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APPLICATIO� FOR CONSTRUCT:jN PERMIT �'`'<«'" � <br /> rm�e�,•.�icm TO BE COMPLETED IN INK—PLEASE PRINT � <br /> cirv oF <br /> ��� everett HEATING SYSTEM: ,' GAS ❑ELECTRIC U__ ' <br /> p � BUILDING DEPARTMENT <br /> G y 259-8810 <br /> DEMOLITION COMBINATION BUILDING �MECHANICAL PLUMBING SIGN <br /> ��, �,'� NNER M1IARqD�RESS � Cltt ZiP _ PHONE <br /> Ky � � �'fnrr�� �����7 F�K� i`�� �t �FV'e\ � �i,'>��n � �, �S �- �� � �� _ , <br /> ��,� <br /> T NT A1All ADDPESS CITY ZIP P��ONE <br /> � <br /> �tl �"��° �� �v� c� ('t¢a� .�7 ffZ"K°� �c Ce�eY-t � ������ �?S5 - ,�Y� <br /> � �� AqC1111ECTORDE5IGNER MRILADORE55 GITY ZiP PHONE <br /> �Z� (�T]j <br /> O�w H d�y GENERALCONiR/GTOR MAiLADDRESS CITY 21P PHONE IICENSE• <br /> M Lb V p�ry qp PMONE LICENSE/ <br /> �y (� AIECMANICALCONiRACTOF AIAIIADORE55 <br /> Y H� PLUMBINGCONTliAGTOR M4ILADDFE55 CITY 2iP PHONE UCENSE• <br /> t�� � <br /> N H — <br /> y H CL�SSOF WORN <br /> O Cy(A .I NEW 'i ADDITION �. � ALTERATION . REPAIR DEMOLITION , � WOODSTOVE/FRPL INSERT � �. BUILDING RELOCATIGi'1 <br /> 5 � CONTICT PERSON AND PHONE NO � <br /> � `�'� � /� <br /> � y(n CONiRACt PRICE OF 1VORK f��/[ i� <br /> O VJ OESCRiDE\YORN AND SOURRE FOOTAGE INVOLVED <br /> / �i C/� �nC `� �! �/�)CC <br /> PROPOSEDl15[OFBUILDiNG I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> ��.���/�, i����J� APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> IEGRL�ESCP�T10NOFPROPERttISHOW BELOWORATiACHFOURCOPIESI PROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTYPEOF <br /> ' WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> ior e�ock oF NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AUTHORITV TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORI2ED 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 7827 RCW ANO 296200 WAC. � <br /> SIGK4TUREOFCONTRACTOFORAULNOF4ED�GENT OATE � <br /> X � '� <br /> e � / , <br /> PRQIECTADDRE55 �/ , � /J �� / /• <br /> '�1 � � APPL NiSCiTYB}/SINESSUCENSENOANDBUSiNESSNAM ,' <br /> `'� ; 7 �'Ex-K��� "1 L= L'e' t'' _�_ ' <br /> PLUMBING MECHANICAL <br /> 1�' N0. TVPE OF FI7(TURE OR ITEM FEE NO. TYPE OF E�UIPMENT FEE <br /> WATER CLOSET(TOILET) A/C—A�HNDLG UNITS—H.P. <br /> f 1 BATHTUB FORCED AIR S`.'STEMS—B.T.U. M E.A. <br /> LAVATORY(WASH BASIN� UNIT NEATERS—B.T.U. M <br /> '�' SNOWER CLOTHES DRYERS <br /> f�• KITCHEN SINK 8 DISP VENTILATION FAN <br /> t DISHWASHEFi RANGE HOOD <br /> ' ' LAUNDFV TRAV WATER HEATEH <br /> � CLOTHES WASHER WOOD STOVE <br /> '�' UflINAL METAL FIREPLACE 8 CHIMNEY <br /> � DRINKING FOUNTAIN FIREPLACE INSERT <br /> 1 ' FLOOR DRAIN HEAT PUMP <br /> � BACKFLOW PREVENTERS GAS PIPING <br /> � ROOF DRAINS—RAINLEADERS � EXHAUST FAN <br /> '�1 SINK(SERVICE—BAR,ETC.) � i <br /> _ - T <br /> �' <br /> SUBTOTAL 5 SUBTOTAL S <br /> 1 PERMIT 5 PERMIT S � r UO � <br /> TOTAL FEE S TOTAL FEE S 'O� <br /> FOR OFFICE USE ONLY: , <br /> lPONTSETBACK PEARSET9ACK SIDESETBFCK PIANGNECNNUAlOER iEE RECEIPTNO <br /> useione LOTaPEA VACANTSITE FEES VALUATION FEE <br /> BUILDING <br /> tYPEGiCONISALLOWA9tE lYPEOFCONSiAGiOAI aN>�5[r r,aaLmauwuxil5 ' <br /> cacuo p�UM81NG <br /> Si2[OFBLpG. NOOFSTONIES BASEMENT MECHAtJICAL �h �� <br /> DCCUPANCVLOAD FIPESPRNNLERSREOU HEIGNTLIMIiATION ADDITIONALPLANCHECK <br /> � <br /> OTHER � <br /> _--� <br /> N[ASONFOfiSPRINNLERS <br /> STATE DUILDING SURCHARGE � <br /> INiARE 0Y PLANSAFP{IOVC�[IY CITY OF EVERETT PUBLIC WORK$ � <br /> � LOCRL SALES <br /> TAX CODE IS 3105 70TAL -j; <br />