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i <br /> pPPLiCAT'rOh FOR CONSTRUCTet,�N PERNiIY ���«" <br /> TO BE COMPLETED IN INK—PLEASE PRINT �� <br /> me Eveigrea� " <br /> CITY OF � <br /> ��,y� everett HEATING SYSTEM: GAS ❑ELECTRIC ❑ <br /> � � � , BUILDING DEPARTMENT <br /> Q> H 259•8810 <br /> t" � y ' DEMOLITION �(,COMBINATION �BUILDING ❑MECHANwAL ,PLUMBING � I$1 GN <br /> PNONE / <br /> H '�' OWN A1A'.LADDRESS GITY � ZIP �O � <br /> K y� �i�n�t rK ��dus ., �'. �IUzo n�,;,, ;��� Z�P '�-��-�"I�J �Z�Z �'3�/��Y <br /> � PHU E <br /> O�H O� IEN�NT NAIIiWORE55 <br /> � <br /> y ABLHITECTOROESIGNER - 'dAILAD�RE56 CRY ZIP FH09E <br /> o� d D1� Qr�E�nina >S'���;� L�IA� ���- l7Zy, <br /> GEN �LCONTPRGTOR MPiLA�DFE55 C�TV � ZP PNC c LILENS'• <br /> H �, � �i�U�rk .�icfus T�'Um �1�97J"Fl <br /> 4']� O MEGHANICALCONTFACTOR MAILADDFESS CITY 21P PNO�E ULENSE <br /> � y� CITV ZIP PHONE LIGENSE• <br /> C PLUMO�NGCONTRAGTOR MAIIA�DRE55 <br /> l� <br /> HH <br /> g �' <br /> � �y C $OFWOflK <br /> . NEW ❑ ADDITION ❑ ALTERATION ❑ i7EPAIR ❑ DEMOLITION ❑ WOODSTOVEIFRPL INSERT G BUILDING REIOCATI N <br /> �5 [+ CO TA R50�lNiDRNONENO. r�C `—j��/��J/ <br /> P� [s] ��i-�=� �ll i�C� `�J �'J • �.� �..�_— <br /> y HO y COHLRACTPNiGEOFN'Ol18 Or— <br /> OESCRiBEWOANANpSOUAREF00TAGEINVQLVED .�� �(�27 ��� 3S3-y��)j <br /> � � / . <br /> PROPOSEDUSEOFOU:LDI � I HEREBY CERTIFY THAT I HAVE READ AND EXAAIINED THIS <br /> / � n J APPLICATION AND KNOW THE SAh1E TO BE TRUE AND CORRECT.ALL <br /> 5 r �ROVISIONS OF LAWS AIJD ORDINANCES GOVERNING THIS TYPE OF <br /> �Ec��oE RIPTiONOFVROPERTV(SNO HBELOWOR Tf�GMFWRCOPIE51 ..��� WORK WILL BE COh1PLETED WITN WHETHER SPECIFIED HEREIN OR <br /> �oT , e�aK oF 4 NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AUTHOFITY TO VIOLATE OR CANCEL THE PROVISION$ OF ANY <br /> ' OTHER STATE OF LOCAL LAW FECULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTPUCTION.THAT I hM AUTHORIZED BY THE <br /> ' OWNER OF THIS PROPERTY TO PERFOFM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> '� // CONTRACTORS LAW�2?RCW AND 29620U WAC. <br /> S�GNRUREOFCONTMCIOROHAuiHON2EDAGENT] Da1E <br /> i <br /> � /��.r//,`1—�J/-'L G <br /> �. S�C�a 1�'�z rt�r�eu� �n� cX:-::�����j�`l.�`'�-=- <br /> '_1 �QIECTADDFE55 �'qppLlC�'�iSCITYB115�NE55UCEH5EN0.AN�BU51NE55NAME <br /> 1 ' PLUMBING MECHANICAL <br /> � NO. TYPEOFFIXTUREORITEM FEE N0. TYPEOFEOUIPMENT FEE <br /> � WATER CLOSET(TOILET) A/C—NHNDLG UNITS—H.P. <br /> f 1 � BATHTUB FORCED AIR SYSTERIS—B.T.U. h1 E.A. <br /> ' ' '3 LAVATORY(WASH BASIN�. �� UNIT HEATER9—B.T.U. A1 <br /> � SHO\!ER � / CLOTHES DRYERS <br /> '�1 / KITCHEN SINK S DISP i VENTILATION FAN <br /> OISHWASHER �7 � RANGEHOOD <br /> 1j �LAUNDRYTRAY ; WATERtiEATER <br /> � CLOTHES WASHER � N'OOD STOVE _ <br /> AtETAL F;9EPlACE 8 CHIMNEY <br /> � URINAL <br /> i�' DRINKING FOUNTAIN i FIREPLACE INSERT 1 <br /> FLOOR ORAIN � HEAT FUh1P -'`-'�_ <br /> .� ' GAS PIPING � <br /> BACKFLOW PflEVENTERS � <br /> �1 ROOF DFiAINS—RAINLEADEflS � E%HAUST FAN _ <br /> � SINK(SERVICE—BAR,ETC.) � � ' <br /> 1 <br /> ` ' SUBTOTAL S / '"• SUBTOTAL 5 � <br /> ' PER611T S PERId1T S <br /> TOTALFEE S TOTALFEE 5 <br /> FOR OFFICE USE ONLY: a¢ceiai No. <br /> FNOIRSETBACN AEARSETBAGK�� . SI�ESET9AGK PLANGNECNNUMdEN FEE , <br /> 2t7� Gu fi�:�i �Pr1� Jr �7 6 �iv � 7i�6'�Si <br /> useza+e LOTAREA v�cu+isrte PEES VALUATION FEE <br /> �- � 81�5 E BUILDING Q � ` �(� — <br /> iYPEOf NiS.AIION'A6lE fYPEOiCONSi.AL70Ll �o� ���'����µ�L�1� p�UR781NG ��� ' <br /> �/ <br /> SREOF9LDG. N0.0=510RIE5 B.ISEMENT MECHANICAL <br /> /�y� SFt Z �p ; <br /> 6' S �/� AODITIONAIPIANCHECK � <br /> OCCUPl.NGYlOAD iIRESPRNNLERS�!WD NEIGHTI�G��TRTiON <br /> � NC� OTHER <br /> f�EA50�i0R SPRINNLERS <br /> S7ATE BUILDING SUFCHARGE � �'i� <br /> wTANEPY PlN15MGPOVEDOY CITYOFEVEflEIT PUBLICWORK$ �D � � <br /> LOCAL SALES <br /> J� g Zi 9L T�CODE IS 3105 TOT^� -�; <br />