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APPLICO.►TIt,rV FOR CONSTRUCTtOIV PERMIT , <br /> ���«« <br /> fhe Ernrgrorn � <br /> uTv or <br /> everett <br /> BUILDING DEPARTMENT TO BE COMPLETED IN INK—PLEASE PRINT <br /> 259-8810 <br /> DEMOLITION COMBINATION BUILDING �ECHANICAL PLUMBING SIGN <br /> uW�� R MAiL DRE�S L�TV 2 P � 11 O�E .���—^ r�� <br /> �a (] ��.C���� - 3 �� n �r-I�n.. �- `ti�� ��'� <br /> � ~ 1[NANJ.� n nnA 0 MAILALO ESS GITY 21P PMONE <br /> [[C' �0 <br /> C Y H _�� \ !Al Y <br /> ,� R� ��ry ZIP PMONE <br /> ABCMITECTORUESIGNER MAILAOORE55 <br /> N <br /> �� �� LiCENSE� <br /> y H G[ ERA NTRRCTOR MPI DiiES�' ^�)��� / ' �� I ,� ;n � !' `�HONE <br /> �C H O � / //// d-YI/ <br /> ,tl c.JS /+ Cl• I 1 u .t J <br /> A�ECMANICAI CO RACTOF 'M/tL AD�I1E55 /CITY / ZIP PMONE UCENS�� <br /> ro y ° A�iV� 153� �����1 <br /> � � � GIiY ZiP PHONE IICENSE• <br /> PWAIPINGCONiRACTOR AUILADDRE55 <br /> �l <br /> O F+ ppp <br /> � � p CLASSOF\YONI. . <br /> My� <br /> 75 NEW � ' ADDITION LTERATION � REPAIR �� DEMOLITION � WOODSTOVE/FHPL INSERT .-1 BUILDWG RELOCATION <br /> y y T[NANT IMPROVEMENT OR INTERiOR REAIODaEL ONLV CONTRCT PERSON ANO PHONE N0. <br /> F1 M CONTPAGTPPICEOFWOPK: � �V '�'� <br /> y H DESCFiIBE WOBR RND 011 RE FOOTAGE INVOI [� � I <br /> � d ti T ,�� �� - EhN� C�Q v� �-�t��1- — <br /> � � � PROPOSEOUSEOFOUIL � G � . I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> y N `�'�" , APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> 0 y PROVISIONS OF LAWS AND OROINANCES GOVERNING THIS TYPE OF <br /> LFGALOESCFIPTIONOFPROPERT'ISHOWNO[LOYIORATTACNFOURCOPIES� yyORK WILL BE COMPLETED WITH WHETHER SPECIFIEO HEREIN OR <br /> ioi B��K °F AU�THORI YRTO VIOLA�TEAOR CANCE�L THE PROVESIONS OF AINV <br /> OTHER STATE OR LOCAL LAW FEGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTV TO PERFORM THE WORK FOR WHICH <br /> ApPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br /> SIGNAtUREOFCDNiRPCTOROA/UTIIOViiZE�.\GENT ORTE <br /> X � ' �� ��� �t ' ���� <br /> PRQIECTAD�RE55 � (� � � ppp�CANTSCITYBUSWE55 ICENSEN .ANOBtI5MES5N4ME <br /> C�v I\��- � <br /> f� � PLUMBING MECHANICAL <br /> I ��, _ FEE <br /> _ NO. TVPE OF FIXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT <br /> - WATER CLOSET(TOILET) lvG—A.�HNDLG UNITS—H.P. <br /> 1 BATHTUB fORCED AIR SYSTEMS—B.T.U. E.A 1 <br /> LAVATORY(WASH BASIM UNIT HEATERS—B.T.U. M �_ <br /> �� CLOTHES DRYERS <br /> = � SHOWER � <br /> KITCHEN SINK 8 DISP VENTILATION FAN <br /> � DISHWASHER � RANGE HOOD <br /> ' LAUNDRYTRAY WATER HEATER <br /> �� i WOOD STOVE ' <br /> CLOTHES WASHER �— <br /> I _�' URINAL METAL FIREPLAGE 8 CHIMNEY <br /> DRINKING FOUNTAIN FIREPLACE INSERT � <br /> fLOOR DRAIN HEAT PUMP ' <br /> �� �1� BACKFLOW PREbeNTERS GAS PIPING <br /> � ROOF DRAINS—RAINLEADERS EXIIALIST FAN <br /> � SINK(SERVICE—BAR,ETC.) <br /> i <br /> � ,� � <br /> .�� � � —r— <br /> I � SUB TOTAL S 1 SUB TOTAL 5 'UU <br /> PERMIT 5 PERMIT S /S' � <br /> I ��� TOTALFEE 5 TOTALFEE 5 '� <br /> l� PLANCNECKNUMBEF FE[ RECGIPiNO. <br /> FRONTSETBRCK REARSETORCK SiDESET�RCH <br /> 115E20NE LOTARER VAGANTSITE FEES VALUATION FEE <br /> '' : YES � � NO BUILDING <br /> LYPEOFLONSI.ALLOWl9lE IYPEOiCONSt.AG1UAl OCcurera FadmntwnGuxnS � <br /> seccr p�UMBING � <br /> �--•— <br /> SIZEOFBIDG. NO.OFSTOFIES O45CMENT MECHANICAL �S �UU <br /> �. ' YES : � NO — i <br /> OCCUPANGYLOAD FIRESPRNNLEPSREdO HEIGNTLIMITATION <br /> OTHEP ' <br /> �._��. VES . � NO STATE OUILDING SURCHARGE � <br /> . ------� <br /> iiEA50N FOR SPRINI(LEPS <br /> STATEENERGVSURCHARGE <br /> pnP�iGATiONACG9V PlANSAPPROVEDOY CITYOFEVEREIT PU�LICWORKS <br /> LOCAL SALES �S � <br /> TAX COOE IS 3105 TOTAL <br />