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r <br /> APPLICATIL.� FOR CONSTRUCT.JN PERMST <br /> Ihe Evnrgmren everett <br /> ��T�oF e <br /> � � � everett <br /> BUILDING DEPARTMENT <br /> A � x � 259-8810 TO BE COMPLETED IN INK—PL�E�A E PRINT <br /> � �v, ❑ DEMOLITION I I COMBINATION i i BUILDING I/MECHANICAL [ I PLUMBING ❑ SIGN <br /> OWNEO MRiLADDRE55 . QIY piP PHONE <br /> H H <br /> I��e.���l Pm�n 2c�c�-i (�c�ma�c��.�-bl v d �u� ass2o3 3��� � Z�51 <br /> � H .�II TENRNi M�ILADORE55 Cllv 2tP PlIONE <br /> � H � <br /> y � PRCIIIiECTOR�E51GNEfl MRRApDI1E55 CITY LIP PHONE <br /> � z <br /> y d G[NEIIAICONiRRCTOR MAiLADD0ES5 CIiY ZiP PNONE LICENSE/ <br /> OH <br /> � n <br /> HL�] r.iec�mmcn�cor+rnncTon naiinooncss cnr, zm r�ror�e uceNSF. <br /> H� � �� � k � �� �� . , �� a� U�. w�.��,�a,Y,dq�a3H 821 •N542(SUNLowIl46��) <br /> � y � PWMOINOCONiR�CTOR 1dAiL�DDR[55 CIIY IiP PMONE UCENS � <br /> z <br /> �,y ~ y cussoFwonK <br /> � �y f I NEW f J AD�ITION IxALTERATION I I REPAIq I I DEMOLITION I � WOODSTOVFJFRPL INSERT CI BUILOING RELOCATION <br /> �� � IENANTIA1Pf10VGMENTOHINTERIOfiFEMOOELf�LY /, /\l GONIACIPEBSONANOPIIONENO. <br /> WNiRACi PRiCEOF WORN: � �O"' ' Ov <br /> yO� OESGRipElYOfiN�N�5l0�W�f�1E,F�0np1�AGnE1NVOlVE� <br /> ��ii aose�w ow�cN µW � I HEREBY CEFTIFY THAT I HAVE READ ANO EXAMINED THIS <br /> �I CWYII•. APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> iEcnioescniarioNOFrn r: rv�sn ancwonni cr+rouacories� PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> WORK WI�L BE COMPLETED WITH WHETHER SPECIFIED HER[IN OR <br /> tor BLOCK oF NOT. THE GfiANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTFIER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> — PER�ORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BV THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WOFK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLV WITH THE STATE <br /> CONT(7ACTORS LAW 1027 RCW AND 296,200 WAC. <br /> SICNATUREOFCONiMCtORO(IAUIMOf1REflAG[Ni OALE <br /> V,.i.c� OZ-03-12-� <br /> rnaccT�ooness L a�/ nn n N,,,, ,^ <br /> X 5urt'1{�oK. 4nC . � --(l-a��m"� <br /> J v��J I.GVUI/�E_, ���LICANISCILVpU51NE55lICENSENO.RND005ME55NRM[ <br /> f ' PLUMBING MECHANICAL <br /> ' ' NO. TYPE OF FI%TURE OR ITEM FEE N0. TYPE OF EOUIPMENT FEE <br /> � WATER CLOSET(TOILET) A'C—NHNDLG UNITS—H.P. <br /> '�' _ BATNTUB ' FORCED AIR SYSTEMS—B.T.U. M E.A. ~— <br /> LAVATORY(WASH BASIN) �— UNIT HEATERS—B.T.U. M <br /> 1 ' _ SHOWER ; CLOTHESDRYERS —�— <br /> � KITCHEN SINK 8 DISP i VENTIL/1710N FAN <br /> '�1 _ DISHWASHER ; RANGEHOOD <br /> LAUNDRYTRAY ; WATERHEATER <br /> 1 ' CLOTHES WASHER _ WOODSTOVE i <br /> URINAL METAL FIREPLACE 8 CHIMNEY � <br /> � ORINKING FOUNTAIN i FIREPLACE INSERT i <br /> 1�' _ FLOOR DRAIN HEAT PUMP � <br /> BACKFIOW PREVENTERS ; GAS PIPING � <br /> ROOF DRAINS—RAINLEADERS �— EXHAUST FAN �_ <br /> =' _ SINK(SEPVICE—BAR,EiG) ' � <br /> — �—— <br /> ' —�— <br /> i <br /> � _ <br /> i __� <br /> � � <br /> �i _ SUBTOT�L S ' SUBTOTAL $ ' <br /> � PERMIT 5 �—_ PERMIT $ �� <br /> � TOTAL FEE S TOTAL FEE 5 ' <br /> FRU1�i5ETp�GN REARSE1pACH 9�ESEi84CK CUNCNELNNUh10E0 FEE RECEIPTNO. <br /> u5ezonE �otenen vacm+tsne FEES VALUATION FEE � <br /> I I YES f I NO pUILDING � <br /> tvfFCfCONSL�ILOW/iBIE 1VFEO�LOHSi.ACIUAI �rAxr hoppMLLi�uxas � <br /> tuwo pLUMf31NG � <br /> --r— <br /> SREOFBIDG. NOAi5i0BIES BASEIAENi MECHANICAL ' <br /> i <br /> I I VES !J NO — <br /> OCCU�ANCVLO�D FIl1ESPPNNlERSREOD MEIGIITIIMIiR110N OTIIER <br /> I I YES 1 1 NO STATG DUII.DING SURCHARGE <br /> (1En50NFOR5PPINNlEBS � T- <br /> STAiEENERGVSURCHARGE i <br /> nrrucnnorvncc.er PlANS/.PPqOVEDBV CITYOFEVERETT PUOLICWORKs ' <br /> LOCpL SALES <br /> TAX CODE IS 3105 �oTA� <br />