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i <br /> APPLICATI4�� FOR CONSTRUCT.JN PERMIT <br /> everett <br /> Ihe Eve�preen � . <br /> CI7V OF <br /> everett <br /> BUILDING DEPARTMENT Tp BE COMPLETED IN INK—PLEA E PRINT <br /> 259-8810 <br /> �7 DEMOLITION I I COMBINATION I I BUILDING P ECHANICAL I I PLUMBING ❑ S�G 4 <br /> /AAIL ADDRE55 � CIIY ZIP PIIONE ��^„� 355• 5 ZZ`� <br /> WNER ( (jl �C� �.U.�JIQ� C V <br /> „r YJ 1 n RDJ)�. ?(07 9-� 1'(vYl U 1/11� " r��oNe <br /> V11�:. — cnr zm <br /> � ^N� MNL�DDf1E55 <br /> ARCHIIEGTOf1DE5IGNER MAILRDDRESS <br /> CIIY ZIP PHONE <br /> Z�P P110pE LICENSE� <br /> GENERALCON7RACTOII <br /> M�IL ADORE55 ���Y <br /> CIIV. 21P PIIONE LICElIS � `` <br /> MEC�����IC�LCOH70�CTOR MNL�DORE55 1�I��y�� q�(]'.�� 821 'H54 SUNI�W��y��/ <br /> �um I.,,o K I I�l 15 . t 24 �� NE- �,�� w' '=,P -" PIIONE LIGENS I <br /> PLUMBINOCONiRAC70f1 MAILAO��ESS <br /> GUS50F WOPK <br /> I:I NEW ❑ ADDITION IxALTERATION I.I REPAIR f 1 DEMOcI�'+'�cr Pensor+nr+o�ri or+eOo�FPPL INSERT U BUILDING PELOCATIO <br /> TENANiIMPROVEMEIlTORIq7ERIOfiREM��EIM+�Y , � — <br /> !n l(% <br /> CON70ACTPRICEOFW011N W3 <br /> ^^,DE.9�Cnlf1_ .FWO�K��^N�SOII^nEF00^^T^��NVOlVEO <br /> 1 �I"�Y�` �j.:.Vl h^.�_��_. <br /> P�rose0U5EOf8Ul0�N0 I HEREBY CEHTIFY THAT I H�VE READ AND E%AMINED THIS <br /> q; � ��.�� _ APPLiCATION AND KNOW THE SAME TO 9E TRUE AND CORRECT.ALL <br /> i J'V PROVISIONS OF L�WS AND ORDIN�NCES GOVERNING THIS TYPE OF <br /> LEOAI.OF.SC�IPTIONOFPA irtrl5u oeiowonn i cnrouncoriesl WORK WILI BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> ior BLOCN oF NOT. ThiE GRANTING OF A PERMIT DOES NOT PRESUME TO OIVE <br /> AUiHORITV 70 VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> PERFORMANCE OFOCONSTRUCT ON.`TH TG AM AUTHORI ED BY THE <br /> — O\NNER OF 1NIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> �PPLIC�TION IS M�DE AND I CO�dPLY WITH THE STATE <br /> CONTR�CTORS LAW 18.27 flCW AND 296200 W�C. <br /> S�G��p1U11EOFCONtIIAC�OROR�UT��ORREOAGENT O�IE <br /> 4,�.c� O Z-D 3r1 Z <br /> '^ X 5ufp {,oK.. 9'nC • ` '�-x1�1 `�(1-°�!'o0'n <br /> PRQIECT�0011E59 !�^__„^ /j/� /j �/�(� /y �PPLICANi5C�1Y0U51NE55LICEN5EN0.AND0U51NESSN�ME <br /> 1 `J(,U�1U(. W�J �..c.�vvv v <br /> MECHANICAL FEE <br /> I � pLUMBINO FEE NO. TYPE OF E�UIPMENT <br /> � � Np, TVPE OF FIXTURE OR ITEM NC—IVHNDLG UNI7S—H.P. '-- <br /> ' � WATER CLOSET(TOIIET) ' <br /> � = FORCED AIR SYSTEMS—B.T.U. M E.�. <br /> � BATHTUB ' ' <br /> � UNIT HEATERS—B.T.U. M �-- <br /> � LAWTORV(WASH BASIN) ���--- CLOTHES ORYERS � <br /> � <br /> SHJWcR � VENiILATION FAN �---�—r— <br /> KITCHEN SINK&DISP ' ' _ <br /> DISHWASHER � _ RANGE HOOD � <br /> � WAIER FIEATER , <br /> LAUNDRY TRAY �—i—'— yrOOD STOVE � — <br /> CLOTHES WASHER � — � ' <br /> � METAL f-IREPLACE&CHIMNEY <br /> URIN�L � FIREPLACE INSERT �'-- <br /> DRINKING FOUNTAIN ' ' — <br /> �— NEAT PUMP � <br /> FLOOR�RAIN �=T GAS PIPING --�—t--' <br /> BACKFLOW PREVENTERS � J E%FI�UST��N � <br /> ROOF DRAINS—R�INLEADERS — ' <br /> � <br /> SINK(SERVICE—BAR,ETC.) �.}--— _�— <br /> — � i <br /> __ ���— _ <br /> i � <br /> � � <br /> — i � <br /> �— � <br /> i <br /> � SUB TOTAL $ O ' <br /> SUB TOTAL $ �_ — — pERMIT S I�' <br /> — PERMIT S _�.;_ — 70TAL FEE S ' <br /> '— TOTAIFEE S FEE RECEIPTNO. <br /> FOONISETOACK REARSE7�ACK 90E SE7��CK <br /> pLAN CHECK NUAI�ER <br /> VALUATION FEE <br /> USE 20NE LOT Af1EA <br /> vncaNr site FEES � <br /> Il YES I I NO BUILOING �— <br /> � <br /> ttcurrvn xoaow�ui�uxns i <br /> IYPEOICONST.ELLOW�BIE 7YPEOFCONSi.ACN�L �qar PLUMBING � <br /> ���� <br /> � <br /> i <br /> SIZE OF�LDO. NO.OF S10RIES B�SEMENi MECHANICAL � — <br /> I I YES I I NO ; <br /> ortien — <br /> OCCUPRlCYICAD fIf1E5P(INNLEOSf1EOD HEIGII7LIMIINION i <br /> I_I YES I I NO S1ATE OUIl01NG SU�CHARGE � <br /> i <br /> REn50Nron5PnINNLEnS ' STATEENFf1GY5URCHARGE � — <br /> � <br /> i <br /> APPL'CAf10NACC.BY PLANS�PP(10VEDOY CITYOFEVERETT PUDLICWOIIKS � <br /> LOCAL SALES 70TAL � <br /> TAX COUE IS 3105 <br /> � <br />