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APPLICATI4N l�OR COPISTRUCI rON PEF�MIT <br /> everett <br /> �h��,�,�a,�.�� e <br /> CITY OF <br /> eyerett <br /> BUI�DING DEPARTMENT TO 6E COMPLETED IN INK—PLEASE PRIIJT ' <br /> 259-8810 � <br /> DEMOLITION COMBINATION BUILDING MECHANICAL �jPLUMBING SIGN <br /> ��Eq MAiLADDAESS <br /> urv z�v rNCH[ - ,�� J Co <br /> � � � � 1 ;N ,q �� i11� � ,� , N 1=v� R � �;� �t5����5 P��35 3 -- <br /> IENANT <br /> Mqit�ODRE55 �TY Z P <br /> ARCMiTEGTOBDESIGNER MAILl�DDRE55 <br /> Crty ZIP PNONE <br /> G[NERALCOtITN�LTOR MMLAOORE55 CiN ZIP PHONE LIGENSE� <br /> H C�H Cltt ZIP %�ONE LICENSE� �-- ' <br /> .T. C� �) MEGNRNIG�LCCNiRRGTOR M�IL�DDRE55 <br /> �t� �Z� <br /> � H vHONE LICENSE� <br /> r��i <br /> PWMOINGCONf CTOH MRILADDRESS <br /> cm ziv <br /> � 'y'y�''� �w���� <br /> �-{ �'� CIJ�SSOFWORK � � <br /> K n NEW . ADDITION ALTERATION �,REPAIR . DEMOLITION WOODSTOVE'FRPL INSERT � BUILDING RELOCATION <br /> O r�i O TENANI iMf HOVEM[NT OR INTER�OR REMODEI ONLV LONIACT PERSON RNO PMONE NO. <br /> ��"� � COMF�CTPRiCEOPWORN: <br /> y~ DESCRIBE WORK AND SOl1ARE FO�TaG[INVOLVED � � <br /> ��� ��)���'C� IIY� Ef� l ,Ll2l� / � , <br /> �.�. d rnoP E�useorew�oiH:; I HEREBV CEPTIFY THAT I HAVE READ AND EXAMWED THIS <br /> �_,lr� APPLIGATION AND KNOW THE SAME TG BE TRUE AND CURRECT.ALL <br /> M <br /> 1� PROVISIONS OF LA1NS AND OFDINANCES GOVEFNING THIS TVPE OF <br /> p.� pq g iE�A�oEscRiPTANOFF;,o�catvi5�owueE�owoa�n�cHvouAcoPiEsi WORK WILL BE COIAPLETED WITH WHETHER SPECIFIGD HEREIN OR <br /> �` n oF NOi THE GRAN1lNG OF A PEFMIT DOES NOT PRESUIdE TO GIVE <br /> H �p7 BLOLY: <br /> SxS y AUTHORITY TO VIOLATE OR CANCEL THE FROVISIONS OF ANV <br /> �y OTHER STATE OR LOCAL LAW REGULATWG CONSTRUCTIGN OR THE <br /> �„� y PERFORIdANCE OF CONSTRUCTION,THAT I AM AUTHOR12ED BV THE <br /> ty �A OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> ��y APPLICATION IS MADE AND 1 COMPLV WITH THE S7ATL <br /> � CONTRACTORSLAW 1927RCW AND296200WAC. <br /> � S�GNALUN[OFC,04iMpON09AuiHORIT[�>�+�M1'T P�.�E <br /> Oy / �� ,/ <br /> w X �Ja,Cl�cttiK. �< < < iG�1.:_« <br /> � PROJFGTR�DRE55 ��J.t,�ULA TSGivBU5i4,351ir��A�0il5�NE5SN4pE __ <br /> / <br /> I PLU BING � ` MECHANIC4L <br /> 1 NO. TVPE OF FI%TURE OR ITEM <br /> FEE NO. lYPE OF EOUIPMENT FEE <br /> I �� – WATER CLOSET ITOILETI — `'_ _ — f`�=A'HP�DLG UNITS–NP. - - <br /> BpTHTUB F'1RCE0 AIR SYSTEMS–B.T.U. M E.A. <br /> LAVATORY�WASH BASIN� <br /> c' �', �NIT NEATERS–O.T.U. M <br /> �� CLOTNES DP.VERS <br /> SHOWER – ' <br /> � KITCHEN SINK 6 DISP _ VENTILATION FAN T. <br /> � DISITYlASHER _ RnNGE HOOD <br /> i� �� WATER H[AT6R <br /> � LAUNDRY TRAV � WOOD STOVE <br /> ' GLOTHFS WASHER ' —. <br /> — � METAL FIREPLACE 8 CHIMNEV <br /> URINAL ' <br /> FIREPLACE INSERT _T_ <br /> ORIYHING FOUNTAIN – � <br /> I �� FLOORDRAIN _ HEAi PUMP <br /> BAGKFLOW PREVENTEPS i GAS PIPING <br /> ROOF Di7AINS–RAINLEADERS ExNAUST FAN <br /> � SINK�SERVICE–BAp,ETC.) � <br /> _'�� <br /> �1� � <br /> i <br /> \' � � <br /> SUB TOTAL $ <br /> _ SUBTOTAL $ <br /> PERMIT $ PERMIT S <br /> TOTALFEE 5 — TOTALFEE S <br /> FR011i5ETBALK RERRSETBALK 51p[SETBACN <br /> VLRNCHECHNUMBER �E.f� R[GPPTNO <br /> USEZONE IOTRNEA VACRNTSITE <br /> FEES VALUATION FEE <br /> � �. VES � N� puILUING _ <br /> tt7'EO�LONSIALLOWI9lf iYPE0FWN5T�GiWt acunucr xoo'vH[un�ur��s - ---- <br /> LqppP PIUMBING ��yC� . <br /> SIZEOFBIW. N�AFSTORIES B�SEMENT MECHANICAL <br /> ' ��, ' YES ' . NO i <br /> OGCUPNlCYIO�D FlRESPPNNLERSREO� HEIGMTlIM9TAT10N <br /> OTHER _ <br /> I ; yES � - NO STATE BUILDING SURCHARGE � <br /> _ '--r— <br /> RERSON FOR SPRINKLERS <br /> STAiEENERGYSURCMARGE <br /> qnPIICAIIONACC BY �1A45ACPRCVEOCV CITY Of EVERETT PUBUC WORK$ <br /> LOCAL SALES -�_ �' 7" • <br /> TAX CODE IS 3105 rorn� �-���� � - <br />