRUCTION.THAT I AM AUT40RIZED BY THE , 1i <br /> �, '� OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH �' <br /> �'' -' � APPLICATION IS MADE AND I COMPLY WITH THE STATE � '��� <br /> '�'� j CONTRACTORS LAW 1827 RCW AND 29R200 WAC. �� <br /> A o <br /> SIGNATUREOFCONTR�CTORORAUTMORIZED�OENT DATE I <br /> � � X �u� e� � Ig�� . <br /> :�: <br /> ; � <br /> rnaecreooaess • �. �`j <br /> I n �` �PPLiCANTSCITV8U51NESSLICENSENO.�NDB MlESSNAME� <br /> �� ` p��� MECHANICAL � <br /> ' NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE . <br /> � WATER CLOSET(TOILET) � A/C—NFINDLG UNIT�H.P. T— ' ;� <br /> � � � BATHTUB ; FORCED AIR SYSTEMS—B.T.U. M E.A. —~ � <br /> �'� � LAVATORY(WASH BASIN)� � UNIT 4EATERS—B.T.U. M � ' +,� <br /> �� SHOWER ' CLOTHESORYERS � 'I <br /> � KITCHEN SINK 6 DISP � VENTILATION FAN ; � <br /> . DISHWASHER � RANGE HOOD � <br /> � LAUNDRYTRAV i WATERHEATER ' <br /> CLOTHES WASHER � WOODSTOVE � <br /> URINAL ' METAL FIREPLACE S CHIMNEY � '1 <br /> DRINKING FOUNTAIN i FIREPLACE INSERT i <br /> FLOOR DRAIN � HEAT PUMP � <br /> BACKFLOW PREVENTERS ; GAS PIPING � <br /> ROOF DRAINS—RAINLEADERS � EXHAUST FAN � <br /> -.,— <br /> SINK(SERVICE—BAR,ETC.) ; ' <br /> � � <br /> 1 . <br /> � � <br /> i � <br /> i i <br /> SUB TOT�L $ ; SUB TOTAL S ' <br /> PERMIT $ � PERMIT $ i <br /> TOTAL FEE $ ' TOTAL FEE $ � <br /> FOR OFFICE USE ONLY: � <br /> fRONT SEIO�CN REAfl SETO�CN SIOE SETOACK PLAN CHECN NUM�ER FEE fiECEIPT NO. <br /> us[zot+e �ot nnen V�C�NT SIIE FEES VALUATION FEE <br /> � <br /> BUILDING � <br /> IYI'E Of LOt1I5.AILOWAAIE IYPE Of CONSI.AC7UAt occUP�ircr Hn p mvtwNfuNnS i <br /> �a�r pLUMBING i . <br /> --� <br /> S4EOFOLOC. NO.OFSTORIES B�SEMHNT MECHANICAL � <br /> i <br /> OCCUPANGVLO�D FIRESPRNNlERSREO'0 HEIGHTLIMITA710N �DDRIDNALPLANCHECK i <br /> i <br /> OTHFR ' <br /> i <br /> OGr1SON FOII SPOINKLEfiS <br /> STATE BUILDING SURCHARGE i <br /> IN1�NE BY PLANSRPPROVEDOY CITY OF EYERETT PUBLIC WORH$ � <br /> LOCALSALES � <br /> TAX CODE IS 31D5 ror�� �f 8 �� <br />