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APPLICATION FOR CONSTRUCTIdN PERMIY e�e�e" <br /> maEroigro4n TO BE COMPLETED IN INK—PLEASE PRINT � <br /> CITV OP <br /> everett �iEATINGSYSTEM: �GAS ❑ELECTRIC 0 <br /> BUILDING DEP�RTMENT <br /> 259-8810 <br /> i DEMOLITION �COMBINATION �BUILDING CIMECHANICAL ❑PLUMBING LI SIGN <br /> ,irrura MMLAOO�ESS cnv zr ruo+e <br /> � � _.1��+ �[Y���_n1�fJ�r� �-►���e�'1�c�. �r 9sz�� 2r2�r7.�-„��s� <br /> � � ti'� <br /> � nnc�mectonoesic�+�n unanoonr.ss cnv zm ruor+e <br /> � _ !�•ot1' n�rc,��n/n��Y /"l!�/nm�n�'.r��]r,�. G�i_��-�7n/ ��-/?44' GhG�E <br /> ccNennico��mncron ua�nooness crtv zir PNONE ULENSEr <br /> � � Y �/�1)'ki O cd.d t/U _ <br /> � M[CHn11IG�LCON1t1nC10R MRILADORESS ���Y ZiP PIIONF LICENSEI <br /> ��� � nr�� <br /> � PWMOINOGONIMGIOq MAII�D�i1C55 CIiV 21P PHONf: IICENSEi I <br /> �� l�'!1'�i I <br /> cuss oF wonK <br /> �NEW I.l ADDITION �l qLTERAT10N I. I REPAIR I 1 DEMOLITION ❑ WOODSTOVE/FRPL INSERT ❑ BUILDING RELOCATION �, <br /> �`—�,/�.� T � � Y' CONGGT PERSON ANO PIIONE��0. <br /> F'1 <br /> Q�� cor�i nncr r�e o�wonK ���7.(�f%.'� "z�'� ���N�� �, <br /> nEsavioe wonK nrro sounn[roomc[inVo�vEo j <br /> �y •�, .� . - nl%�!_f:�i�7 t . �;^02 �rn i S2-17-44 <br /> � vnoroseouseoFom�ortm 1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS � <br /> �„� APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL I <br /> �� LEGRL�ESCRIPTIONOP PqOPER7V(SIIOWNO[LOW ORRi1PCHFOUfiCOPIESi PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS NPE OF <br /> � WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> ior '7 o�ocrc �or NOT. THE GRANTING OF A PERMIT �OES NOT PRESUME TO GIVE II <br /> AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANV <br /> � _ I <br /> �� 1�1\/ � T� �� ���'�IO/�J �J--� ������.`'�I(J� O111ER STATE OR LOCAL LAW f1EGULATING CONSTRUCTION OR THE <br /> � - + . PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BV THE <br /> _�� AI �i`�C�E rJ Y�. h . �'� APPLICA�TION1SSRMADfl A DPE COMPLY WITOHKT ER STATE I�� <br /> CONTRACTOPS LAW 18.27 RCW AND 296.200 WAC. �///�/ <br /> SIGN�TURE iMGTORORAUTMORIZED�GENT U�TE <br /> / ' <br /> X � <br /> reaect nooeess <br /> 3t � APPIIG�FTSCIiY�USINESSLICEN5EN0.AN08 INESSNRME <br /> i�� �� PLUMBING MECNANICAL ��B <br /> I ��, NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF E�UIPMENT FEE <br /> � 2 WATER CLOSET(TOILET) Q ' — A/CrAIHNDLO UNITS—H.P. <br /> i � <br /> 1 I BATHTUB �;= FORCED AIR SYSTEMS—B.T.U.' M E.A. ' <br /> LAVATORY(WASHBASIN) � UNITHEATERS—B.T.U. M i <br /> ��� SHOWER �" CLOTHESDFY RS ' � <br /> �I KITCHEN SINK 8 DISP VEN71LA710N' AN � <br /> � DISHWASHER � � — RANGEHOO � <br /> i LAUNDRYTRAY � WATERHEATER <br /> CLOTHES WASHER " � � WOOD STOVE{� � <br /> I �� URINAL � METAL FIREP � CE 8 CHIMNEY � <br /> DRINKING FOUNTAIN i FIREPLACE INSCRT i <br /> FLOOR ORAIN � HEAT PUMP • �� <br /> � BACKFLOW PflEVENTERS � GAS PIPINO t ' � � <br /> �� ROOF DRAINS—RAINLEADERS � EXHAUST FA � � � <br /> SINK(SERVICE—BAR,ETC.) ; � <br /> � �� — .�-- f : ."_.,,/oee . _ 3 a� _ <br /> � � <br /> , � � <br /> �� , ' <br /> — , i' i � <br /> i SUB TOTAL S ; — 1 !6� SUB TOTAL $ 30 ' — <br /> PERMIT $ � , PERMIT $ � i <br /> ��'_( TOTAL FEE $ ' � ' TOTAI FEE g 3U ' " <br /> FOR OFFICE USE ONLY: I <br /> FBONTSETBACK RE�RSETORCK SIDESETBACK PUNCNECKNUMOER FEE �y/./.Z �ECEIPTNO. <br /> 2_��, z�,� � �i �7 �3�' X�3o �. ys' s-��o9 <br /> usezW�E� LO'TA�PEA` vncanistte ' FEES �q+� VALUATION FEE <br /> �—L � C�C..I�� �E� BUILDINO�G� S±t �� � rj .D7 yd G � / � <br /> ivPEOitONiS.ALL WABIE IYPEOFCON9.A�IURL occuwrtr NoaoMiuxOuxns C/feerr <br /> r � <br /> °W.�,° � PLUMOINO ��; s Q i �O <br /> S12EOFOlDG. NO.OF5101i1E5 B�SEMENi M[CHANIC�L yt ' � <br /> �i$5 SF �#- S� O '00 <br /> F p I J � <br /> S ADDITIONAL PLAN CHECk � <br /> OCCUPW1CYlORO FIOESP@INLERSREOU HEIGMiIIMIi�110N � <br /> Y. � <br /> NJ � O7HER . � <br /> ncn,or+ron srniektEns —�— <br /> STATLBUILDINGSURCHARGE �$ O <br /> i��inke uv PUNSAPPOOVEO DY CITY OF EVERETT PUBLIC WORKS � Q ;o u <br /> LOCALSALES , <br /> (.,,,✓ 9� g�Y TAX CODE iS 3105 rou� , �/p ; � $� <br /> — � <br />