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: ! APP�ICATI�i��i+il F�F; CONSTRU'CT�iON PE�MIT <br /> ; .' <br /> everett <br /> � 1he Eveigieen � � <br /> CITY OF <br /> � everett � <br /> i BUILDING DEPARTMENT <br /> i 259•8810 TO B�c COMPLETED�N INK—PLEASE PRINT <br /> I ❑ DEMOLITIUV ❑ COMBINATION ❑ BUILDING C7 MECHANlCAL ❑PLUtd81NG � SIGN <br /> I pWNER MAILADOflE55 GTV 21P PNONE <br /> � � � F O/:-+n- . 2?O�l^ �i��-/.ecf��✓t"�ii-ls-e�i-u4 �3 3�� �16�J' <br /> � ENANT MOILADDRE55 CITV ZIP PHONE <br /> � �AflCNITECTOF0E51GNEB MAILADDRE55 CIN 21P PHONE � <br /> + ,�t�n��oN /37 � <br /> �ia a �e �/i e� . �•� /Srin �>.�i�.i,'li �'S.�4n �S..z_ �lf'9� .�z�.c'�,. .r.�in� <br /> CENEBALCONTRACTOfl MAIL UflE 5 CITV ZIP PHOHE UC[NSEN <br /> MECHMlICALCONTMCTOR MAILA��RESS CITV ZIP PHONF. LICENSE� <br /> I PLUMBINQLONTflACTOR MAILADDR[SS CITY 21P PI!ONE LICENSEi <br /> i <br /> ' CLASSOFWOqK <br /> ' i ❑ NEW ❑ ADDITION ❑ ALTERATION REPAIR � DEMOLITION ❑ WOODSTOVE/FRPL INSERT C BUILDING RELOCATION <br /> TENAMIMPROVEMENTORMTERIOFREMODELONV ,i. WNTACTPERSONANDPHO'JENO. <br /> ; .COMflACTPi11GEOFWOHK: � SLDm <br /> DESCflIBEWORKANDLOUAFEFOOTAGEINV EP <br /> I <br /> ; rAoroseouseoFeuaoiNc 1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> � ���T (d APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> � LEO�LDES�RIPTIOIJOFPHOPEflT1'�SHOWNBELOWORATfACHFOURCOPIES) PROVISIONSOF!AWSANDORDINANCESGOVERNINGTHISTYPEOF <br /> i WORti WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> �oi BLOCK oF __ NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> � AUTHORITY TO VIOLATE OR CANCEL THE PFOVISIONS OF ANY <br /> 1 -{�, .n ��91- �193-031 -a rn8� OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> 1 �— PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> I p� OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> �=1��J��, � r i iYCfC�� � 9'3 APPL!CATION IS MADE AND I COMPLY WITH THE STATE <br /> /� CONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br /> � �rrl_� ll F✓P�n'�'� SIGNATUREOFCONTRACTORONAUTHORIZEDAGENT DATE <br /> ��.�1 T` �r ! <br /> �PflQ1ECTA0DRE55 A � ���� `�—�v��U <br /> . � APPLICM7TSC BUSINEoSLL^ENSENO.ANDBUSINESSNAME <br /> � PLUM8ING MECHANICAL <br /> NO. TYPE OF FIXTURE OR�TEM FEE N0. TYPE OF E�UIPMENT FEE <br /> � WATER CLOSET(TOILET) � A/C—A/HNDLG UIJITS--H.P. � <br /> � BATHTUB ; � FORCEU AIR SYSTEMS—B.T.U. M E.A. � <br /> ' LAVATORY(WASH BASIN) i UNIT HEATERS—B.T.U. M i <br /> - SHOWER ' CLOTHES DRYERS � <br /> KITCHEN SINK 8 DISP � VENTILATION FAN ; <br /> DISHWASHER � RANGE HOOD � <br /> LAUNDRYTRAY ; WATER HEATER ' <br /> CLUTHES WASHER � WOOD STOVE � <br /> � URINAL ' METAL FIREPD�CE 8 CHIMNEY � <br /> � DflINKING FOUNTAIN i FIREPLACE INSERT i <br /> FLOOR DRAIN � HEAT PUMP � <br /> I � BACKFLOW PREVENI'EHS i GAS PIPING ; <br /> - ROOF DRAINS—RAINLEADERS � cXHAUST FAN � <br /> � SINK(SEHVi;.'E—BAR,ETC.) ; ' <br /> � <br /> � <br /> i <br /> � <br /> SUB TOTAL $ ; 5UB TOTAI $ ' <br /> • PERMIT $ � PERMIT $ i <br /> TOTAL FEE $ ' TOTAL FEE $ ' <br /> FRONTSETBACN REAflSETOACK SIDESETBACK PLANCHECKNUMBER FEE RECEIPTNO. <br /> USEZONE LOTAREA VACN1TSItE FEES VALUA'fION FEE <br /> ❑ YES 0 BUILDING . � <br /> TYPEOFLONSLRLLOWnBLE TYPEOiCON57.AC1URL actiPu+cY No.mmv[luNcuxirs � <br /> , _�' cpWP pLUM81NG � <br /> T <br /> SIZEOFBLO(3. NO.OFSTOPIES BpSEMENT MECHANICAL � <br /> � � ' 7A Z. ❑ YES O � <br /> OCGUPANCYLOAD FIRESPRNNIEP.SREO'D MEIGHTLIMITATIO OTHEH � <br /> � ' <br /> i ❑ YES L. STATE BUILDING SUfiCHARGC- � <br /> REASON FOP SPRINHLERS --� <br /> ; STATEENEflGYSURCHARGE i <br /> � <br /> �PPLICATIONACC.OY P.ANSAPPROVEDBY CITYOFEVERETT PUBLICWOPKS � <br /> LOCAL SALES <br /> ��.�-� TAX COOEIS 3105 TOTAL � <br />