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�� \ �u" r <br /> �PPLICATI��iM FOR CONSTRUCT�ON PERM1� <br /> ��B E"�'D`�" � everett <br /> CITYOF e <br /> everett <br /> BUILDING DEPARTMENT <br /> 259•8810 TO BE COMPLETED IN INK--PLEASE PRINT <br /> ❑ DEMOLITION O COMBINATION L I BUILDING �'�MECHANICAL ❑ PLUMBING Ll SIGN <br /> ���OI MtILADDflE55 CITY 21P PIIONE <br /> W�Ps� � �! �I � �aei �5a�-�-19� <br /> TENANT IAAILADURE55 CI1Y <br /> -i!�Li�u _ _ . „ . $j° PHONE <br /> r-{/����.y� <br /> ARCNITECTORDESIGNEq IMILAODRE55 CITY ZIP <br /> PNONE <br /> �OEN��CONTR�CTO I AODfiE55 <br /> �/�/ r /� �/'� /��P-N�ON`B�^ IICENSEt <br /> \V 'Vl 1 �l GIiY �^Z1 Oti/I G(J- 'J l / <br /> MECH�NIC�IC RACTOR MAILADORE55 � ����`� <br /> � Cli 2�P PHONE UCENSE• <br /> , PLUMBINOCONTR\CTOp MAILRDDRESS ��T� Z�P — �I��� <br /> PIfONE LICENSEI <br /> , CUSS OF NqqN <br /> ❑ NEW IJ ADDITION �J�tTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRpL INSERT ❑ BUILDING RELOCATION <br /> TFNNIT IMPF.OVEMENT OR INTf:HpR NEMWEL Oy CONIACT PEASON�ND PHONE NO. <br /> CONTMCTiRIGEOFWORN: � a <br /> DE9CFIBE 1NpR �ND WARE F TAGE INVp�VED <br /> S��LL.Q� �CU(l�Q/� �L <br /> PROPOSEDUSEOF nomo <br /> `�� � I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> - APPLICATION AND KNOW THE SAME TO BE TRUE AND CORHECT.ALL <br /> , LEWLDESGRIP710NpFpqOPERTV�9HOWN8ELOWOflATTqCNFOURCOPIES) PROVISIONSOFLAWSANDORDINA�CESGOVERNINGTHISTVpEOF <br /> tor a�a�: oF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PEHMIT DOES NOT PRESUME TO GIVE <br /> AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANV <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFURMANCE OF CONSTRUCTIGN.THAT I AM AUTHORIZED BY THE <br /> . OWNER OF TH�S PROPERTV TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 7827 RCW AND 296.200 WqC. <br /> SIGNRTUREOFCONiBRGTpqdq THOR2 D�GENT DA7E <br /> I <br /> � VNOIECTADUpES , / � � / <br /> - � � v APP�ICANTSQTYBU511 $$��LENSEN6. NDBt' .VESSNRME <br /> ' PLUMBIN MECHANICAL <br /> . NO• TYPE OF FIXTUflE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> , WATER CLOSET(TOILET) � A/C—,q�HNDLG UNITS—H.P. <br /> BATHTUB � <br /> ' � FORCEDAIRSYSTEMS—B.T.U.. E.A. i <br /> LAVATORV(WqSH BASIN) � UNIT HEATERS—B.T.U. M � <br /> ' SHOWER � CLOTHES DRYERS �— <br /> ; KITCHEN SINK d OISP i VENTILATION FAN i <br /> DISHWASHER � RANGE HOOD � <br /> i <br /> � LAUNDRYTRAY ; WATER HEATER , <br /> CLOTHES WASHER � WOODSTOVE � <br /> URINAL � <br /> ' METAL FIR6PU�CE 8 CHIMNEY , <br /> DRINKING FOUNTAIN � FIREPLACE INSER7 � <br /> FLOOR DRAIN � HEAT PUMP � <br /> BACKFLOW PREVENTERS ' <br /> � GAS PIPING - , <br /> ROOF DRAINS-�RAINLEADERS � EXHAUST FAN � <br /> SINK(S'cRVICE—BAR,ETC.) � ' <br /> i <br /> � , <br /> i <br /> � <br /> � <br /> � <br /> � , <br /> i ' <br /> SUB TOTAL S � ' <br /> PERMIT $ � SUB TOTAI $ d � -- <br /> ' PERMIT $ ��_ <br /> TOTAL FEE $ � <br /> FRONT SETBACK TOTAL FEE a 7 f� — <br /> AEARSETD�CK SIDESETB�CK PLANCNECNNUMOEfI fEE <br /> RECEIPT NO. <br /> USE20NE LOTAREH VRCANTSIIE FEES <br /> Cl YES ❑ NO �ALUATION FEE T_ <br /> 1YPEOfCONSL�LLpWABLE TYPEOFCONSI.ACIVAL accvo�rp x00fpW«pM6UNi15 BUILDING . i <br /> 4ROVP � <br /> PLUMBING � <br /> SIZEOFBLD(3. NO.OFSTOfiIES BASEMENi � <br /> ❑ Y[S CI NO MECHANICAL � _ <br /> OCCUPANCYLO�D FIRESPRNNIEASRE00 HEN'+Ni�IMIfA710N OTFIER � <br /> ❑ YES ❑ NO <br /> S7A7E OUILDING SURCNARGE ' <br /> REASp!!FOR SVRINNLERS � <br /> STATEENERGVSURCNARGE � <br /> APPLICATIONpCC.BY PLANSMPROVEDBV CITYOFEVERETT pUOLICWORKS 1 <br /> LOCALSALES � <br /> TAX CODE IS 3105 Torn� � <br /> � � <br />