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�::>a'. <br /> APRLICAZ �ON FOR CONSTRUtr ►10N PERMIT <br /> everett <br /> IDe Ererg;Qen � <br /> H c� arv oF <br /> ��� everett <br /> > y BUILDING DEPARTMENT <br /> q � H 259-8810 TO BE COMPLETED IN INK-PLEASE PRINT <br /> � y y DEMOLITION COMBINATION � BUILDING MFCHANICAL PLUMBhIG Q�' SIGN <br /> ~�'� OWNEF IAARADDPE55 CITV Z�P ^HONE PJ��-�s `-� <br /> rye e~i 1.5'3�.� a�..Tv �n�..- SLc� � 4b�-r Of�,ic..��,P.le.fl `i�'z �6 <br /> �� e4t�� l, <br /> �H � j�. MAiL/�DpRE55 LiiY ZIP PMONE ��.6-YJZ3-��"�O <br /> N H Q���-L-c E.vG�v`�r.,�e-b lc-o� �..,. vAus� �iwti. � �lnl A�-u�� �..�� ��1. _ <br /> y z � �ARCNRECT DR DESIGNER MAIL RDDR 4c clTr Zi'r ��vfiE fp-c-�ii-i..z a.rJZ.�. <br /> �OH d ��. _�rT. 'i10� C. ST w�6 A.�x..� �a,L '�S3- I�x� <br /> �y �GENERALCOMTR�CIDH M0.iLADDflE55 GiPv ZiP PHONE UCENSE� <br /> ~ � `" CIfY ZIP PMONE LiCENSEt <br /> (�]� Q MECHANICRILONiRACTOR M�RJ1pORE55 <br /> z H �ay ,Z PIUMBINGGONTflALTOR MRILAD�FE55 Cltt 21P FMONE ��CENSE� <br /> �� <br /> r+ H <br /> � LL4550F WORN <br /> H <br /> O C57 p� xNEW _. AD�ITION ' �. ALTERATION �. : REPAIR �. �. DEMOLITION I-�. WOODSTOV6FRPLINSERT .-! BUILDINGRELOCATION <br /> �C] C'� TENANTIMPPOVEMENTORINTERIORREMO� LONIY � CONTRCiPERSONANOPNONENO. <br /> i <br /> ' LLNTq�CT PRILE OF\YORN: <br /> zH �n <br /> y � � DESCRIBEWOFKANOSOUl.REf00iRGEIN OLVED <br /> '�,3 _ o <br /> eaoaos[ous OFBUILDING I HEREBY CERTIFY THAT I HAVE READ AND ERAMINED THIS <br /> i APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECL ALL <br /> L[WLDESCl11PTIONOFPROPEFN�SMOWNBELOWOR�TT�CHFWFGOPIES) PROVISIONSOFLAWSANDORDINANCESGOVERNINGTNISTYPEOF <br /> WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> �or e�ocK oF NOT. THE GRANTING OF A PEFMIT DOES NOT PRESUME TO GI\'E <br /> AUTIiORITY TO VIOLATE OR CANCEI THE PROVISIONS OF A�VY <br /> �C�����„����'f'1 OTHER STATE OR LOCAL LA1V REGULATWG CONSTRUCTION OR THE <br /> _i��y L<-- PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORI2ED BV THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR 6YHICH <br /> APPLICATION IS MADE AND I COIdPLV WITH THE STATE <br /> CONTRACTORS LAW 1827 RCW AND 296.200 WAC. <br /> SiGNAIDREOFGONtRACTONORRUt110Ri2[DRGCNt DAL[ <br /> 35a(`) X �, � �'� 6/8�90 - <br /> '�1 PRCJECTADDRESS — <br /> �PPt IC 4IIT5 GIIY�VSINE55 LICUiSE NO hND�OSP1F 55 t1nME <br /> '_' PLUMBING MECHANICAL <br /> NO. TYP[OF FIXTURE OR ITEM FEE N0. TYPE OF E�UIPMENT FEE <br /> ��t _ WATER CLOSET IiOILET) A C—A�HNDLG UNITS—H.P. _ ___ <br /> BATHTUB FORC[U AIR SVSTEMS—�.T.U. 1.1 E.A. <br /> ' ' LAVATORV(WASH BASIN� UNIT HEATERS—B.T.U. M <br /> SNOWER CLOTHESDRYEFS <br /> ' NITCHEN SINK 8 DISP VENTILATION FAN <br /> ' DISHWASHER RANGE HOOD <br /> LAUNDRY TRAY WATER HEATEii <br /> ClOTf1ES WASHER � WOOD STOVE <br /> 1 URINAL i METAL FIREPLAGE 8 CHIMNEY <br /> � DRINKING FOUNTAIN � FIREPLACE INSERT <br /> FLOOR DRAIN HEAT PUMP <br /> BACKFLOW PREVENTE9S GAS PIPING <br /> � ROOF DRAINS—RAINLEADERS � EXHAUST FAN <br /> �'' SINK(SERVICE—BAR,ETC.) � <br /> � ' <br /> � — <br /> �� SUBTOTAL S SUBTOTAL 5 <br /> - PERMIT $ PERMIT $ __ <br /> TOTAL FE[—S1 � g —� <br /> FPONiSETBRCN R[f.R5ET9ACK 9DESETBRCN PLANCMLCHNUIfBER F[�/, 1� /.y EGEIPiNJc�� � <br /> /.� �c'r. 3 0 <br /> D �yF / <br /> USE20NE lOTAP[A VACANTSRE � FEES N FEE <br /> '-; VES '.—� N� BUILDING ��y J��3 �3J C/0.�� ��� � <br /> tYPEOiLONSi.AILOWBLE 7YPEOiLONSTPtjUAL a�u���ucv xoo�wrtwimu'���5 <br /> 1/ //� ' � / �'/°�Q PLUM�ING <br /> ,� <br /> 512EOFBLDG. (J � NOAFSiOFIES BAS[MENT MECHANICAL <br /> ��i U �. � vEs D(No � ; <br /> OGGUPRNCVLORD FIRESPRNKLER�S/RE00 HEIGHTLOdIiRTION OTHEfl �__ <br /> �3O .._iYES �aNO STATEBUILDINGSURCHAA3E iSO <br /> RERSONFORSPRINNLEPS <br /> STATEENERGVSURCHARGE <br /> n�r�ucnnor+acc ev au s vPROVEDBY CITY OF EVERETT PU�LIC WORKS <br /> 1�� LOCAL SAlES � <br /> l TAX COUE IS 3105 TOTAL <br />