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J <br /> .PPLICATIOI. FOR CONSTRUCTIiN PERMIT e�'��e`r <br /> the EvurOreen TO BE COMPLETED IN INK—PLEASE PRINT � <br /> CIN OF <br /> y �rr� everett HEATWG SYSTEM• GAS O ELECTRIC ❑ <br /> �'i� y BUILDING DEP.4RTMENT <br /> 259•8810 <br /> > y c~i� ' ❑ DEMOUTION � COMBINATION ` ' BUILDING ❑b1E�:HANICAL �PLUM9ING ❑ SIGN <br /> �� n ���,W��AIL/�DDRES� �V�/ // (���TJYIA � �/(//{��/< C.�I�Ho/ /O(O�( ���s3�/DG�y <br /> 1-3 "�1 TENANT WILAOOFE55 GI� ZIP � PHGNE <br /> �1HKI <br /> y M APCHITECTOR DESIGNEA H�AIL D E55 � QTV J ZiN PNONE�_���� <br /> � _� D11L Qech E t��in�� ��Y(�� �I 8 <br /> � � GE LONTP�G70R NAILADDRE55 CITY ZiV PMONE LLENSE <br /> �r�'�.2���. 1�4��1Sa�1w,C ) 7iPu/Yj�IG�'9J�A <br /> `�O,J ('�y rJ p�ry 21P PNONE LIGENSE/ <br /> H m u MECMANILAL ONTRALTOR AUIL�DDRE55 . <br /> n� c� <br /> �y� PLUMBINGGONTN/.6TOR MAIL.NDNESS Lltt ZIP PNONE I�LENSE/ <br /> C' <br /> � y s oF wonK <br /> � �y �NEW ❑ ADDIT�ON ❑ ALTERATION � REPAIR ❑ DEMC�tTION ❑ WOODSTOVFJFRPLINSERT G BUILDING REIOCATIOt� <br /> �CANiACT PERSON ANp PHONE N0. <br /> �� [if CpNTMGTPRICEOFWORN <br /> y O y pESCRIBE RK ANO SOU�HE FOOTAG INVOLVED f , \���� '"7_ C".„ � `�?_��A�'7 <br /> COns�x't "/ ,�. �� .3,� � , <br /> PROPOSEDUSEOFBUILq�r+c ' I HEREBY ;ERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> �)� /� .{-/1i,7�� ��S/(�/�L^FJ APPLICATIpN AND KNOW THE SAME 1 O BE TRUE AND CORRECT.ALL <br /> � ���r�� PROVISIONS OF LAWS AND ORDINANC[S GOVERNING THIS TYPE OF <br /> � woe RIPTWNOFFROPERTYI ��BEIOWOF TAC✓"OUHGOFiES� .,/�l � y�ORK WILI BE C01dPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> ��_BLOCK OF �y ��r � NOT. THE GRANTIIJG OF A PERMIT DOt: NOT PRESUME TO GIVE <br /> AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW HEGULATING CONSTRUCTION OR THE <br /> - PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHOR12ED BY TNE <br /> r ,,� � /��� OWNER OF THIS PROPERTY l0 P[RFORM THE WORK FOR WHICH <br /> /�/�7 � ����ly'r wL( �-ti-G�V APPLICATION IS MADE AND I COMPttV WITH THE STATE <br /> +'- CONTRACTORS W 2�A<C W AND 29 D WAC. <br /> SIGNATUREOFC TOROq�R�THOBIZEDR Nt OATE <br /> / ` /, <br /> � 7�) � 11 �L�t� X ���� � <br /> � <br /> PR0.ECTMORE55 �p �NiSCITYB MESSLICENSENO.ANDBUSiN 5 E <br /> ' 1 PLUMBING MECHANICAL <br /> 1_� FEE <br /> Np, TYPE OF F;%TURE OR ITEM FEE NO. TYPE OF EOUIPMENT <br /> > WATERCLOSET('�OILET) /-"� - A/C-A/H4DLGUNITS-H.P. <br /> --� - FORGEDAIRS:'STEMS-B.T.U. 61 E.A. <br /> '�' / BATHTUB _ <br /> � tAVATORY(WASH BASIN�� � I�NIT HEATERS-B.T.U. M <br /> '�' �' SHGWEFi .. ' - / CLOTHESDRYEFiS <br /> KITCHEN SINK 8 DISP 5 ; VENTILATION FAN <br /> DISHN/Af�,HER � RANGE HOOD <br /> ; �q�INDRI'TR4Y ' - � W��TERHEATER � <br /> CLOTHE:�Wi\SHER WOOD STOVE ' <br /> URINAL ' _/ IAETAL FIREPL a.CHIMNEV O ' - <br /> ' t DRINKIN(i f�OUNTAIN _ � FIREPLACE INSERT � <br /> FLOOF DRAIN HEAT PUMP ' <br /> Ow� BACKFLCVJ PREVENTERS X GAS PIPING � <br /> ROOF D9AINS-'iAINLEADERS � EXHAUST FAN <br /> ' SINK(SERVICE-BAR.ETC.) � ��• -u} C/ ' - <br /> �' _ � <br /> � <br /> � � <br /> � � <br /> i <br /> 'w SUBTOTAL S — <br /> 1 SUBTOTAL $ pERMIT S <br /> •�' PERMIT $ TOTAL FEE S <br /> � l OTAL FEE $ <br /> FOR OFFICE USE ONLY: aecemrr,o <br /> FflONTSETBACIt PEARSETBACK SIDESETBPGK PLANCNECNNUMBER FEE� �� � ��/ . <br /> .- _ � ,-, � � � <br /> ' � ' FEE <br /> USEZONE LOTANEA VALRNTSITE FEES VALUATION <br /> I � BW:DING � �I � � <br /> h- �� J/� <br /> LYVEOffANiS.NLOwA9lE TVVEOfCONSi.KiOµ accu�; xau�uixtuxn6 P���ABING �//.' : <br /> SREOFBLDG. NO.OFSTORIES BASEMENT MECHANICAL ��r� <br /> ��h ' � n' A�PITIONAI PLAN CHECK � <br /> OCCUPANCY AO � FIPE6PRnNR/LFSPEO� HEiGHTLIMIT�TION <br /> /V � ' i <br /> L OTHEF i <br /> REASONFOR6FNINKlERS �i /) <br /> STATE BUILDING SURCHARGE <br /> iNTAKE6Y PIANS�PPROV[DBY C!TYOFEVERETT PGBUCV/ORKS Zr� � <br /> LOCALSALES <br /> TAX CODE IS 3105 TOTAL <br />