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�t;, �: <br /> APPLICATId:� FOR CONSTRUCTIi�N PERMIT <br /> everett <br /> �E��� e <br /> �,�� <br /> everett <br /> BUILDING DEPARTMENT TO BE COMPLETED IN INK—PLEASE PRINT <br /> 259-8810 �o.w� m�•�y <br /> ❑ DEMOLITION ❑ COMBINATION fL]'�UILDING ❑MECHANICAL L MBING� ❑ SI(3N <br /> �p S M MA0.IDDRESS GIiY 21P PMONE <br /> fvoxald�ar�let �03 I�witf �Te F�xe�". lA�a.. �is�.o� �-sy-�is3 <br /> 7E}yy�T MAILAOORESS GITV 2�P FHONE <br /> ' �,�,s�«oss To.0 Sec��ces.T,� a8oi l��{t Gl.r� yvexEtt ��ie2o i zs,-�I-31! <br /> MCHIIECTOqDESiONEN 1AA0. Nf55 CITY Z�F FMONE <br /> �QlurelT I,.l ?J��o�. NE ��'`PI Re�-ww�- qEoS3 868-188 � <br /> p�pK�}p��pq W�I�ADDREBS Cltt 2�P NONEj� I- �NCENSE/ 'i'�{�yWSI�lIP <br /> T�r�r W. S�sso� T-� i q i io bb�* Ave.S, '3td4 6. Su��e �os �rx� i.i,b� ��n3 z <br /> IEpIWI CONTR�LTOR A0.ADDPESS CITV 21P � PMON TE LICENSE� <br /> � fqJMlIqCONTqACTOR M�R E93 CIiY 21P PIqNE UCENSE� <br /> ; �E as <br /> , «w.�� <br /> � ❑ NEW ❑ ADDITION �ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVFJFRPL INSERT ❑ BUILOING RELOCATION <br /> iE�M11t M%qVEMENi OR MiEPqR REMODEL ONLY CONTALi PEPSON AND PlqNE NO. <br /> � oaaa�c.rn�oF»on�: � Tt� �-8�bS7oD <br /> 1 lENd11cNAS0UM�EFO0TA0EttNOlVEOr ' ,�1.-I�, <br /> � S (.Fa�1 �it Q L7�,�1 — "180 <br /> + rnoroeeouseaeutioMAa I HEREBY CER7IFY THAT I HAVE READ ANU E%AMINED THIS <br /> � �J��1 CQi — /'cGtyN � � APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECL AlL <br /> i ��pKpegoqmtqwoFriqrenir�g�pwn ORATTACNFWRCAPIES) PROVISIONS OF LAWS AND ORDINANCES GOVERNINO THIS T.'PE OF <br /> WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> � aT�_ &�� � NUT. THE GRANTINO OF A PERMIT DOES NOT PRESUME TO OIVE <br /> ') C � _I � AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANV <br /> � v�W�UJ�IS Z A�I�OY� �TJ � OTHER STATE OR LOCAL LAW REGUUTING CONSTRUCTION OR THE <br /> -I PERFORMANCE OF CONSTRUCTIOPJ.THAT I AM AUTHORRED BY THE <br /> ��� �S� � (O OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> ,� APPIICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTOAS LAW 18.27 RCW AND 296.200 WAC. <br /> �� SION�NREOFGONTRACtOqOPAUTHORIZED�6ENT D�TF. ��/37rg� � <br /> l ; �( 'but�n�SS Z'�,K S2Nl <br /> � nia�cr�ss � , - -� #OD251M- <br /> I� � �p1 �1 �y�/n �a qgz� � APPLILANTSGTVBUSINESSLICENSENO.MlDBUSINESSNMIE <br /> wV v <br /> � � pLUAMIIq MECHIINICAL <br /> ;; - Np. TYPE OF flIITURE OR ITEM FEE N0. TYPE OF EOUIPMENT FEE <br /> �.� WATER CLOSET(TOILET� � NC—AMNDLG UNITS—H.P. � <br /> g�7�{nJB ' FORGED AIR SYSTEMS—B.T.U. M E.A. � <br /> !; ' � UVATORV(WASH BASIN) '7 � UNIT HEATERS—B.LU. M � <br /> ;� SHOWER ' CLUTHES DRYERS �— <br /> KITCHEN SINK 6 DISP ; VEN7ILATION FAN ; <br /> �� DISHWASHER � RANGE H000 � <br /> LAUNDRY TRAV ; WATER HEATER ; <br /> , CLOTHES WASHER � WOOD STOVE � <br /> "� URINAL ' METALFIREPlXCEBCHIMNEY � <br /> 'j DRINKINO FOUNTAIN � FIHEPLACE INSERT � <br /> { FLOOR DRAIN � HEAT PUMP � <br /> ,'� BACKFLOW PREVENTERS ; GAS PIPING _ ' <br /> ROOF DRAIN^�RAINLEADERS � E7(HAUST FAN � <br /> ;J � SINK(SERVICE—BAR,ETC.) ' ' <br /> I , <br /> � � <br /> � i <br /> j � � <br /> I � � <br /> � � i <br /> f SUB TOTAL E ; SUB TOTAL E ' <br /> PERMIT S � PERMIT S � <br /> j TOTAL FEE S ' TOTAL FEE E ' <br /> � <br /> � FIqNT5E7BA=K PEARSET&�CN SIOESETB�CK P4VlGNE NUMBER FEF �j� REGEIPTNA. <br /> r i � � <br /> � usezor+ tota�e�.l�� VACANTSIIE FEES VALUATION FEE <br /> � � ' Zx 1w ❑ YES C�NO BUILOING — ��(J�� <br /> ocWr�xcr rroaowtu�xcurirs <br /> TTEOf /LIOW�BIE TVPEOfypYitRC1U�L �pqp ��, pLUMBING � <br /> �� � �_ <br /> ? �BREOFBLDO. NO.OFSTORIES BASEI�IENT <br /> � MECHANIC�L � <br /> f � y S� I ❑ YES NO , <br /> � OCCUPANCYLO�D FIRESPRNKlER5RE0'0 NEIQNT/L1M�ITAsTION OTIIEP i <br /> �O ❑ VES �NO `rJ STATE BUILOING SUtiCHARGE �� <br /> � <br /> I R1S�SONFOqSPRINKLEflS - <br /> � <br /> STAiE ENERGY SURCH�(iGE i <br /> I M{LICATIONACC.BY PlANSAPPR BY CITYOFEVERETT PUOLICWORKS � <br /> �1 �� LOCAL SALES � <br /> TAl(CODE IS 3105 TOTAL �I�i <br /> 1 <br /> ; <br />