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S � �-�.- <br /> � APPLICATI�1 FOR CONSTRUC'1�ON PERMIT ? <br /> r�E�y��� everett <br /> ���oF e <br /> � � everett <br /> BUILDING DEPARTMENT <br /> O � -• 259•8810 TO BE COMPLETED IN INK—PLEASE PRINT <br /> ��� ❑ DEMOLIiION !_', COMBINATION XBUILDING MECHANICAL PLUMBING SIGN <br /> OVINER MRR�DDRESS CIIY ZiP PMONE <br /> MasE� �i:��E 3s�2�w.�r„���•t� ��zo r �sz-�3� y <br /> ��� IEN�Ni MAIL RDDRESS LITV ZiP PNONE <br /> �� ARGHITECTOHDESIGNEfR� M�IL�DDRE55 iY 21P PHONE <br /> �o EI-�� i.J�b(' �: �va �7�-� � 3'"�/F�C .St. C'"t� R�2o1 33Y-F��z_ <br /> y GENEMLCd1TP�CTOR MRII�DDR QiY 21P PHONE UCENSE• <br /> �!p''1 �Y✓a/E � <br /> W MELHANICMCONTR�LTOR MNL�DDRESS CIiV IIP PNONE LICENSE� <br /> �` ` NO Nc �_ <br /> >~ PIUMBI1NGCONTR�CTON f M�IL�DDRE55 CITV�7� QZIP PHONEc; LIGENSEI <br /> t'M SItJc_ ,�orti+fo✓ �✓c�/Y/Lf ( r�il,lll �S�D—IG�� <br /> � C1A550FWORN <br /> �w � NEW xADDITION �.. �. ALTERATION . �� REPAIR i : DEMOUTION WOODSTOVE/FRPL INSERT I ; BUILDING RELOCATION <br /> TEIUNT IMPRO\'EA:ENT OB INTERq/R P�E�MO�pEL ONLY CONT�R�G/T�FERSON RN�PHONE NO. <br /> �� �p1�TMLTPHILEOFWOHI(: <NL7'r �''�ry) �N L' (C/L. � � �-3?Y� <br /> pESCNIBE WOPK�NDSOU�RE FOOT�GE INVOLVED ��0 *� �� <br /> -- — 2-�['Z -�s�9y <br /> PNOPOSEDUSEOFBURDING / I HEREBV CERTIFY THAT I HAVE READ AND E%AMINED THIS <br /> , wY�"k-.�v"'r— J¢/�(.G� / V7µ'� APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.AlL <br /> LEGALOESCRIP110NpFPqOPERiV�SMOWNBELOWOR�TfACHiOURCPIE51 � PROVISIONSOFLAWSANOORDINANCESGOVERNINGTHISTYPEOF <br /> ior1Y �� e�ocK � oF ��� � O E�r WORK WILL BE COMPLETED WITH WHETHER SPEGFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AUTHORITV TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LA'.Y REGULATING CONSTRUCTION OR THE - <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BV THE <br /> OWNER OF THIS PROPERTY TO PERFORM 1HE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLV WITH THE STATE <br /> CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br /> Ty SIGNRTUREOFCONiR�CTORORRUiMORREDAGENT D�tE <br /> / 7 / �� � �f i4-�e_ X �/�-�i%�3a✓ ��� Y':�c�g�iy <br /> . PRQIECT�ODRE55 <br /> '� �PPL �NiSCItYB SLiCEN5EN0�NDBU5iNE55NAME I <br /> PLUMBINCi MECHANICAL <br /> t�' NO. TYPE OF FlXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE � � <br /> �: WATER CLOSET(TOILET) A/C—A/HNDLG UNITS—H.P. <br /> '�1 �� BATHTUB FORCEDAIRSYSTEMS—B.T.U. M E.A. <br /> ' ' LAVATORY(WASH BASIN) UNIT HEATERS—B.T.U. M , <br /> � SHOWER CLOTHES DRYERS <br /> �' KITCHEN SINK 8 DISP VENTILATION FAN ; <br /> t ; DISHWASHER RANGE HOOD <br /> ' " LAUNORVTRAY WATER HEATER <br /> ��. CLOTHES WASHER WOOD STOVE <br /> �1 URINAL METAL FIREPLACE 8 CHIMNEY � <br /> DRINKING FOUNTAIN FIREPLACE INSERT <br /> � � FLOOR DRAIN HEAT PUMP ' <br /> �' BACKFIOW PREVENTERS GAS PIPINCa I <br /> ROOF DRAINS—RAINLEADEFS EXHAUST FAN I <br /> '�' SINK(SEHV�CE—BAR,ETC.) <br /> '�' <br /> ' 1 <br /> 1 ' SUB TOTAL $ SUB TOTAL $ <br /> � _ PERMIT $ PERMIT S I <br /> -- TOTALFEE $ TOTALFEE E I <br /> � FRONTSETBACK RE�RSEiB�LN SiDESETBRCN PUNCNEC NNABER FEE REGEiPTNO. <br /> — -rc�1�- o avv� lfe �.� 3 0 <br /> usExor+� IOT�flER �ACRNTS�TE FEES VALU�TION FEE <br /> �j �.. YES `�� � BUILDING �� i — <br /> tYPEOiCOHSLAILaWI�BIE tYV�F_Of.C�ON�StAL�N�_r��� �qap�r xoaGxAuxcuxn5 <br /> l- )' �;`�I 1�� C�i 7� " � PLUMBING <br /> � SIIEOFBLOG. 2/ NOAFS�OAIES B�SEMENT MECHANICAL <br /> �7{0 <br /> �� � YES . � NO <br /> OCCUPANGYIOAD FIqESPNNNLER5PE0'D NEIGN7UMiTAT10N OTHER <br /> I U '�� VES NO � STATE BUILDING SURCHARGE <br /> X 5' t-a <br /> flEA50NFOR5PRiNNLENS <br /> STATEENERGYSURCHARGE <br /> •PPLIC�TqNRCC.BY PUNSAPPPO DBY CITYOFEVEflETT PUBLICWORKS ' <br /> LOCAL SALES � <br /> TAX CODE IS 3105 *�r�� a J ' SZ <br />