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APPLICATIC;�.�� FOR CONSTRUC7,�N PERMIT <br /> everett ' <br /> fM Everprex� e . <br /> CIiV OF <br /> everett <br /> BUILDING DEPARTMENT <br /> 259-9810 TO BE COMPLETED IN INK—PLE�A E PRINT <br /> ❑ DEMOLITION 1-1 COMBINATION IJ BUILDING V.YMECHANICAL I IPLUMBING ❑ SI(iN <br /> ' �p M111LADDRESS CIfY ZIP PHONE <br /> � nc.�nold (Lu�� 2�2� (�:u,-�c�J�p�lvd C��� q�sZo3 353 • 5�1�+55 <br /> iENANT MALA�ORESS QTY 21P C��ONE <br /> �RCHITECTORDESqNEF MAILI1DOflE5S CItY 21P PHONE <br /> OENEIiQCONTMCiOH M111LI1�UOE54 CIIY 21P PIIONE UCENSEI <br /> � MECIUWIC�LCON7R�CTOR M�ILA�DBESS CITY 21P PHONE LIGENS � <br /> �um I..o K 11�113 • t 24 A� N�e.. K.v�.klamd q`bQ3H 82� •N54�5UNLOWxl46T�1� <br /> �r�ur.rex�oca+tiucion u�a�ooness arv zir rrror+e uceNs � <br /> C1A39 OF WORK <br /> (.l NEW Cl ADDITION (XALTERATION 1 I REPAIR I .I DEMOLITION I� I WOODSTOVE/FpPLINSERT ❑ BUILDINORELOCATION <br /> iEIUNT MPIqVEMENT OR INiERIOR REMODEI Mr�I_Y r^� CONiACf PERSON AND PHONE NO. <br /> CONTMCT PPICE OF WOfIK: I lV (� ' v � <br /> /^' �DES�C`II►IB�E W011K ANO SLW�'R�,E,F�,O�OTr�OeE�INVOLVEO <br /> � r�sEouseaeviCoxro � I fiEREUY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> �,1 WMYII� APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> I LEMLOEBCRIPTpNOFP tvisi+ BELOWORA CHFWRCOPIES� PROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTYPEOF <br /> WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> �oi atxK oF NOT. THE GRANTINO �F A PERMIT DOES NOT PHESUME TO QIVE <br /> AUTHORITY TO VIOLATE OR CANCEL THE PROVI310N5 OF ANV <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> — PERFOFiMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BV THE <br /> OWNER OF THIS PROPERTY TO PEHFORM THE WOHK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLV WITH THE STATE ` <br /> CONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br /> 516NAtUREOFCIXJIMCTORORl1UTIbRIZEO��ENI DATE <br /> V,�.�� 02.o3"iz <br /> ��T,�,E� SAirr�R. Q/J Q.t�CriJ'e, X 5�{•oK 4nC . `-�l �-(L�LOD'n <br /> �PPLICANB CITV BUSINESS IICENSE NO.IIND BOSMESS NAME '1 <br /> ' PLUMlINO MECHANICAL <br /> � NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT ' FEE <br /> WATER CLOSET(TOILET) � /VC—A/HNOLG UNITS—H.P. � <br /> � BATHTUB ' FORCED AIH SYSTEMS—B.LU. M E.A. ' <br /> � UVATORY�WASHBASIN) ��_ UNITHEATERS—B.T,U. M i <br /> i SHOWER � CLOTHESDRYERS � <br /> KITCHEN SINK 8 DISP i VENTILATION FAN ' <br /> DISHWASHER � RANGE HOOD � <br /> LAUNDRYTRAY ; WATER HEATER ' <br /> CLOTHES WASHER i WOODSTOVE i <br /> URINAL ' METAL FIREPLACE 8 CHIMNEY ' <br /> DRINKINO FOUNTAIN � FIREPLACE INSERT ; <br /> FLOOR DRAIN � HEAT PUMP � <br /> ' 7ACKFLOW PREVENTERS i GAS PIPING i <br /> I �. _ ROOP DRAINS—RAINLEADERS �— EXHAUST FAN � <br /> SINK(SERVICE—BAR,ETC.) ' ' <br /> � ' — , <br /> � � <br /> , — � <br /> � � <br /> � � <br /> , — � <br /> SUBTOTAL S ; SUBTOTAL S 'C� ���� <br /> PERMIT S �— PERMIT S I � <br /> TOTAL FEE S ' TOTAL FEE S ' <br /> FRONTSETB�CN REAli5EI0�CK SI�ESETB�GK PLANGNECKNUMBEfl FEE RELEIPTNO. <br /> USEZONE LOTAflEl1 VRC�NTSIIE FEES VALUATION FEE <br /> I I YES I.1 NO BUILOING � <br /> MFOfCONST.AIWWAEIE lY{'EOFLONSf�CNAL acu^"KY MOaOwtluxoUNnf � <br /> cnar <br /> PLUMBING i <br /> SIZEOFBIW. NO,OFSI0RIE5 BASEMENf � <br /> MECNANICAL � <br /> I I YES I.I NO � <br /> OCCUPANCVIOAU FIRESPRNNLERSf1EOD IIEIGNILIMITATION OTIIER i <br /> u Yes t_i No � <br /> STATE BUILDING SUfiCHARGE � <br /> flEA50NFOR6PRINNLEPS • <br /> STATE ENEIiGY SURCHARGE i <br /> APPLICAt10NACC.BV PUNSAPPqOVEDOY CITYOFEVEflETT PUBUCWOflKS � <br /> LOCpLSAIES � <br /> TAX CODE IS 3105 ToiA� � <br />