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;"� r�`; <br /> APPLICATItrN FOR CONSTRUCT�ON PERMIT <br /> fho Evnqrmn everett <br /> CITV OF � <br /> �v��rett <br /> BUILDING DEPARTMENT <br /> �p a_gg1p TO BE COMPLETED IN INK—PLEASE PRINT <br /> MOLITION ❑ COMBINATION I I BUILDING I I MECHANICAL I I PLUMBING I J SIGN <br /> NEII MHILADOfiE55 CI7Y ZIP PHONE <br /> /�Yitrzuc.� L NSTX�fT�N 37//-�ZZNO PL SE Cvc.�irciT �bzoPi 537-907 � <br /> TENANi MpILADDRESS CITY IIP PHONE <br /> A:iCHItECiGR0E51AGNER MAILA�DRESS CITY ZIP PHONE <br /> /7odc-`irr LFfa�+7prani JbUz Cocsy GvL'*��`�T 9L'L��i ZS�7 - 3[S6 <br /> GENEPA�CONTRALTOR MAILAUDAE55 CIiV ZIP PHONE LICENSE� <br /> �/�-rrrza.� �urs/7z��rcz.� j7//-/Zi^'� �� Sc� Ei�iZEiT 9bu�Y� 337-9u75 SlL�Y6$czlW <br /> MECNANICALCONifiAGTOR MAILAOOR@55 CIiV �IP /r <br /> PNONE LICENSEI <br /> PWMOINaCONIR�C7017 M�IL�DUIIf::S CIIY )11` I'IIONf: _—�ICPN.^.@� <br /> CLASS OF WORN <br /> L7 NEW ❑ ADDITION ❑ AITERATION U REPAIR EMOLITION C] WOODSTOVE/FRPL INSERT ❑ BUILDING RELOCATION ! <br /> IENANTIMPf?OVEMEN70flINiEN10RREMOOELONIY � CONTACTPEPSONANDPHONENO. . I <br /> CONTRACT PRIGE OF WORK: i <br /> UESCRIOEWORKANOSOUAREFOOTAGEINVOLVEU -- i <br /> /7d�rovE N s'�r,...�- 1FR-Cri c� � <br /> PROPOSEDUSEOFBUILOING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS ' <br /> S v�vtT APPLICAT�ON AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL ' <br /> LEGAL DESCRIPT�ONOF PROPERTY�SHUWN 9ELOW OR A1T4CII FOl1R COPIES) PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF j <br /> ior S{� 6 e�ocK _ 3,y oF Swqtw Ec.-�S Z N� WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE I <br /> AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> �'A�rrSUN 77> EvE��G�� W/� µc��„rDrNo OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OH THE <br /> PEqFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> f/� p[R-T TiSt'i�Evf /Zrt•'aDt r... (/v� 3 OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH I <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. , <br /> � � � r5 Pd- ECOi1p$ O� r/}�� SIGN-��lJ OFCONT{iACiORDOAUT PREDAGENT DATE � <br /> /�-vcrro.z oF TiYL` /UuNTY uF SNoiron+�if � <br /> PRQIECT ADOFiE55 /� <br /> Z7�O �YE�SE/T /-�YL.� ���LIC�NISCIIY 51 ESSLICEN O. SN�ME � <br /> P UMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE I <br /> WATER CLOSET(TOILET) � A/C-MHNDLG UNITS-H.P. , i <br /> BATHTUB ; FORCED AIF SYSTEMS-B.T.U. M E.A. � <br /> LAVATORY(WASH BASIN) � UNIT HEATERS-B.T.U. A1 ; <br /> SHOWER � CLOTHES DRYERS � <br /> KITCHEN SINK 8 DISP ; VENTILATION FAN � <br /> � <br /> DISHWASHER � RANGE HOOD —�- <br /> - LAUNDRYTRAY ; WATERHEATER �— <br /> CLOTHES WASHER � WOODSTOVE ; I <br /> URINAL ' METAL FIREP CE&CHIMNEY —�— <br /> DRINKING FOUNTAIN � FIREPLACE INSERT ' <br /> FLOOR DRAIN � HEAT PUMP —�— <br /> � BACKFIOW PREVENTERS ; GAS PIPING � <br /> � ROOF DRAINS-RAINLEADERS � EXHAUST FAN , <br /> SINK(SEFVICE-BAR,ETC.) ; � <br /> --�—— , <br /> � , <br /> — — ' — --�— <br /> i � <br /> — � — � I <br /> � <br /> � � � <br /> SUBTOTAL $ ✓ ; SUBTOTAL $ � I <br /> PERMIT $ i PERh11T $ � � <br /> TOTAL FEE $ ' TOTAL FEE E � <br /> PRONTSETBACK REARSETBACN SIDES@TOACK PLANCHECKNUMOLR FEE REGEIPTNO. <br /> USEZONE �oTnnen vncnNrsir[ FEES VALUATION FEE <br /> I.1 YES C I NO p�ILDING ; <br /> fYPEOFWNSI.AILOWAOL[ IY1KOfLONSi.ACIU�I �.'��rlxcr anppxnpNfUNnS � <br /> f.OWI' I <br /> PLUMUING � <br /> i <br /> SI.EOFULD(3. NO.OPSTORIES U�SEMEN7 MECNqNICAL i <br /> I_7 YES ❑ NO — � i <br /> OCGUPANCYLOAD FIRESPPNKLERSOEO'� HEIGHTLIMI1A710N OTHER � <br /> f_l YES 1-.1 NO � � <br /> STA�E BUILDING SURCHpqGB � y i S� I <br /> RUSON I�CF SPAINRLERS <br /> r i <br /> � STAiEENEAGY5URC11AliGE � I <br /> APPUCATION ACC.DV PUNS APPqOVED OY � <br /> CI7Y OF EVERETT PUBLIC WORI<5 � i <br /> LOCAL SALES '— <br /> TAX CODE IS 3105 TO7AL 'y�l i <br />