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r � �� <br /> APPLICATI�N FOR CONSTRUC�r-JON PERMIT <br /> ffre Eve�green <br /> everett <br /> CIN OF � <br /> everett <br /> BUILDING DEPARTMENT <br /> 259-8810 TO BE COMPLETED IN INK—PLEASE PRINT <br /> fl DEfdOLIT10N I I COMBINATION I I BUILDING I I MECHANICAL I I PLUMBING ❑ SIGN <br /> OWNEN MNLADDRE55 CITY ZIP p110NE <br /> Lvt� l�ay 3ry•- /'�.�� r'� tu; tiyzu3 �2�i—ss�a <br /> TEN T MAILAUOIlE55 CI7V 21P PNONE <br /> �RCHITECT OR OESIGNER MAIL AO�RE55 CITV ZIP PHONE <br /> GENEFIILCONiRRCTOR MAILADDRE55 CI7Y 21P PIIONE UCENSE� <br /> MECN�NIC�LCONiRACT00 M�ILADDRE55 CIIY LIP PIIONE LICENSE� <br /> �1•w• Wn�Y �c��yl1•c �IIG_.�,_E�iG� LUi 5�101 ZS5 1331 A1�r�Lwl� l3') KT <br /> PLUMBINCCONiR�CTOR MAILADDfiE55 CIIY ZIP PNONE IICENSE� <br /> CLA55OF WORK <br /> . NEW I. 1 ADDITION I I ALTERATION I I qEPAIR I 1 DEMOLITION I I WOODSTOVE/FRPL INSERT [ I BUILDING RELOCATION <br /> ENANTIMPROVEMEN70RIN7EFIOBNEMOD�LONLY ���� CONT�CTPERSONANOPIIONENO. <br /> ` ��^� :� <br /> CONTP�CTPRICEOFWORN: J <br /> DESCRIBE WORN�NO SOUAPE FOOTAGE INVOW ED <br /> l.� iC L�r � G ���� <br /> PROPOSEOUSEOFBUILDI 1 HEREBY CERT�FY THAI' 1 HAVE READ AND EXAMINED THIS <br /> �lc �.a„, APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> LE6ALDESC TIONOFPfiOPERTYI NOWNBELOWORATTACHFOURCOPIES� PROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTYPEOF <br /> WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> �oT BLOCK oF NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANV <br /> OTHER STATE OR I.00AL LAW REGULATING CONSTRUCTION OR THE <br /> PEFFORMANCE OF CONSTAUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STAI'E <br /> CONTRACTORS LAW 18.27 RCW ANU 296200 WAC. <br /> SICN4IURE CONip�CiOflOR�U1HOflIZEOAGENT 0�1E <br /> X � <br /> PRQIECT�DDRESS I' «. � � CL <br /> 4-jf C� ��'iy %�/� MPLI NTSCIIYBUSMESSIILENSENO OBUSIN[SSNANc <br /> � i �- r � <br /> PLUMBINO MECHANICAL <br /> NO. TYPE OF FI%TURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) � NC—NHNDLG UNITS—H.P. � <br /> BATHTUB ; FORCED AIR SYSTEMS—B.T.U. M E.A. � <br /> LAVATORV(WASH BASIN) � _L_ UNIT HEIITEFS—B.T.U. M ��L ' <br /> � <br /> SHOWEP � CLOTHES DRYERS �— <br /> KITCHEN SINK 8 DISP ; VENTILA110N FAN ' <br /> DISHWASHER � RANGE HODD , <br /> LAUNDRY TRAY ; WATER HEATER � <br /> CLOTHES WASHER i WOOD STOVE ; <br /> URINAL METAL FIREPLACE 8 CHIMNEY � <br /> DRINKING FOUNTAIN i FIREPLACE INSERT ' <br /> FLOOR DRAIN � � <br /> HEAT PUMP —T <br /> BACKFLOW PREVENTERS ; G�S PIPING � <br /> ROOF DRAINS—RAINLEADERS �— E%HAUST FAN , <br /> _ SINK(SERVICE—BAR,ETC.) ; � <br /> � ; <br /> � , <br /> �— <br /> � ; <br /> — —r— <br /> SUB TOTAL $ ; SUB TOTAL $ ���— <br /> PERMIT $ � PERMIT $ ___. ��j�.'_ <br /> TOTAL FEE $ ' TOTAL FEE $ �i�`---- <br /> FPONTSElOACN IIEAfISEIB�CK SIOESETBr1CK PLANCHECHIll1M0Ef1 FEE RECEIPiNO. <br /> USEZONE �ornnen vncnr�rsre FEES VALUATION FEE <br /> I I YES I I NO BUILDING i <br /> TVPEOFCOHSLRLLOWABLF fYPEOftONSiACIUAL a[ureYcr xorMmvfu�xcuxns <br /> enar i <br /> PLUAIUMG � <br /> SIZEOFOLOG. NOOFS1001ES O�SEMEN� —�r�r <br /> M[CIIANIC�L � ��� <br /> I I YES I I NO -------- <br /> OCCUPANCYIO�D FIRESPONeLER5f1E0D IIEK+N�LIMIfr1110N O711ER i <br /> I I YES I I NO STATE BUILDING SURCHARGE � <br /> � <br /> oN ron srniNK�ens —�— <br /> STATE ENEf1GV SUfiCfIARGE � <br /> APPLICATIONACC.FIY rinNsnrrnoveonv CITYOFEVERETT PUBUCWORKS � <br /> LOCALSALES ' <br /> TAX COOE IS 3105 TOTAL ,� , �; -- <br />