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i <br /> � APPLICATI�.N FOR CONSTRUC7 .aN PERMIT <br /> everett <br /> �E��� e. <br /> CITV OF <br /> everett <br /> BUILDING DEPARTMENT TO BE COMPLETED IN INK—PLEA E PRINT <br /> 259•8870 <br /> ❑ DEMOLITION I.I COMBINATION I I BUILDING V ECHANICAL 17 PLUMBING ❑ SIGN <br /> ER M�ILADOFE55 CITY 21P PIIONE <br /> �Yd2n� SornU�/,b-Y� 2'13 D Pama�c�,�s P�I �d E�,�o�t �►`s2o3 �5•3u l�- <br /> TENANT �ILAOORE55 CIIV ZIP PIIONE <br /> ARCNITECTOROESIONER M�ILAUORESS CI7Y 21P PNONE <br /> OENER�LCOHifl11CTOH MARAODRESS CIIV 21P PMONE LIGENSEI <br /> MEGI�M1�CAlCONTRACTOR M�IL�DORE55 CI�Y� 21P � PHONE LICENS SUNLOWI�4fxT� <br /> �wn I.p K 1 �q ►g � '�4 R� �F- W�-I�Cland `30.3H 821 •N542� � <br /> PLUMBMOCONTMGTOR iMM1.ADDRE55 CITY PP PHONE IICENS / <br /> CLASSOF WJIIN <br /> I�1 NEW ll ADDITION �AITERATION I-I PEPAIR I I DEMOLITION I I WOODSTOVEIFRPLINSERT ll BUILDINORELOCATION <br /> ,� TENANT MAPROVEMENT OR IN7ERIOR NEM1OO,EI���N� GONUCI PEfISON�NO P110NE NO. <br /> I� CONIP�Ct PPICE OF YN11N: �`l�� •`�`� <br /> �I DESC111PEWOAKANOS1W,A,R�E�FOOUrOnE�INVOLVEO <br /> .i ^ � fi""N �"'�"" � <br /> !I d EOUSEOFBVI n+a I HEREBV CERTIFV THAT I HAVE READ AND EXAMINED THI9 <br /> '5,�� (�,JyyU,�� APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALl <br /> il iEw�oescnmrar�oFr rtr�s�iee�owon� c��rouncoriesl PFiOVISIONSOFLAWSAN00RDINANCESGOVERNIN(3THISTYPEOF <br /> WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> j; wt e�ocK oF NOL THE GRANTINO OF A PERMIT DOES NOT PRESUME TO(31VE <br /> � AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANV <br /> OTHER STATE OR LOCAL LA'N REOULATINO CONSTRUCTION OR THE <br /> � -- PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZEO 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 iB27 RCW AND 298.200 WAC. <br /> SiONATUREOFGaNtRnCTCROH�UTHORRE0�0ENT WTE <br /> y I�i.c� OZ-/03���2� /� " � /� -I� <br /> '� � PROJECTADOHE99 L ^ S�• ' "C • M+� • ' '�'_-- " ' <br /> lAiv�nA /�/� ��� APPLIC�NISCITYBUSINESSIICENSENO./�MOBUSMESSNAME <br /> vW!/wi Wll <br /> �;' PLUMBINO MECHANICAL I <br /> 1'. TYPEOFEOUIPMENT FEE <br /> .�i NO. TYPE OF FI%TURE OR ITEM FEE NO. <br /> �I WATER CLOSET(TOILET) � AIC—NHNDLO UNITS—H.P. � <br /> � FORCED AIR SYSTEMS—B.T.U. M E.A. ' <br /> ;I BATHIUB � <br /> LAVATORY(WASH BASIN) � UNIT HEATERS—B.T,U. M � <br /> + SHOWER � CIOTHES DRYERS � <br /> 1 i � VEN7ILATION FAN � <br /> KITCHEN SINK 6 DISP <br /> � i RANGEHOOD ' <br /> DISHWASHER <br /> LAUNDRVTRAV � <br /> WATER HEATER � <br /> , CLOTHES WASHER i WOOD STOVE ' <br /> 1 UflINAL ' METAL FIREPLACE 8 CHIMNEY ! <br /> FIREPLACE INSERT � <br /> DRINKINO FOUNTAIN � � <br /> 1 FLOOR DRAIN —!— HEAT PUMP � <br /> � ' BACKFLOW PREVENTERS ; 6I1S PIPING <br /> � � E%HAUSTFAN ' <br /> � ROOF ORAINS—RAINLEADERS <br /> SINK(SERVICE—BAR,ETC.) � � <br /> � — i <br /> — i <br /> � <br /> ;� _ � <br /> � i --�—i_� <br /> � —� � <br /> I ' i <br /> SUBTOTAL S ; SUBTOtAL S ' <br /> � � PERMIT S � PERMIT 5 I � <br /> � TOTALFEE E ' TOTALFEE S <br /> � � FRONTSETBACN REIPSETB�CN S��ESEIB�CN PUNCIIECKNUMOER FEE RECEIPTNO. <br /> { <br /> USEZONE LOTMtE� VAC/�NTSITE FEES VALUATION FEE <br /> i <br /> �� I I YES I I NO Bl1ILDING � <br /> �� ttPEOiLONSI.�IIOWABIE lYi'EOfCONSt.ACIWI �w"�r xouowlt�ixtVens — � <br /> � � rnwr pLUMBING � <br /> � 812E OF BL00. NO.OF S70PIE5 BASEIAENi MECHANICAL -. .IfF <br /> 1 I I YES I I NO ' <br /> , <br /> OCCUPANCYLOAD FlfiESPPHNLER5f1E00 �IEI611ILIMIIAIION <br /> OTIIER ' <br /> I-.I YES I�I NO SLATEUUILDINGSURCHARGE � <br /> �— <br /> ' PEA:ANFORSPpIN8LEB9 • � <br /> � SiATE ENEf7GV SURCHARGE ' � <br /> 1 I1VPlICAiIONACC.BY PUNS�PPIIOVEDBY CITYOFEVERETT PUBLICWORKS � <br /> LOCAL SALES � � _ <br /> TAX COOE IS 3105 iOTAL <br /> ''�Y� �;. i � .. ' . , ' . <br />