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' � I�,- � �..;;+ ;'•.••,. <br /> �� ��v APPLICATIOinI FOR CONSTRUCT��N PERMIIT <br /> everett <br /> Iho Evorgraan e <br /> CI7 V OF <br /> everett <br /> BUILDING DEPARTMENT TO BE COMPLETED IN INK—QL ASE PRINT <br /> 259•8810 <br /> f-I DEMOLITION ❑ COMBINATION f 1 BUILDING � i MECHANICAL ❑ PLUMBING ❑ SIGN <br /> OWNER MAl1.ADDRESS � CI7Y 21P �N NE .-+ <br /> ,�p l�� Y� ��� �C �l -�� �O� �v1QUi� lj Uc, c �� � <br /> �ENANi��\ "" • ' —_ M41LAUDf1[.5 CIiV ZIP PNONE <br /> ARCHIIECTORDE5IGNER MAILAODRESS CITV ZIP PHONE <br /> lEMLCO RGCTOR MARr1DORE55 1��`Y 21P P 0 E LICENSEt <br /> ', YALLEY NATU�AL GAS, INC �If y— L� ,I �I�1��.�)� � <br /> MECHRNICALC(N�iFACTOR�5�5 �'��g`S�3O� JAZ•Z�J4} CITY 21P �'PHO E LICENSEM <br /> 2605 McDougdl <br /> rwMmrmcornnncion � � nhn�t00 i1pD1 cuv zm rnor+e UCENSEI <br /> cinss oF wonK ^� ��–� <br /> I I NEW I-I ADDITION �CL.4N�HATION I J REPAIR l 1 DEMOLITiON ❑ WOODSTOVElFRPL INSERT ❑ BUILD�NG RELOCATION <br /> 7ENANT IMPROVEMENT OH INTENIOR REMODEL O�yNL�V CONTAGT PERSON AND PHONE N0. <br /> CONTRACTPRICEOFWORK: � �W <br /> DESCRIBE WORK ANO S U�RE FOOTAGE INVOLVED <br /> 2r��'�IJ�Y�tCQ °�- I� <br /> PROPOSE�USEOF� it wc �� I HEREBY CERTIFY THAT I IiAVE READ AND EXAMINcD THIS <br /> APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> �EG�L�ESC(i1PT10NOF PFOPERTY(SIIOWN BEIOW OR ATi�Cll FOUH COPIES) PROVISIONS OF LAWS AND ORDINANCES GOVERNING TFIIS TYPE OF <br /> WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> �oT o�ocK oF NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATI�G CONSTRUCTION Ofi 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 1 GOMPLY WITH THE STATE <br /> CONTRACTORS LAW 10.27 RCW AND 296.200 WAC. <br /> SICNAIU�EOFCONifiACTOf1011AU1HONREDAGENT O�TE <br /> PROJEGTFDDRE55 ` \ ��`-`� ����� � <br /> �� i /� , � \ � \ � APPLIC�NTSCIIVBUSMESSLICENSENO.ANOBUSINESSNpME <br /> ����/ ) <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF rIXTURE OR ITEM FEE N0. TYPE OF EOUiPMENT FEE <br /> WATER CLOSET(TOILET) � NC—A/HNDLG UNITS—H.P. _�_ <br /> BIITHTUB ; FORCED AIR SYST[MS—B.T.U. E.A. ; <br /> LAVATORY(WASH BASIN� � _ UNIT HEATERS—B.T.U. M _T <br /> SHOWEFi � CLOTHES DRYERS ' <br /> KITCHEN SiNK&DISP _�_ VENTILATION FAN � <br /> DISHWASIIER � RANGE HOOD � <br /> LAUNDRY TRAY ; WATER HEATER ' <br /> � <br /> CLOTHES WASHER � WOOD STOVE �_ <br /> URINAL ' METAL FIREPLACE 8 CHIMNEY ; <br /> DRINKING FOUNTAIN i FIREPLACE INSERT i <br /> FIOOR DRAIN —'— HEAT PUMP : <br /> BACKFLOW PREVENTERS ; GAS PIPING � <br /> ROOF DRAINS—RAINLE�DERS --�_ EXHAUST FAN � <br /> ---•— <br /> SINK(SERVICE—BAR,ETC.) ' � <br /> � <br /> � ' <br /> — —�+— <br /> � ' <br /> � — i <br /> � ' <br /> � ' <br /> SUB TOTAL S ; SUB TOTAL $ ' <br /> PERMIT $ � PERMIT S _�y�� <br /> TOTAL FEE $ ' TOTAL FEE 5 <br /> �RONTSE70ACN flEAflSETBACK SI�ESET�ACk PIANCHECNNUMBER FEE flECEIPTNO. <br /> VSEZONE LOTAREA ��CANTSITE FEES VALUATION FEE <br /> I) YES C1 NO BUILDING . ' <br /> IYPEOFCONS7.AllOWABLE 1YCEOfCONSI.AC1VAl OauruKr rwa�Dw[LuxGUHns i <br /> ��aP pLUMBING i <br /> SIZE OF OLD(3. NO.OF STOf11ES �ASEMENL MECII�NICAL \J )y/[/ <br /> I I YES I I NO �- <br /> � <br /> OCCUPANCYl0�0 FIRESPfiNKlER5PE00 NEIGIITLIMITATION OTHE(i � <br /> i <br /> I_1 YES I 1 NO S7A7E BUILDING SURCHARGE � <br /> � <br /> ❑E�SON FOR SPRINKLEBS � <br /> STATEFNERGYSURCHARGE � <br /> nrrucnnor�ncc uv a�nH;nernaveoor CITY OF EVERETT PUBLIC WORKS ' <br /> LOCAL SALES �� <br /> TAX COUE IS 3105 TOTAL <br />