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APPLICATIO�d FOR CONSTRUCTI�iN PERMIT ; <br /> everett . � <br /> fhe Ewryreen � <br /> CI7V OF <br /> everett <br /> BUILDING DEPARTMENT TO BE COMPLETED IN INK—PLEASE PRINT <br /> 259-8810 <br /> ❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑MECHANICAL ❑PLUMBING ❑ SIGN <br /> qyNQp �AAILAU�RE55 GITY ZIP PMONE <br /> '�' ' � Alles"�ac� 198�t�Ca�pulUoo��No �iea 1,, �I�133 54/-GiG C <br /> ��µi MAILPODRE55 CITY ZIP PHONE <br /> ARCHITECiORDESK3NE MAILADOPE55 GITY ZIP PHONE � <br /> �or�e�F �IIP�Q/� 5av�,� 5y6-���G i <br /> QENEPALCONTMCTOR fM�L�ODRE55 CI7Y 21P PHONE LICENSEt <br /> ^ CIiY ZIP PHONE `_ LILENSE� � <br /> MECNANICALCONTMCTOF MAILADDRESS <br /> PLUMBIN�CONTRACTOfl MAILADDRESS CITV 21P PHONE LIGENSE• <br /> CLASB OF WOPK <br /> �NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ OEMOLITION ❑ WOODSTOVE/FRPL INSERT O BUILDING RELOCATION <br /> TENANTIMPPOVEMENTOflIMEPIONREMO�ELONLY CONT�AOiP�E�`S�NµAIIN�S IA�/ YG^� '� G _ ' <br /> GONTMCI'FRICE OF WORK: � �� <br /> DEBCN�BE WORK AND SWARE FOOTAOE INVOWED C � <br /> � <br /> � JoN q a� � - ' <br /> PpOPO9EDUSEOFeUIL�INO I HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS ; <br /> r"l� APPLICATION AND KNOW THE SAME TO BE TAUE AND CORRECT.ALL � <br /> IEMLDEBCRIPTIONOFPROPERTV(SMOWNBELOWORA7TACHFOURCOPIES) PROVISIONSOFLAWSANDOADINANCESGOVERNINGTHISTYPEOF � <br /> WORK WILL BE COMPLETED WITH WHETHER SPECIFIEC HEREIN OR . <br /> �pT �7 e�ocK oF NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE ' <br /> AUTHORITY TO VIOLATE OR CANCEI THE PROVISIONS OF ANY ; <br /> wl°� S� aL �� A� J 0� � lle 0 OTHER STATE OR LOCAL U1W REGULATING COKSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE t <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> CO u APPLICATION IS MAOE AND I COMPLY WITH THE STATE � <br /> �—� CONTRACTORS LAW 18.27 RCW AND 296200 WAC. � <br /> O I I�� SIGNATUREOFCONiRACTOflORAUTMOflREDAGENT DATE <br /> 3-/'� ' <br /> �,� r,Efaa� aQc.i�a4�/� mav�r.� I <br /> PpO.IECTMUFE&S <br /> ��' / � � nAn^,�//Q , APPUCPNTSCITY SINESSLI�ENSENO.ANDBUSINESSNMIE <br /> ti ��'� - <br /> PLUMBIN� MECMANICAL ' <br /> N0. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EDUIPMENT FEE <br /> WATER CLOSET(TOILET) � A/C—lUHNDLG UNITS—H.P. � ; <br /> BATHTUB ; FORCED AIR SYSTEMS—B.T.U. M E.A. ' � <br /> LAVATORY(WASHBASIN) . I'. � UNITHEATERS—B.T.U. M � I <br /> � �' SHOWER ' CLOTHES DRYERS ' � <br /> KITCHEN SINK 8 DISP i VENTILATION FAN i f <br /> DISHWASHEfl � RANGE HOOD ' <br /> LAUNDRYTRAY ; / WATER HEATER ' <br /> � <br /> CLOTHES WASHER � W000 STOVE � <br /> URINAL ' METAL FIREPLACE 8 CHIMNEY ' <br /> DRINKING FOUNTAIN i FIREPLACE INSERT � <br /> � HEATPUMP ' <br /> FLOOR DRAIN � <br /> BACKFL7W PREVENTERS ; GAS PIPING , <br /> ROOF DRAINS—RAINLEADERS � EXHAUST FAN ' � <br /> ' SINK(SERVICE—BAR,ETC.) � � � <br /> � <br /> � � <br /> i � ' � <br /> � ' <br /> , ' i <br /> SU8 TOTAL $ ' SUB TOTAL $ ' � <br /> PERMIT $ � PERMIT $ � <br /> TOTAL FEE $ ' TOTAL FEE $ ' � <br /> FHONTSETBAC� RFARSET�CI� SI�ESETBACI� PUNCNECNNt1MBER33 PEE � � RECEIP�. f <br /> J S I <br /> use2Q114— LOTAREA VACANTSITE FEES VALUATION FEE � <br /> �� �' � YES ❑ NO BUILDiNG $7q 3 � ,J ' � <br /> � : <br /> 1YPEOFCDNSLALLOWGBLE ttP OfCON57.ACNAL �o�Y NO.INOw[lliMGuxrt6 i <br /> GRWP p�UM81NG � �� <br /> [ <br /> � � � � lii <br /> gQ�ppg�pp. NO.OFSTORIES BASEMENT MECHANICAL {, <br /> 1'f05 3f J�'G Z ❑ YES � N� p � t <br /> OCCUPANC LO�D FIflESPflNRLEflSREO'D HEIOHTLIMITITION OTHER Q � i <br /> ❑ YES �J NO STATEBUILDINGSURCHARGE ' � � <br /> qEA60N HSPRINKLEflS �� <br /> STATEENERGYSURCHARGE � <br /> _ i <br /> APPLICATIONACC.BY PLANSAP�VEDBV CITYOFEVERETT PUL�LICWORHS � <br /> // LOCALSALES 7U ,� <br /> 7 TAl(COOE IS 3105 TOTAL <br /> �' <br /> i: <br /> .v. . �.... � w.....r.�-w-�' .��.�..�wp. t'..�.-.... ... ..._�.�. l:. ^lA. <br /> �� � <br /> .�^ <br /> . : .� . � .. ,�� .. �- <br /> ,W .1�. ':n.. <br />