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pPPLICAT14.�1 FOR CONSTRUCT�ON PERMIT <br /> everett <br /> Me Ew/�raen � <br /> CITV OF <br /> everett <br /> BUILDING DEPARTMENT TO BE COMPLETED IN INK—PLEASE PRINT <br /> 259-8810 <br /> ❑ DEMOLITION u COMBINATION i' BUILDING MECHANICAL I l PLUMBING i 7 SIGN <br /> OWNER MAILADDRE55 ��T� �S� w�_'�I' <br /> �INI.EY �G41�?`� Mb 1'.�.�� �ADb� �'� ► - <br /> MAIL�DDRE55 GITV 21P PHONE <br /> C""' , x��i�„�.�i �'o p�X 140b �Ver�' 9b?�A(o 2iib-fo�71 <br /> �^��` GI1Y ZIP PNONE rC I � <br /> ARCMITECTORDES�GNEfl MAIL�OIDR�AESS /�y�. �//��� /���yu py� nqne w'�_/ �} <br /> G�RAIGONTRA OR���� I 1� S I7n�� CITYMO/N714TI I'��•_ PHON�_� L�SE�II�Y� <br /> MECH�NICALCONiR�CTOfl MAILADDRE55 LIiV 21P PHONE LICENSE• <br /> PWMBINGCONTflACTOR MAILADDRE55 CITY ZIP PHONF. UCENSEI <br /> CUSS OF WORK <br /> f ! NEW ❑ ADDITION �. ALTERATION i� REPAIR ❑ DEMOLITION I-�� WOODSTOVE/FRPLINSERT ❑ BUILDINGRELOCATIO <br /> TENANTIMPROVEMENTORINTEPIOR EMODELONLY CONi TPERSONANDP ONEN . <br /> �� � � <br /> CONTRACT PRICE OF WORK: <br /> DE HIBE WORK D SIXIARE FOOTAGE INVOL D <br /> 123o S.F <br /> P E us oFeui oiN I HEREBY CERTIFY THAT I HAVE READ AND E%AMINED THIS <br /> APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> LEGNLDESCR�o7prypppqpPERTY�SHOWNBELOWOB�TTACHFOURCOPIES� PROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTYPEOF <br /> WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> tor B��K �F A�THORI YRTOTV OLATE OR CANCE�L THE PROVISIONS OF A1NY <br /> (� OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> P� � �� OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 1027 RCW AND 296200 WAC. <br /> SIGNA EOFGONTRACTORORRUTHORRE GENT DATE <br /> PROJECTADDRE55 APPLIL� SCITYBU SSLILENSENO.AN 11SINE5 NAME <br /> PLUMBING MECHANICAL <br /> Np, TV�E OF FlXTURE OR REM FEE NO. TYPE OF EQUIPMENT <br /> FEE <br /> WATER C�OSET(TOILET) � A/C—NHNOLG UNITS—H.R � <br /> BATHTUB ' FORCED AIR SYSTEMS—B.T.U. M E.A. <br /> LAVATORV(WASH BASIN) � UNIT HEATERS—B.T.U. M � <br /> � CLOTHES DRYERS ' <br /> SHOWER � <br /> KITCHEN SINK 8 DISP ; VENTILATION FAN <br /> DISHWASHER 1 RANGEHOOD � <br /> LAUNDRY TRAY WATER HEATER i <br /> CLOTHES WASHER � WOOD STOVE <br /> URINAL <br /> � METAL FIREPLACE&CHIMNEY ' <br /> DRINKING FOUNTAIN � FIREPLACE INSERT � <br /> FLOOR DRAIN � HEAT PUMP ' <br /> bACKFLOW PREVENTERS ; GAS PIPING � <br /> ROOF DRAINS—RAINLEADERS � E%HAUST FAN ' <br /> SINK(SERVICE—BAR,ETC.) � � <br /> � <br /> � ' <br /> SUB TOTAL $ '' SUB TOTAL $ 1 <br /> PERMIT $ � PERMIT 5 � <br /> TOTAL FEE $ ' TOTAL FEE S ' <br /> PIANCHE NIJaB FEE RECEIPTNO <br /> FFONTSETBACK REARSETBACK SIDESETBACK O <br /> LOTFNEA VACANTSITE FEES VALUATON FEE <br /> usezor+e �...; YES [,: NO � � <br /> eui�oiNc ' <br /> 7VPEO�CONSI.ALLOWABLE 7VPEOFCONS7.ALIUAL �v�Ntr x0ovbmRUHGuxrtS ' <br /> i <br /> � ° PLUMBING ' <br /> _ <br /> SIZE OF BLDG. NO.OF STORIES BASEMENT MECHANICAL � <br /> �,-: YES . ' NO � <br /> OCLUPANCVLOp� FIRESPRNKLERSREO'D HEIGMTUMITATION <br /> OTHER ' <br /> f i YES L: NO STATE�UILDING SURCHARGE ; C� <br /> FEASON FOR SPflINKLERS <br /> STA7EENERGVSURCHAR�E <br /> APPLICATION PCG.BY PtANS APPROVED BV gITY OF EVEflE1T PUBLIC WORKS ' <br /> � LOCAL SALES �� ;� <br /> TAl(CODE IS 3105 TOT�� <br />