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APPLICATI� FOR CONSTRUC7�.�'N PERMIT Ve'e1 <br /> TO BE COMPLETED IN INK—PLEASE PRINT � <br /> the Eve/grcen <br /> CITY OF <br /> �everett [ HEATING SYSTEM: �GAS ❑ELECTRIC ❑ _� <br /> BUILDING DEPARTMENT <br /> 259-8810 <br /> DEMOLITION COMBINATION BUILDING �(MECHANICAL PLUMBING SIGN <br /> OWNER MAILAOD 55 QTV ZIP /'J PMONE <br /> � ; � i� �/(^. ✓f `/���`� �3��-iG'-='n <br /> f���f:� d/lsc ��.��,� � l <br /> TENANT MAILAODRESS CIiY ZIP PHONE <br /> rno� srce� �ao E�r nww u�m ��r[ 4aw4 <br /> ARCMRECtORDE5IGNER MAILAOpRE55 GTY ZIP PHONE <br /> G[N[RALCONTRAGTOR MAILAUDRESS GITV 21? PWONt LICENSEd <br /> • <br /> Id CHF CAL WNTPFCTOR MNILAODRESS CITV 21P �'MONE LICENSE k <br /> pAoa`�wAa.� gL1ob-'19�3 �l07-799,5 Md[.ibY15l4Zt'I►� <br /> �i��sa� baR.vsc� "!10'1 DE�¢a'c s w Sra, <br /> PWMBINGCONTRAGTOR MAILADOflE55 CITY ZIP PHONE LICENSER <br /> CLASS OF WORK �/ ' <br /> �. . NEW '�.� �. ADDITION yv�LTERATION �. . REPAIR �. � DEMOL7TION . - WOODSTOVE/FRPL INSERT _. BUILDWG RELOCATION <br /> CONTACT PEPSUN AND PMONE NC. -y <br /> CONiHACIPflIGCOFWORK�2 ��t� �C�� �w,��� _ 1��`���� -- <br /> OESCRIBE'NORKANOSOUAREFOOTFGEINVOLVEO �{JSZb'� VQ'� O�FF� <br /> 8l7-tc.'t� ��W�'rT DI�PS 3f�o0� <br /> PROPOSEDUSEOFpUILDING I HEREBY CERTIFY THAT I H�VE READ AND EXAMINED THIS <br /> v r-r-«c SI�At�- APPLICA"iION ANP KNOW THE SAME TO BE TRUE AND CCRRECT.ALL <br /> LEGALOESCFIPTIONOPPFOPERTYISHOWNBELOWORATTACHFOUFLOPIES) PROVISIONSOFLAWSANDOFC:.JANCESGOVERNINGTHISTYPEOF <br /> WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> �or BLOCK oF NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AUTHORITY -f0 VIOLATE OR CANCEL l"HE PROVISIONS OF ANY <br /> O-fHER STATE OR LOCAL LP.W AEGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRi:CT10N.THAT I AA4 AUTHORIZED BY THE <br /> OWNER OF TliIS P^nOFERTY TO PERFORM THG WORK FOR WHICH <br /> _ APPLICAT` '�' IS MADE AND I COMPLY WITH THE STATE <br /> ' GONTRACTURS LAW 1827 RCW AND 296200 WAC. <br /> — — SIGNATOREOFCONiRACT R�RIZEDAGENT DATE <br /> X �.��� 9� <br /> PROJECTA��RE55 <br /> �a`O �� G� ��' pPP I NTS CI7Y BUSINESS LICENSE N .AND�USIGE55 NAME n MI� 1 H�, � <br /> PLUMBING w MECHANICAL <br /> NO. SYPE OF FIXTURE GR ITEM FEE ' NO. TYPF OF E�UIPMENT FEE <br /> WATER CLOSET(TOILET) A/C—FUHNDLG UNITS—H.P. <br /> BATHTUB 'i FOFCED AIR S`.'STEMS-9.T.U. M E.A. <br /> LAVATORY(WASH BASIN) UNIT HEATERS—B.T.U. M <br /> SHOWER CLOTHESDRYERS _ <br /> KITCHEN SINK 8 DISP VENTILATION FAN �_ <br /> DISHWASHER RANGG HOOD ' <br /> LAUNDRY TRAY ' NlATER HEATER <br /> CLOTHES WASHER WOOD ST9VE _ <br /> URINAL METAL FIREPLACE&CHIMNEY <br /> DRINKING FOUNTAIN i FIREPLACE INSERT � <br /> FLOOR DRAIN HEAT PUMP ' <br /> BACKFLOW PREVENTERS GAS PIPING <br /> ROOF DRAINS—RAINIEADERS EXHAUST FAN ' <br /> SINK(SERVICE—BAR,ETC.) i � ct n�.�� <br /> __ � �} ..t—.=�`r�.__- — <br /> SUBTOTAL $ � SUBTOTAL $ Ji7 ' <br /> PERMIT 5 PERMIT $ /S ��_ <br /> TOTAL.FEE $ ' TOTAL FEE 5 �S ' ' <br /> FOR OFFICE USE ONLY: <br /> nEceiaT ruo. <br /> FRONf56113ACR f1EFHSETBACH SIOESETOhCY. Pl4I1GHFCkNUA�f�FR FEE <br /> �1��l� <br /> usezoNe ioraaen vncnrutsiTe FEES VALUATION FEE <br /> BUILDING <br /> IYPE�FC01.i5.ALLOWABI£ iVPEOFCONSTPCiUAL occucnHa xaovDnEu.r.Gu'ins — <br /> enouv PLUMBiNG <br /> SIZE OF BLDG. NO.OF STORIES BFSEMENT MEGHANICAL � <br /> i <br /> OCCUPANCV LDAO FIRF SPRNKIF.RS RE0'0 HEIGHiIRAITPTION ADDITIONAL PLAN CHLCIC — � <br /> __"_"_ � <br /> — 1 <br /> OTHER � <br /> ---f— <br /> RFASON FOR SPRMKLEFS ' <br /> STATE BUILDING SURCHARGE � <br /> INTAKEDY PLA S�PPROVEDBY CITYOfEVERETT PUBLICWOflKS � <br /> }�_ LOCAL SALES <br /> �r� �-S`{ TAX CO�E IS 3105 TOTAL <br /> �`u <br />