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I�F. <br /> APPLICAti..:DN FOR CONSTRUI:�f ION PERMIT <br /> everett <br /> �E�-�� e <br /> cin oF <br /> everett � <br /> BUILDING DEPARTMENT TO BE COMPLETED IN INK—PLEASE PRINT <br /> 259-8810 <br /> ❑ DEMOLITION ❑ COMBINATION Cl BUILDING ,D1�lpECHANICAL l I PLUMBING U SIGN <br /> ��q MARAUDRESS � /� CIiY/ 21P ��y P�I.I�ONEy� <br /> �T[' /l!ta'Y c�/Z %c �,�L`Q'���!! ""'v, fXYX:�[L�V'f <br /> ��7µ{ M�ILA�ORE 5 CITY 21P PHONE <br /> APCNITECTOi10E510NER tURADDPE55 CITY 21P P�E <br /> OENERAICaMTMCTOR WIL�ODRESS CIiY 21P PNONE IICENSE� <br /> , • �� � �ll .� �'�if 9'B�oC� oh 9�33' /Uo/l�u.ln �.S <br /> ���7q/�T p WKADDNE55 Gltt 21P PHONE LICENSE� <br /> 1 <br /> p��y9Mp�pNTRAGTOR MAILII�OPESS Cltt ZIP �110N[ LICENSE� � <br /> Ii <br /> Cl/�38 OF MIORI( I <br /> NEW ❑ ADDITION ❑ ALTERATION O REPAIR ❑ OEMOLITION l7 WOODSTOVEIFRPL INSERT ❑ BUILDING RELOCATION 9 <br /> � 7EWWTM%IOVEMEM011W1TERIOPREMOQf,�IXILV CONIACTPERSONiVlOPIqNENO. � <br /> � a� � <br /> �pNTRACT PRICE OF wOHI(: <br /> �g�q�WJ{e(�Wp$pUAfIE i00T�0E INVOLVEU <br /> D OFBVRDWO I HEREBY CERTIFY THAT I HAVE READ AND E%AMINED THIS � <br /> APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECL ALL � <br /> �EpkpE9GpIpT10NOFPiqPEHTY15��8ELOWONATT�CHFWRGd'IES� PROVISIONSOFLAWSANDORDINANCES�OVERNINaTHIST'PEOF <br /> WORK WILL BE COMPLETED WITH WHETHEH SPECIFIED HEREIN OR <br /> �ot e�ocK oF NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO OIVE I <br /> AUTHORIT i TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATINO CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PEHFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br /> SIONATUREOFCONTMCTONORAUTHd11ZE0A6ENT DATE <br /> � <br /> � .�t���s��— X �..� Y�.r��� <br /> I �pOJE�T�DD�E59 A���NT GTYBUSMESSLICEl1 �.µDBU5�NE55NM1E <br /> i ` <br /> f <br /> P�����NQ MECHANICAL <br /> jq, TYPE OF FlXTUAE Ofl REM FEE NO. TYPE OF EDUIPMENT FEE <br /> WATER CLOSET(TOIIET) � AIC-IVHNDLG UNITS-H.P. � <br /> BATHTUB ' FORCED AIR SYSTEMS-B.LU. M E.A. ' <br /> � <br /> LAVATORY(WASH BASIN) � UNIT HEATERS-B.T.U. M i <br /> SHOWER ' CLOTHES DRYERS ' <br /> KITCHEN SINK 8 DISP � VENTILATION FAN � <br /> OISHWASHER � RANGE HOOD ' <br /> ' WATER HEATER ' <br /> LAUNDRY TMY � � <br /> CLOTHES WASHER � WOOD STOVE ' <br /> URINAL ' METAL FIREPL7�CE 6 CHIMNEY ' <br /> DRINKING FOUNTAIN � FIREPLACE INSERT � <br /> FLOOR DRAIN ' HEAT PUMP <br /> i <br /> ' GAS PIPING � <br /> . BACKFLOW PREVENTEHS � <br /> � ROOF DRAIN�RAINLEADERS � EXHAUST FAN ' <br /> SINK(SERVICE-BAR,ETC.) � � <br /> i ' <br /> � ' <br /> � <br /> � � <br /> i <br /> � <br /> � <br /> SUB TOTAL S <br /> � SUB TOTAL S ' <br /> PERMIT S � PERMIT S � <br /> TOTALFEE E ' TOTALFEE E ' <br /> I <br /> FRONTSETB/�CI( REARSE7BAGK SI�ESEiRA.^.N PLANCNECKNUMBER FEE RECEIPTNO. <br /> USEZONE IOTApEA v�cu+rSnE FEES VALUATION FEE <br /> ❑ YES ❑ NO BUILOING ' <br /> 7YPEDiCON57.�LLOWABIE TYPEOFCONSf.AC7UAL a-1�� �q�IUMGUNitS i <br /> tuav pLUMDING � <br /> i <br /> S�ZEOFBL00. NO.OFSTORIES P%.SEMENT MECHANICAL � <br /> ❑ YES ❑ NO ' <br /> OTHEP � <br /> I OCGUPANCYLOAO FIIIESPRNNIERSREOU HEIGNTUMIT�IIdI � <br /> ❑ YES O NO � <br /> STATE BUILDING SURCH�AGE ' <br /> flEA50N FOR SPPINNL[RS � <br /> STATEENE�GVSURCNARGE <br /> i <br />