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I�r tA <br /> APPLICATION FOR CONSTRUCTIv�I PERMIT everett �, <br /> m�eYr�9�mn TO BE COMPLETED IN INK—PLEASE PHINT . � <br /> arv oF � <br /> everett HEATING SYSTEM: ❑GAS O ELECTRIC O ' ' ' <br /> BUILDING DEPARTMENT � <br /> 259-8810 <br /> xi DEMOLITION i I COMBINATION I I BUILDING �f 1 MECHANICAL ❑PLUMBING C7 SIGN <br /> pydlER ) M�ILADyD�RE55 /� / CIiY [��7 21P PHOpNE /�7�7 <br /> �i�' � �Or�/1oiS�[� 7L�l1�1 U[1 I.t�')'Jrl �. IOI�� ���0 2i0 31 <br /> IENANT MARADDRE55 GI7Y 2�P PHONE <br /> AIiGHIfECTONOES�GNER MRILRUOflE55 GITY ZIP 7HONE <br /> OFNER�ICONTRACTOF MA0.AUORESS CI1V 21P P1qNE LILENSE� <br /> /l,!�w(�,�o(� 4•U� P.n, Q�,� �t S2? F'va-� 2S?'—�(`�� �/�u/Uc� 3'�3 L O <br /> MECN�NICALGONTHACTOR MAILADDOESS CI1Y 21P VFIONE LICENSE/ <br /> PWMOINGCONIR�CTOR M�IL�DDRESS GIiY ZIP PNONE LICENSE� <br /> GUSS OF WORN <br /> I I NEW I I ADDITION f 7 ALTERATION 1 I REPAIR 7� DEMOUTION I-.l WOODSTOVE/fRPL INSERT ❑ BUILDIN4 RELOCATION <br /> CONTACT PEflSWI AND PNONE NO. Q /�] <br /> CONTR�CT PR�CE OF WORK Kr . rr Z��+�� O s � <br /> DESCPIBE WO�N ANU SIXI�AE FOOTAGE ttNOLVED <br /> PROi'OSEUUSEOFBUILDING I HERE9Y CERTIFY THAT I HAVE READ AND E%AMINED THIS <br /> APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECL ALL <br /> LEGALDESCRIPTpNOFPA01'ERIV(SNOWNBEIOWOAATTAGHFWRCOPIES) PRO��SIONSOFLAWSANDORDINANCESGOVERNINGTHISiVPEOF <br /> WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> �or �L eiacrc S�Z oF Q � NOT. l'HE GRANTING OF A PERMIT DOES NOT PRESUME TO(iIVE <br /> AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW REGUUTING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLV WITH THE STATE <br /> CONTRACTORS LAW 7827 RCW AND 296200 WAC. <br /> SIGNIITURE OF CONTMCTOR ON AUTHORIZED�6ENT DATE <br /> � rnaeci eoonfesns <br /> X ,�K >�! <br /> ' / ( L� Cj�bl N� V-Q AP%1G1NTS GTY BUSMESS LICE E NO.AND BU51 IE85 NAME <br /> PLUMBIN6 MECNANICAL <br /> N0. TYPE OF FlI(TURE OR ItEM FEE NO. TYPE OP EOUIPMENT FEE <br /> WATER CLOSET(TOILET) � NC—AINNDL6 UMTS—H.P. �__ <br /> BATHTUB ; FORCED AIR SYSTEMS--B.T.U. M E.A. ' <br /> LAVATORY(WASH BASIN) � UNIT HEATEHS—B.T.U. M _�_ <br /> SHOWER ' CIOTHES DRYERS � <br /> KITCHEN SINK 8 DISP � VENTILATION FAN ' <br /> DISHWASHER � RANGE HOOD � <br /> LAUNDRY TPAV ; WATEfi HEATER ' <br /> CLOTIIES WASHER � WOOD STOVE i <br /> URINAI ' METAL FIREPWCE 6 CHIMNEY � <br /> DRINKIN(i FOUNTAIN i FIREPLACE INSERT � <br /> FLOOR DRAIN � HEAT PUMP � � <br /> BACKFLOW PREVENTERS ; GAS PIPING ' <br /> ROOF ORAINS—RAINIEADERS � E%HAUST FAN � <br /> SINK(SERVICE—BAR,ETC.) ; � <br /> � <br /> � � <br /> � � <br /> i <br /> � � <br /> i � <br /> SUB TOTAL S ; SUB TOTAL S ' <br /> PERMIT S � PERM�T S � <br /> TOTAL FEE $ ' TOTAL FEE S ' <br /> FOH OFFICE USE ONLY: <br /> F110NTSE7BACK �EARSETBACN SIOESElOACH PUNCHECKNUMBEH FEE RECEIPTNO. <br /> USE ZONE �OT AREA V�CANT SIIE FEES VALUA710N FEE <br /> BUILD�NG � <br /> IYI'EOfCONiS.MIOWPBIE TYPEOICONS7.RC7UAL 041mextr xopoMWNGUNrtS i <br /> �A�P PLUMBING i <br /> T <br /> SIZE Of OLDG. NO.OF STOPIES DASEMENT MECHANICAL ' <br /> � <br /> OCCUPANCY LO�D FIRE SPflNKLERS REO'D HEIGHT�IMIiA710N AODITIONAL PLAN CHECK i <br /> OTHER � I <br /> i <br /> REASON FOR SPIiINKI.ERS 1 <br /> STATE BUILOING SURCHAfiGE i . <br /> INIAKEltY PLANS�P FQ OVE_DBY S�L� CITYOFEVERETT PUBLICWORKS � � <br /> ��'�'� � LOCAL SALES <br /> dh , `� ...• TAX CODE IS 3105 roT�� ; <br />