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APPLICATIOei FOR COWSTRUC`Irl'JN PERMIT everett <br /> tne Eveigreen TO BE COMPLETED IN INK—PLEASE PRINT � <br /> cm oF <br /> everett HEATING SYSTEM: ❑GAS ❑ELECTaIC ❑ I <br /> BUILDING DEPARTMENT <br /> 259-8810 <br /> � I DEMOUTION O COMBINATION i I BUILDING • ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br /> E- M�IL DORE55 � C TY 21P � PHONE <br /> i� o Cl�—.. �P �, I ; � . � ,� C'�- ' DS <br /> iENANi AIL RE55 CRY PHONE <br /> ARCMIiELTCADESIGNER M41LAO�PE55 CITY 21P PNONE <br /> Gfu[R�LCONTf1�GTOP MMLPOOfiE55 CIiV 21P CNO�yE LILENSE/ <br /> MEC�LC�p1lTNRC(OH MAI�A�ORE55 QTY ZIP PNONE IICENSE/ <br /> PWI!ORlGCONiRACiOR MAILAODfiE55 GTV ZIP PHONc LICENSEt <br /> CIASS OF WORN <br /> ' I NEW U ADDITION ❑ ALTERATION I_l REPAIR ❑ DEMOLITION .� WOODSTOVEIFRPL INSERT ❑ BUILDING RELOCATION <br /> CONTACT PEFlSON AND PHONE tlO. <br /> CONTfi4CT PflICE OF WORK ' <br /> DESCNIBE WORK ANO SOUnPE FOOTAGE WVq.VED <br /> PnOPO5EDU5EOKBWL0ING I HEREBV CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> LEGRLDESCRIPiIONGF PROPERTY�SMOWNBELOW ORATTAGHFOUR COPiES� PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OF <br /> ior e�ocrc oF NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> � AUTHORITY TO VIOI.ATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OA LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTV TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 1827 RCW AND 296.200 WAC. <br /> SIGNATUREOFCONTRO.CIOROPAUTNGRI2E�AGENT �ATE <br /> Pf10.1EG�A0pfiL5 / � ����U� O �� <br /> / � ni 'r`� Ol �A3JIT APPUCANTSCITVBUSINE55 E ENO.ANOBUSMESS( <br /> l' UF� /V��TJ <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) A/�A/HNDLG UNITS—H.P. � <br /> BATHTUB ' FORCED A�R 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 /> LAUNDRY TRAY � WATER HEATER ' <br /> CLOTHES WASHER --� WOODSTGVE � <br /> URINAL ' METAL FIFEPLIICE S CHIMNEY ' <br /> DRINK.ING FOUNTAIN i FIREPLACE INSERT i <br /> —�— <br /> FLOOR DRAIN � HEAT PUMP _ ! <br /> BACKFLOW PREVEPITERS ; GAS PIPING T_ <br /> —�— EXHAUSTFAN <br /> ROOF DRAINS—RAiD:IEAUERS ' ----�— <br /> SINK(SERViCE—BAF,ETC.) � ' <br /> ._ � <br /> � <br /> —�— <br /> � � <br /> � � <br /> � � <br /> — � � <br /> SUB TOT�L $ ; SUB TOTAL $ <br /> PERMIT $ � PERMIT $ i <br /> TOTAL FEE $ TOTAL FEE $ � <br /> FOR OFFICE USE ONLY: <br /> FPONISE1p�CK �EMS[1��CN SIOESElOACN PUNCNECKNUMBER FEE PEGEIPTNO. <br /> USEZONE �OTAREA VACANiS1iE FEES VALUATION FEE <br /> �UILDING <br /> rvPEOfLON15.AlLUWRflIE IYPEOfLONSI.ALNAL ouu�eMcv xoamvfluxGuxnS � <br /> cnav pLUF1�ING i <br /> i <br /> SIZEOFBLDO. NO.OFSTORIES B�SEMENT MECHANICAL � <br /> i <br /> OCGUPANCYLOAO FIRESPRNKIERSREO'D H[IGIIiLIMIfATIM� ADDI110NALPLANCHECK � <br /> 1 <br /> OTHER � <br /> fiEA5011 fOR SPRINKLERS i <br /> STATE BUILDING SURCHARGE � <br /> i <br /> ir�i�,�rov rinr+snrrnoveonr CITYOFEVERETT pueucwonks � <br /> LOCAL SALES � <br /> TAX COOE IS 3105 TOTAL �('� <br />