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� <br /> ,����5 ) <br /> 3������ �.����f ��,��.�t, ���.��-�= -� �._i�- �, /C����� <br /> Y APPLICATION FOR CONSTRUCT�ON PERMI'�� <br /> everett <br /> fho Evmg/een � <br /> CITY O� <br /> everett <br /> BUILDING DEPARTMENT <br /> 259-8810 TO BE COMPLETED IN INK—PLEASE PRINT <br /> DEMOLITION COMBINATION BUILDING MECHANICAL PLUMBING SIGN <br /> 01VNEH MAILAD�RE55 CITY :IP PHOM1[ <br /> �v i� �3sivcl5's- s.� • �; ��st 3 � 3- Sis� <br /> IENANi MAILAOOFE55 Cltt ZIP PMONE <br /> P " <br /> ro <br /> p � y ARCwIEGtORDESiGNEP MAItPD�RE55 CIiY ZIP PMONE <br /> 67 <br /> C N <br /> y G[NERALCONLqACtOii MAItPODRESS f.liY 21P PIIONE IICENSE� <br /> ,� � S-�A�IL �4�t.r.� 73r ��.�r: /i� � S ��_ _w�4 S,f'/SC ���5`"�S'i S�/1/kf�S/c�,✓<, <br /> y�1 %7 h�[CMANIGLCONTRACT RIAILADDRESS CITV 21P PHONF. LICENSEI <br /> '11 M �O <br /> � y � <br /> 'LUM0INGCONiRRCTOR MAILAOORESS Cltt ZIP PlIONc UCENSE� <br /> '� <br /> VC _ <br /> � y � LLASSOFWORK <br /> � p �W ,. . ADDITION . , ALTERATION . ! REPAIR �. DEMOLITION . . WOODSTOVFJFRPL INSERT .J. BUILDING RELOCATION <br /> p��L{ , TENANT iMPROVE61ENt OR INi[RiOR qEMOOEL ONLY LON/tACT PERSON AND PHONE ND. <br /> i �7 � CONiRACTPRICEOFWORN: �U �� ( �C.� -S/ <br /> �� � �E �iIpEWORKnNO50URREF00TAGEINVOLVED <br /> 5� H �] <br /> ?S c w �, : - � �: • Ross Or,�u� 3�3 8s4c� <br /> � C � eaoaoseouseoFauaoinc � I HEREBV CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> d° �6c t APPLICATION AND KNOW THE SAME'i0 BE TRUE AND CORRECT.ALL <br /> � y LEGAlDESCRiPT10NOFPROPERTY�SNOWNOEIOWORRifACHFOURCOPIE51 PROVISIONSOFLAWSANDORDINA�ICESGOVERNINGTHISTVPEOF <br /> � WORN WILL BE COMPLETED WITH WHETHER SPECIFIED HEF+EIN OR <br /> ior 3 ° � eiacK �� oF F� NOT. THE GRANTING OF A PERMIT COES NOT PRESUME TO GIVE <br /> AUTHOFITV TO VIOLATE OR CANCEI THE PROVISIONS OF ANV <br /> -�� �`r�� OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> — � PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BV THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE A�D I COMPLV WITH THE STATE <br /> CONTRACTORS LAW 18.27 RCW AND 2962C0 WAC. <br /> SiGNATUREOFLONTRAGTORORAUiNOPtZEOAGENT ORTE <br /> PPOJ TADDRE 5 � (L_.�i����. <br /> 2 � t APPLiCANTSCIttBU5ME55LICEN5EN0 /N�9U9NESSNn6�E <br /> . PLUMBING MECHANICAL <br /> i��, N0. TYPE OF FIXTURE OR ITEM FEE N0. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) A/C—lvHNDLG UNITS—H.P. <br /> , � , BATHTUB FORCED AIR SYSTEMS—B.T.U. M E.A. <br /> LAVATORY(WASH�ASIN) � UNIT HEATERS—B.TU. M � <br /> � SHOWEF � CLOTHES DfiYERS <br /> �' I__+ KITCHEN SINK 8 DISP i VENTILATION FAN <br /> 'i DISHWASHER RANGE HOOD <br /> LAUNDfiV TRAV WATER HEATER <br /> ' � CLOTHES WASHER i WOOD STOVE _ <br /> ` �=1 URINAL METAL FIREPLACE 8 CHIMNEY <br /> I DRINKING FOUNTAIN FIREPLACE INSERT <br /> FLOOR DRAIN � HEAT PUMP <br /> BACKFLOW PFEVENTERS GAS PIPING <br /> '-1�i ROOF�RAINS—RAINLEADERS E%HAUST FAN <br /> � SINK(SERVICE—BAR,ETC.) _ <br /> �, <br /> ��� <br /> � SUBTOTAL S SUB TOTAL 5 <br /> �i � � PEiiMIT S PERMIT S <br /> �� TOTALFEE 5 TOTALFEE 5 <br /> ��1 '� fRONiSETBBCN RE�qSEi&1CK SIpESETBRCN PlA LNE N�UM4R FEE �� AECEtP�NO �/ 1 <br /> �� G J l <br /> useza+e IOTAREF vncu+Tsrte FEES VAWATION FEE <br /> °� YES �] NO '� T <br /> - BUILDING -� �`.� / 'C G <br /> tYPEOfLONSiALlOWl9lf iYPEOlCOHSfAC1UAL o[Curuwr npnoMui�uxrt5 i-- <br /> sxao p�UMBING <br /> _� <br /> SRE OF BLDG NO OF SiOHIES BASEMENT MECHANICAL <br /> 5 YE9 �-NO <br /> Of.f,uP�NLYLOAO FIRESPPNNlERSREOD MEKaNiIIMITRION OTHER <br /> ^{ ': ! YES AG NO STATE DUILDING SURCHARGE � �J <br /> REASON FOR SPflINNLERS i <br /> STATEENEflGVSURCHARGE <br /> ACPIICATIONRCC.BY PIANSpPPA��DOV CITYOFEVEflETT PUBLICWORK$ � <br /> /�� LOCAL SALES � <br /> y g��� TAX CODE IS 3105 TOTAL � Z <br />