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APPLICATItiN FOR CONSTRUCT ��N P'ERM�T � � <br /> everett <br /> �h�E�e.a��� e <br /> CITV OF <br /> everett <br /> BUILL'ING DEPARTMENT TO BE COMPLETED IN INK—PLEASE PRINT <br /> 259-6810 BUILDING MECHANICAL PLUMBING SIGN � <br /> DEMOLITION COMBINATION X <br /> � �iTY Zip PHOrvE <br /> � OK'NER MAILA�JRESS <br /> L-RA�G W•eo 30 (yIFLNe�.IR ���R6TT 98�-a� — <br /> TENANT IARiI AUDRE55 <br /> GiiV ZiP PMONE <br /> qRCHRECTOR0E51GNEP IAA�LA�DRESS <br /> CITY ZIP PNDNE <br /> y�~ MAIL ADGRESS <br /> CITV ZIP PMONE LICENSE� <br /> '�.T.C'�� GENEPALCONTRACTOP ___ <br /> [t��s� <br /> C�H QTY ZIP PHONE LiCENSE e <br /> NECHP.NIGPLCONTRP TOA MAiLAD�RESS <br /> Y H C/J PHONE UCENSE/ <br /> Q{.' ZIP <br /> H �� PWM8INGCONTRACtOR MAIL40�PESS <br /> y H <br /> � H� ClPSS OF WORN . <br /> � H� � _ NEy�/ �_-. ADDITION -�. ALTERATION - FEPAIR DEMOLITION X WOODSTOVE/FRPL INSERT , : BUILDING RELOCATION <br /> y y� CONiACT PERSON PND PHONE N0. <br /> T[NANT IMPFOVf.IAENS OR INTERIOF REiA00EL O!!LV �yFl.`` �O�O rf C�� G bg.s <br /> w� ✓�"J J <br /> p '��'� CONTR4CT PPICE OF WORK: <br /> l•J 4 �1� <br /> y OES�FiBEWORKANO50UPREFOOTAGEINVOIVED n <br /> � �g -�+��T,�-�--��_ -- .. <br /> H CTJ aaoaose�a����'ti� I HEREBV CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> �� n � _/2 APPLICATION AND KNOW THE SAtdE TO BE TRUE AND CORRECL ALL <br /> �� PROVISIONS OF LAWS ANO ORDINANCES GOVERNING THIS TYPE OF <br /> � y� t[c;n�oESceianoriorPaoaea*vlSNow�ueetow0anrrncNFouacuo'.esi yyORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> or NOT. THE GRANTING OF A PERMIT DOES NOi PFESUME TO GIVE <br /> H Z 1OT B��N AUTHORITV TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> gy OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> n d y PERFG3MANCE OF CONSTRUCTION.THAT I AM AUTHORIZED 8V THE <br /> 'C..�" C� OWNER OF THIS PROPERTV TO PERFORM TIIE WORK FOR WHICH <br /> � «� APPLICATION IS MADE AN� � COMPLY WITH THE STATE <br /> i <br /> y p y CONTPACTORS IA�N 1827 RCW AN�296.200 <br /> S:utlAtpREOFGONiRACTOqORAUTHOBIZEDAGENi �ATE <br /> PJ� X `�h �,.�'�t�— <br /> '�o (rA6Na�.i�A ��,�a�r� <br /> � raaecraooaess nvrucnr+r��. -- ��""�"F'"�'""'"� � <br /> PL'JAIB�NG MECHANICAL <br /> �_ ryp, � TYPE OF FIXTURE OR ITEh1 FEE NO. TYPE OF EOUIPMENT <br /> FEE <br /> I � WATER CLOSET(TOILET) __ A'C—lvHNDLG UNITS—H.P. <br /> +�.� FORCL"D AIR SYSTEMS—B.T.U. M E.A. . <br /> BATHTUB _ — I <br /> LAVATORY(WASH BASIN� _ UNIT HEATERS—B.T.U. M <br /> CLOTHES ORYERS � <br /> ;'°�� SHOWER ' <br /> ! KITCNEN SWn 8 DISP VENTILATION FAN �— <br /> RANGEHOOD <br /> DISHWASHER _ <br /> LAUNDRY TRAV ; WATER HEATER � <br /> ---� WOODSfOVE ' <br /> ' �i _ CLOTHES WASHER <br /> METAL FIF[PLACE 8 CHIMNEY <br /> URINAL <br /> FIREPLACEINSERT <br /> DRINKING FOUIJTAIN HEAT PUMP <br /> FLOOR DRAIN GAS PIPING -- <br /> ` ��. BACHFLOW PREVENTERS .-- <br /> ROOF DRAINS—RAINLEADERS EXHAUST FAN <br /> '� r SINK(SERVICE—BAR.ETC.) <br /> +r.! <br /> � <br /> �..�I I SUBTOTAL $ _ SUBTOTA! S _,3�_r� <br /> PERMIT 5 __ PERMIT 5 � <br /> — TOT�L FEE 5 TOTAL FEE 5 3 rl �� <br /> �� FRONTSETBACN REARSETBACK SipESETpAGN <br /> VtANC11ECNNOMOER FEE RECEIPTNO <br /> USF./ONE <br /> �or anen VACNNT SITE FEES _ VALUATION FEE <br /> ' 1 YES I-� NO BUILDING - <br /> accure¢v eoormnu�x:.unns — — <br /> 1vPE0FLON5t.All4JlROLE LYPEOfCOYSL.ACiOAt �„p�p pLUldBING <br /> SSEOFO�DG. NO.OFSTOhIES �AS[MENT MECHANICAL „J � �J <br /> '. '. YES ' 1 NO I <br /> OCCUPANGY LORD FIRE SPfiNHLERS R[OD NEIGHT�IMITATION <br /> /�THEH — <br /> , �� YES �. , NO STATEBWLDINGSUR:HARGE <br /> nEASON ioR SaRieKLEas S1ATE ENERGV SURCHARGE ' <br /> pPPUCATIONALC.BV PIRNAPPPAOV[DOY CITYOFEVERETT PUBUCWOR!(S ' <br /> LOCAL SRlES jp� <br /> TAX COUEIS 3105 T�TA� <br /> � <br />