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. ... _ . ... :.:,., <br /> APPLICATIO.� FOR CONSTRUCT.JN PERMIT <br /> m,E„,ro„B� everett <br /> cm oF � <br /> �verett <br /> BUILDING DEPARTMENT <br /> �59-8810 TO Bt COMPLETED IN INK-PLEASE PRINT <br /> DEMOLITION U COMBINATION I I BUILDING I I MECHANICAL I I PLUMBING I_I SIQN <br /> OWNF.F O MAI�ADDRESS CITV ZIP PHONE <br /> '�AUL 57a��CE.� 2933 f�orXEFr:LC..> l �rj 98Z��/ / Z' <br /> Anv�57� M��A6S�cH �� G✓.:/.'_- 33f- 3 � <br /> TE-NA/M M�ILADDRE55 CITY ZIP PMONE <br /> �O�E� <br /> �RCHITECiORDESICNER MAILAODRE55 CITY ZIP PMONE <br /> /t/cwE <br /> �GENE ALCONTRACTOP MAILADORESS CITY ZIP Pi.ONE LICENSE� <br /> �,�J/l-Q.�...� <br /> MECMANICALCONTPRLTOfl MRILADDRE55 CITY ZIP PHONE LICENSE� ' <br /> /�mvE <br /> PLUMBIN6CONTRACTOR MRILADDRE55 �IN ZIP PHCNE LICENSE� <br /> 11/o.vE <br /> CUSSOF WORK � <br /> ❑ NEW ❑ ADDITION U ALTERATION f 7 REPAIR �DEMOLITION CI WOODSTOVE/FRPL INSERT ❑ BUILDING 9ELOCATION <br /> TENANT IMPROVEMENT OR MTERIOfl REMODEL ONIY CONTACT PERSON ANO PHONE NO. ' <br /> CONTMCT PRICE OF WOpN: � <br /> DESf.qIBE WORK�ND SOUARE FOOipGE INVOLVED <br /> PROPOSEDUSEOFBUILOING / I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS , <br /> _�EM OZ/Tio�y SFr� APPLICAT�ON AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL � <br /> LEWLOESCflIPTIONOF PROPERTY�SHOWN BELOW OR AT�qC 1 FOIIE�LOPIES) PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF . <br /> L0T1� BLOCK /r7,1,� pF r ,�-�c� WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. TNE GRANTING OF A PERMIT DOES NOT PRESUME TO OIVE ' <br /> /7 AUTfIORITY TG VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> I�I�� `�� Gi/ai?Q� OTHER STATE OR IOCAL LAW REGULATING CONSTRUCTION OR THE � <br /> ' PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY 7HE � <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH � <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTR RS LAW 18.27 qCW AND 296.200 WAC. <br /> SIGNAT EOFGONTR�CTOROflAUTH 12EDAGENT UATE � <br /> Z93o oA � <br /> 5 5�3 90 - 6 �- oi�-txx13 <br /> PRQIECTAODflESS <br /> P IC�NT ' S1 ES LILEN NO.AN I151NESSN4ME <br /> PLUMBING ME A CAL <br /> NO. TVPE OF FIXTURE OR ITEM FEE N0. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) � C—A/HNDLG UNITS—H.P. i <br /> BATHTUB ' FORCED AIF SYSTEMS—B.T.U. M E.A. � � <br /> UVATORY(WASH BASIN) � UNIT HEATERS—B.T.U. M ; <br /> SHOWER � CLOTHES DRYERS � � <br /> KITCHEN SINK 8 DISP ; VENTILATION FAN ' � <br /> DISHWASHBp � RANGE HOOU � ' <br /> LAUNDRYTRAY ; NIATERHEATER � . <br /> CLOTHES WASHER � WOODSTOVE ' � <br /> URINAI ' METAL FIREPLACE 8 CH�MNEY � ' <br /> JRINKING FOUNTAIN � FIREPLACE INSERT ' <br /> i <br /> FLOOR DRAIN HEAT PUMP � <br /> BACKFLOW PREVENTERS GAS PIPING ; <br /> ROOF DRAINS—RAINLEADERS EXHAUST FAN � � <br /> SINK(SERVICE—BAFl,ETC.� ; � � <br /> � <br /> i , <br /> � <br /> � <br /> � , <br /> SUB TOTAL $ ; SUB TOTAL $ ' � <br /> PERMIT $ � PERMIT $ � � <br /> TOTAL FEE $ ' TOTAL FEE $ � <br /> FPONTSETBACK PERNSETBACK SIDESETB�CK p�ANCNECNNUMBER FEE RECEIPTNO. <br /> USE20NE LOTRREA Vr1C�NTSITE FEES VALUATION FEE � <br /> ❑ YES ❑ NO BUILDING i <br /> lYPEOFCONSLAdOW�9LE TVPEOiCON51.ACI0AL ocavarKr xoawrtu�ucuxns � <br /> GPWP � <br /> PLUMBING ' <br /> � i <br /> SIZEOFBLDG. NO.OFSTORIES BPSEMENT MECHANICAL i <br /> n ves ❑ No , i <br /> OCGUPANCYLO�D FIRESPRNKlER5flE0'U NEIGIITLIMIT�TION OTHER � , <br /> ❑ YEE ❑ NO STATE BUILOING SURCHARGE � <br /> PEASON FOR SPRINKLERS � <br /> STATE ENERGY SURCHAFiGE i <br /> � t <br /> APPLICATIONACGBY PLANSAPPROVEDBY CITYOFEVEfiE1T PUBUCWORNS � � <br /> LOCALSALES � ; <br /> TAX CODE IS 3105 TOTAL � � <br />