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APPLICATIt�.� FOR CONSTRUCT �N PERMIT e���P�t <br /> the Eve�grenn TO BE COMPLETED IN INK—PLEASE PRINT � <br /> CITY OF <br /> everett -- ------- --- <br /> HEA�!^!G SYSTEM: IJ GAS ELECTRIC IJ ,_______ _______ <br /> BUILDING DEPARTMENT I------ ---- � <br /> 259-8810 <br /> I I DEMOLITION � � COMBINATION � fiUILDING � �MECHANICAL i i PLUMBING I i SIGN <br /> (Oy�.'N�ER / MAllA0DRryE55 CIIY / ZIP{ PIIONE ey <br /> Y/I��!/ ��i2c`�� �!C%��� a��, !`a i"(. ,�l��i1!'l7 /J�.�� �i(��� ..�i�! - S�i��/� <br /> � iEN�NT MAII RDf1BES5 d�Y ZIP PIIONG <br /> AqCH17ECTOR�E5IGNER MAILAO�R[5 CITY 21P PIIONE <br /> S1/� <br /> GENERALCONTRALTOR MRILR��RESS, CIiY 21P PH01lE LIC[NSEt <br /> S��il, <br /> MECH�NICPLCONTRACTOR MAILR�DRE55 CITY ZIP PIIONE LICENSEI <br /> PLUMBING CONTfl�CTGd MNl AODRESS QTY ZIP PHONE ULENSE■ <br /> CLASS Of WOflK <br /> I I NEW I I ADDITION !�ALTERATION i � REPAIR i I DEMOLITION I ! WOODSTOVE/FRPL INSERT I I BUILDING RELOCATION <br /> CONlnf.i 1'BNSOII ANO PI10NE NO <br /> LONTq�GT PRICE OF WORK '�(J U <br /> UESCRIBE WOflN AVD SOU�RE POOIDGE INVOIAED <br /> / /l / � 1 � <br /> � /7 S<t�0 1�� C '��/�. C J.!r��H A!/11.1J� $C`s- �'�- <br /> PROPoSEOUSEOFOIIII�INf � I HEREBY CEF:7IFV TI1AT I HAVE READ AND EXAMINED THIS <br /> S• � �p ,..�n� � /�� ��yi� ��;�, ,�, APPLICATION AND HNOW THE SAME TO BE TRUE AND CORRECL ALL <br /> IEG�LDES IPTIONOFPROPERTY1511 NOEIOWOHRT7ACHFOIIRf, iesi PNOVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTVPEOF <br /> � r / � � WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> �or� 1 eiocK �? oF I� 'I� �� (--e�l,x! NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AUIHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANV <br /> �J� �). /�% OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PEfiFORMANCE OF CONSTflUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPIICATION IS MAOE AND I COMPLY WITH THE STATE <br /> CONTRACTOp LAW 18.27 RCW AND 296200 WAC. <br /> SIGNRTUPEOF Tq�CiOflOH�lIT110HRE��GENT D�TE <br /> , <br /> I <br /> X , ` �f <br /> PRQIECTADDflES . ���� ' I�l�"" / _ �`� ^ <br /> q / ' � ' PPI .ANiSCIlY01151N65U ENSENO �NOBUSMESSN�ME <br /> V � <br /> PLUMBING ' M CHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TVPE OF EUUIPMENT FEE <br /> WATER CLOSET(TOILET) � A/C--A�HNDLG UNITS—H.P. � <br /> — --'--- -- -------- ---'— <br /> BATHTUD ; FOflCED AIR S`.'STEhiS��-B.T.U. M E.A. ; <br /> LAVATORY(WASH BASIN) � UNIT HEATERS--B.T.U. M I <br /> — — - --�— -- —T— <br /> SHOWER ; CLOTHES DRYERS <br /> KITCHEN SINK 8 DISP � VENTILATION FAN ; <br /> �— — --r— <br /> DISHWASHER RANGE HOOD � <br /> LAUNDRV TRAY ; WATER FIEATER <br /> CLOTHES WASHER —�— WOOD STOVE <br /> URINAL �_ __ METAL FIREPLACE 8 CHIMNEY ! <br /> DRINKING FOUNTAIN � FIREPLACE INSEFiT � <br /> FLOOR DRAIN � HEAT PIIMP � <br /> BACKFLOW PREVENTERS ; GAS PIPING ; <br /> ROOF DRAINS—RAINLEADERS � E%HAUST FAN <br /> SINK(SERVICE—BAR,ETC.) ' ; �� <br /> --- --- —� —— � I <br /> , , � <br /> T � <br /> _ _� � <br /> I <br /> 1 <br /> �r�. <br /> SUB TOTAL $ ; SUB TOTAL 3 <br /> PERMIT $ �— PERMIT $ � <br /> � —.— <br /> TOTALFEE S ' TOTALFEE $ ' <br /> FOR OFFICE USE ONLY: <br /> -- ------- _ __ _ _ -- --__— <br /> FNONTSETORLR ItEAHS@IOACK SIf1C5G70ACK 1'IAIICIIECRNIII.IOCR fCE RECEIPTNO <br /> usezoNE LOTPfiEA VnLANT51iE FEES VALUATION FEE <br /> T <br /> 131II1.01NG � � � <br /> - '�O_. _ /S � nA <br /> IYFEOfCONISAIIOWh��F IYPLOfGNI51Af.11lq on.uwcn uu�xlmulnmuNus -------�--- - �---- - — i <br /> cmum Pll1MBING ' <br /> y,� V-�� �. 3 __ I--- -;- <br /> SIZEOFBIDG NOOFSiORIES OASE�IEII� ��ECIIANICAL � <br /> .AL C�IG —� o � <br /> OLCUPRNCYLORD FlOESPflNNlEOSRE�'0 IIEIfI1T1I1.11TA710N ADDITIONALPLANCHLCK 'J �7 S� <br /> i <br /> uJ OThIER � <br /> RE�S FORSPNINNI.ERS <br /> S7ATE Bl11LDING SURCHAIiGE � i� <br /> INTRNLBY PlANSAPPROVED9Y CITYOFEYEREIT aueucwonKs � <br /> /I� LOCAL SALES � <br /> �r ��3,�j� TAX COUE IS 3105 TOTAL � q � � � <br />