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^ r- <br /> APPLICATIt�N FOR CONSTRUCTION PERMIT <br /> ,n,e„„o,,,e� everett <br /> �,TY��F e <br /> everett <br /> BUILDING DEPARTMENT <br /> 259•8810 TO BE COMPLETED IN INK—PLEASE PRINT <br /> ❑ [IEbIOLITION ❑ COMBINATION ❑ BUILDING ❑MECMANICAL (7 FLUMBING ❑ SIGN <br /> OWN��R � MAILMOf1E5S CITY ZIP PNONE <br /> /� ET �i�I�tNl�nt� /c4!S f r'a5' Lynnwron Ctl�. 7S15-4�F`a4 <br /> TENANT MAILAOdiE55 �ITY ZIP <br /> P��ONE <br /> A{iCHiTECTORPESqNER WIL�DDRESS Cf Y ZIP p�pp�E <br /> GENEMLCONTfl�1CTOfl 1MRMdiE55 CITY 21P PIqN[��- LICENSEI <br /> ����,e�( .I CoNoo Co�csf, / y3f ios�►;rsa, e�ar � 4eza�! �/N�ci/WL /,�� <br /> MEGHANIGILCONTRACTOi1 I.ML�DDHESS QiY ZIP PlIONE tIGENSE� <br /> P1111ABMOCONTRACTOR MAIL�ODqE55 CItY ZIP PIIONE LICENSEI <br /> ��a�s oFwaxc <br /> EW ❑ AODITION ❑ ALTERATION CJ REPAIR LI DEMOLITION I.I WOODSTOVE/FRPL INSERT L7 BUILDINO RELOCATION <br /> 7ENNlT�APIIOVEIAENT qi NlTERIOR REI'.00EL QIIY CONUCT PERSON O PIqNE N0. <br /> ��T��,�: � � � k� e 3�/ - z�8 � <br /> �RIBEWON(NASWAqEfOOTMJ .aVED <br /> ko►r� 357 . �h. <br /> raoroseouseoceuxorm . I HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED THI3 <br /> __�e 5 i ot��-y e I � APPLiCATION AND KNOW THE SAME TO BE TRUE AND CORRECt ALL <br /> lEOLLOEBCRIPTpN OF PROPERiV(6l/OWH BEIOW d711iTAC11 FWR GWIES� PROVISIONS OF LAWS AND ORDINANCES OOVERNINO THIB TYPE OF <br /> �or I3 �I� eiopc Z oF � a� WORK WILL BE CAMpLETED WITH WHETHER SPECIFIEO HEREIN OR <br /> NOT. THE ORANTIN6 OF A PERMIT DOES NOT PRESUME TO GIVE <br /> l AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> r c� n I OTHER STATE Ofl LOCAL LAW REQUUTINO CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.TMAT 1 AM AUTNORIZED BY THE <br /> .� � .� � � � OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> - APPLICATION IS MADE AND ! COMPLY WITH THE STATE <br /> CONTPACTORS LAW 78.27 RCW AND 296200 WAC. <br /> �I�v �UM15 U SqNATUflEOFCONTR�CTdiqi�UTHORREDl10ENT D�TE <br /> PROJECT WIXiES ///e�:%�GP" l � <br /> '/�/Z J `J � APPLIC�NTfiCITY �ME6SLICENSEIp.NNlUBk1ESSNiVAE <br /> PLUMBINO MECNANICAL <br /> NO. TVPE OF FlIITURE Oq ITEM FEE NO. TYPE OF EpU1PMENT FEE <br /> WATERCLOSET(TOILET) p � _ A/C-AIHNDLOUNITS--H.P. , <br /> Z- BATHTUB 6 ' - FORCED AIR SYSTFMS-B.7.U. M E.A. � <br /> Z UVATORY ASH BASIN) � , UNIT HEATERS-B.tU. M ; <br /> SHOWER � / CLOTHES DRYERS � <br /> KITCHEN SINK 6 DISP ; — ( VENTILATION FAN ' <br /> / DISHINASHER � � _ l RANGE HOOD � <br /> LAUNDRY TRAY � WATER HEATER � <br /> / CLOiHES WASHEH � — WOOD STOVE � <br /> URINAL ' � METAL FIREPL7ICE 6 CHIMNEY � - <br /> DRINKINO FOUNTAIN i FIREPLACE INSERY ; <br /> FIOOR ORAIN � HEAT PUMP � <br /> BACKFLOW PREVENTER3 ; QAS PIPIN6 � <br /> ROOF DRAINS-RAINLEADERS � E%IiAUST FAN i <br /> SINK(SERVICE-BAR,ETC.) ; � <br /> i i <br /> i i <br /> i � <br /> i i <br /> �— —T <br /> i i <br /> SUB TOTAL S S� i - SUB TOTAL i c " <br /> PERMIT f � PERMIT { -� <br /> TOTAL FEE S y '� TOTAL FEE S / '-� <br /> FRONT6ET&1CN PEAq6ETB11CK SIDESETB�CK PLANCNEGKNUAIDE9 FEE PECEIPTNO. <br /> 2- v 2v S c/G ���'���' 3c�9S <br /> use i L T AREA VACNIT SITE FEE5 VALUATION FEE <br /> � CXJU � , �YES I.J NO BUILDII�G i O-a <br /> TYPFOffANST./LLIOWAEIE TYPEOiCONSTACTWiL �' NoaowFuixaun�i - ' '3�v '; _ <br /> (/- �✓ (/_ AJ a°R'01"j � PLUMOING yS�i — <br /> _�_ <br /> 512EOFBlU3. NO.OFSTOi11E8 BASEMENT `/ MECHANICAL 9U � � <br /> 1�' } 1 J � ❑ YES lU NO ; � <br /> OCCUPANCYL D FIIIESPRNKLEPSI7EOD IIEIOHTLMITAIJQN � OTHEIl j <br /> ❑ YES ❑ NO �� S` ' <br /> d"�V STATE BUILDING SURCHAROE ��jj <br /> RE�SONFOiiSPRWKlEflB l- <br /> STA7EENERGVSURCHRRGE i <br /> APPLICATIOH ACC.BY PIANS APiROVEO BY CITY OF EVERETT PUBLIC WORKS 30 �^ <br /> LOCIIL SALES <br /> TAX�OUE IS 3105 TOTAI ? ��b <br />