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� � <br /> APPLICATIOtv FOR CONSTRUCTI�N PERMIT <br /> �E,�,�„�„ everett <br /> an oF � <br /> everett <br /> BUILDING DEPARTMENT <br /> 259-8810 TO BE COMPLETED IN INK—PLEASE PRINT <br /> i DEMOLITION COMBINATION ix BUILDING MECHANICAL PLUMBING : SIGN <br /> OWNER M�IL ADDRE55 CITY ZIP PMONE <br /> ���' � ���ADDfl���L �Ib PbL�lt'�lL 6A1� Z,�V�K.i'!(1' ai�N?�I ?1�-'1123 <br /> hM�IE <br /> 11PCMITEGTORDESIGNER MAILADDRBSS CItY 21P PHONE <br /> ���yAt���S gZo� E4Ptf b�►�� a1�r�Za3 2r-�1- OfX� <br /> GENERALCONTA GTOR MAILADDRESS GI—�� I PHONE LICENSE� <br /> �lFX✓LPOJ� (.oAIr3CK�G'rIQJ Cb P.0 P.d,c orSB �iv�i'�ri' di�lraob 25�1 9M!I 11C�ulA�L '�431.0 <br /> M[GHANICALCONTRqCTbR MMLADDRE55 CITY ZIP PMONE LICENSEI <br /> PLUMBING CONTR�GTOR M�IL AU�RE55 CITY 21P PMONE �ICENSE t <br /> CL�55 OF WORK <br /> I ' NEW xADDITION x ALTERATION �.-. REPAIR . � DEMOLITION ,.I WOODSTOVEIFRPL INSERT ��' BUILDING RELOCATION <br /> TEN�Ni IMPROVEMENT OR INTERInOR PEMODEJL,QNLY CONTRCT PERSON�ND PMONE NO. <br /> CONTRACTPRIGEOFWOPIt: / ��O � � �L �� <br /> DESGRIBE ORK AND SOUFRE FOO AGE INV ED <br /> ot.�/1�C H' o <br /> PROPOSE USEOFB �onc I HEREBY CERTIFY THAT I HAVE READ AND E%AMINED THIS <br /> APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> LEGRLDESCP TIOryOFPROPEFtY�SHOWNOELJWORARAGMFOURCOPIES� PROVIS�ONSOFLAWSANDORDINANCESGOVERNINGTHISTYPEOF <br /> WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> ior BLOCK oF NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT 1 AM AJTHORIZED BY THE <br /> OWNER OF THIS PROPERTY 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 /> SIGN�T A ORORAUTHORI2EDAGENT D�TE <br /> I��il-�j2 <br /> PFQI TADDRE55 "' 7/ b �_ <br /> � /_ � APPLIG�NTS CITV BUSI ESS UCENSE NO.AND BUSINE55 Nr1ME <br /> (J� <br /> PLUMBIN(i MECNANICAL <br /> NO. TVPE OF FlI(TURE OR ITEM FEE N0. TYPE OF EQUIPMENT ' FEE <br /> WATER CLOSET(TOILET) A/C—lVHNDLG UNITS—H.P. <br /> BATHTUB FORCED AIR SYSTEMS—B.T.U. ��I E.A. � <br /> LAVATORV(WASH BASIN) � UNIT HEATERS—B.T.U. M ; <br /> SHOWER � CLOTHES DRYEIiS � <br /> KITCHEN SINK 8 DISP VENTILATION FAN ; <br /> DISHWASHER RANGE HOOD �— <br /> LAUNDRY TRAV WATER HEATER ' <br /> CLOTHES WASHER WOOD STOVE <br /> URINAL ; METAL FIREPLACE 8 CHIMNEY <br /> DRINKING FOUNTAIN � FIREPLACE INSERT ; <br /> FLOOR DRAIN � HEAT PUMP �— <br /> BACKFLOW PREVENTERS ; GAS PIPING ; <br /> ROOF DRAINS—qAINLEADERS � EXHAUST FAN � <br /> SINK(SERVICE—BAR,ETC.) ; ' <br /> � � <br /> � <br /> � <br /> � <br /> SUB TOTAL $ ; SUB TOTAL $ ' <br /> PERMIT $ � PERMIT $ � <br /> TOTALFEE $ TOTALFEE S <br /> ���TB��' ' REARSETBAGK '�I SIDESETBRCK � '� PLANCHECK�UMBER �� ^�� �^ PECE�O�,' <br /> V O O o` <br /> USE Z LOT AREA . VqCANT SITE `./ �ES VALUATION FEE <br /> ^�� �. �. YES ;�`�O BWLDING <br /> TYPEOFCONS1AlLOWRBLE iYPEOiCON51.ALTUAI atunntt MCaoWEwNeuxns �7 �3� 318 / � �JO <br /> I GPOpo � <br /> . R l�� PLUMBING <br /> —.— <br /> 5!IEOFBLDG. NO.OFSTORIES BASEMENT MECHANICAL ��" <br /> t, '�� a ,�-Fes � ; n�o — <br /> OCGUP NCYLO(�0 FIRE RNKLERSREO'D HEIGPTLIMITATION OTHER "—'�— <br /> , ~J I . . YES � . NO STATE BUILDING SURCf1ARGE � � �) <br /> REASON FOR SPRINKLEFS <br /> U�L STAiEENERGVSURCHARGE —i— <br /> APPLICATIOKACC.BV PUN AP VEO BY CITY OF EYERETT PUBLIC WORKS �( �(1•',y� �.J/�.GI'�.�. <br /> // LOCIIL SALES ,, � <br /> l TAX CODE IS 3105 TOTAL / ',' � <br />