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APPLICATI�.�N FOR CONSTRUCI oON PERIVIIT <br /> everett <br /> Ne E�ergiecn <br /> ��rv oF e <br /> everett <br /> BUILDING DEPARTMENT <br /> 259-8810 TO BE COMPLETED IN INK—PLEASE PRINT <br /> [ ' DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING !7 SIGN <br /> Ol'1N MFIL POORESS CITY ZIP PNONE <br /> �o� oC ��L,�tse�L I�Z9 ��v7� 3 3S- i/SCo <br /> TENANT MAILAODRESSI CITY ZIP PHONE <br /> ARCHITECi0R0E51GNER MqILAU�fiESS CITV ZIP PHONE <br /> GFNERALWNTRACTOR MAILRODRESS CITV ZIP PHONE LICENSEa <br /> IAECypyICALC�ON�TR/A�CTO�R MAILADDRE55 GTV ZIP PMONE LICENSEA <br /> l I�/L�/�—"i� <br /> PLUMpINGLONTR�GTOR MqILp�UFE55 CITV 21P PHONE LICENSE/ <br /> CLASS OF WORK <br /> ❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL INSERT ❑ BUILDING RELOCATION <br /> TENANT IMPROVEMENT OR INiER10P REMOOEL ONLV GONTFCT PEFSON AND PHONE N0. <br /> CJNTRFCT PRILE OF WORN: <br /> DESLRIBE WORK ANO SOURRE F�YJTRGE INVOWED <br /> PROPOSEDl15EOF8UILDING I HEREBY CERTIFV THAT I HAVE READ AND EXAMINED THIS <br /> APPLICATION AND KNOW THE SAIdE TC 3E TRUE AND CORRECT.ALL <br /> LEGAI.�ESCRIPTIONOFPROPERTV�SHOWNBELGWORATTACNFOIIHCOPIES� PFOVISIONSOFLAWSANDORDIN.4NCESGOVERNINGTHISTYPEOF <br /> WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> �or BLOCK oF NOT. THE GRANTWG OF A PERM;T DOES NOT PRESUME TO GIVE <br /> AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> — PERFORMANCE GF CONSTRUCTION.THAT I AM AUTHORIZED BY TFIE <br /> OWNER OF THIS PROPERTV TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THF ST,^.TE <br /> CO�LFft7R_%T1F L1V!10.2i RCW ANU 6200 WAC. <br /> 5 NATUREOFCON ACT � ORAUTHOFIZE AGE i DFTE <br /> X <br /> PROJECTA�DRE55 � <br /> � � � APPUCANTS BlISI -SS LICE E NO �ND BUSINES AME <br /> PLUMBING MECH AL <br /> NO. TYPE OF FIXTUHE OR ITEM FEE N0. TYPE OF EOUIPMENT FEE <br /> INATEfl CLOSET(TOILET) 4 , - _ .4/C—NHNDLG UNITS—H.P. <br /> BATHTUB ; FORCED AIR SYSTEMS—B.T.U. M E.A. � <br /> LAVATORY(WASH BASIN) � UNIT HEATERS—B.T.U. M � <br /> SHOWER s ; CLOTHES DRYERS (p!,j(}' <br /> KITCHEN SINK 8 DISP i VENTILATION FAN 1 S(J�_ <br /> / DISHWASHER � RANGE HOOD (0 5� <br /> LAUNDAYTRAY � WATEH HE�TER ' <br /> � CLOTHES WASHER � WOOD STOVE <br /> URINAL ' METAL FIREPLACE 8 CHIMPiEY <br /> DRItF/ING FOUNTAIN i FIREPLACE INSERT <br /> FLOOR DRAIN � HEAT PUMP � <br /> �ACK�LOW PREVENTERS ; GAS PIPING <br /> ROOF DRAINS—RAINLEADERS � EXHAUST FAN T— <br /> SINK(SERVICE—BAR,ETC.) ; <br /> — � <br /> � <br /> � <br /> — �— <br /> SUB TOT�L $ '�_ SUB TOTAL 5 ' � <br /> PERMIT $ � PERMIT 5 <br /> TOTALFEE $ �; ) TOTALFEE 5 <br /> FfiONTS`_TBRCN RERRSETOACK SipESETBAGH PLANCN[CNNNA�ER FEE RECEIPTNU. <br /> USEZONE LOTAREA vncn�irsire FEES VALUATION FEE <br /> ❑ YES ❑ NO BUILOING � <br /> tYPEOFCONSi.AIIOWABLE iYPEO'C0�15TACiUAL octUveH:x x00rmv[uix;win5 <br /> GNouP <br /> PLUMBING � <br /> SIZ[OFBLDG. IIO.OFSTOHIES BASEMENT MECHANICAL <br /> ❑ YES o No — 3a5d <br /> OCCUPANLV LOAO FIqE SPRNKLERS REO'0 HEIGHT LIMITATION OTHER i <br /> ❑ YES ❑ NO S7A7E�UILUINQ SUFiCHARGE ' <br /> ��[�SON FOR SPRINNLEIiS — — -—� <br /> STATE tNtHlSV S�IiCHARGE i <br /> hPPLICRTIONALG.PY PIANSRPPROVEDBY CITYOFEVERETT PUBIICWORKS � <br /> LOCAL SALES --� <br /> TAX CODE IS 3105 rorn� �'.'Sf� <br />