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APPLICATIO:r FOR CONSTRUCTI�N PERMIT everett <br /> rn9eVe,y,een TO BE COMPLETED IN INK—PLEASE PRINT � <br /> CITY OF <br /> everett HEATING SYSTEM: ❑GAS ❑ELECTRIC Q <br /> BUILDING DEPARTMENT <br /> 259•8610 <br /> ' J DEMOLITION COMBINATION BUILDING ��MECHANICAL PLUMBING SIGN <br /> OWNER \ MAILADDtiESS PMONE <br /> � � G7V 21P <br /> (�ll,� - I �-�, ���1�,� �,�� �/�� ) D�. �3�0� �s'� -��3c� <br /> TENANT MAII D�RE55 CITV ZIP PMONE <br /> nnC�qikcr no nc�;gu�q MAIL ADDRE55 <br /> CITV ZIP PHONE <br /> GE FRALC NTPqCTOR ILA�DRES CITV IP PMO UCENSE� /� <br /> � / ' � C � L � C <br /> ���j <br /> MECNRNICALCON ACT MAI�AD�RESS CITV ZIP �NE UCENSE:1 �' � '.�� <br /> y <br /> PLUMBINGGONTRACTOR ^ - ���f� <br /> MAI�AU�qE55 CITY 71P PHONE UCENSE 1 ' 1- <br /> � <br /> . CLASSOFWOFK _ °;,�j., <br /> �.�_NEW ,.�: ADDITION ... LTERATION . -�. REPAIR �, � DEMOLITION � WOODSTOVElFRPL INSERT � ' BUILDING RELOCATION .��:':� <br /> • � WNTACT PERSON AND PMONE NO. ? � -:i.i <br /> ����- .>�� <br /> CONTPRCT PRICE OF WORK i� i' '�- <br /> D SCfl18E W K AN S A f00T GE INVOIVED �� �y .'�.i� <br /> . i d-- , a"�r <br /> PROPOSEDUSEOFBUILOIN. � I HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS �� �A� <br /> J APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL �' � , �,n� <br /> IEGAL DESCPIPTIONOF PqOPERTY�SHOWN BELOW OR�TTACNiOURCOPIESI PROVISIONS OF LAWS AIJD ORDINANCES GOVERNING THIS TYPE OF - � ���'"=`i <br /> �or e�ocK oF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR ' �--'+� <br /> � NOL THE GRANTING OF A PERMIT DOES NOT P I ' - <br /> RES 1ME TO GIVE �-:��;:a <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 I AM AUTHORI2ED BV THE ' <br /> ' OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH � �.��,�.._i�• <br /> — APPLICATION IS MADE AND I COMPLY WITH THE STATE "�` <br /> - CONTRACTORS LAW 18.27 RGW AND 296200 WAC. <br /> ; SIGNATUAE OF CONTPACTOR Oq AUTHORIZED RGENT DATE <br /> / d . <br /> . PRQIECT�DDRESS � /^� ^ /� ` � �L � � �j'� ( � <br /> ( I �- II I/1/ 1 � APFULRNTS CITV�USMES LI ENSE NO r1N SINE55 NRME <br /> I 7 / <br /> � PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TVPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) � FUC—A�HNDLG UNITS—H.P. <br /> ! BATHTUB � � - :�.-;'�5 <br /> FORCED AIR SYSTEMS—B.T.U. E.A. <br /> � LAVATORY(WASH BASIN) � UNIT HEATEtiS—B.T.U. M � � -'=�� <br /> SHOWER � CLOTHES DRYERS , , � �;�.',`�'�� <br /> - _ KITCHEN SINK 8 DISP ' VENTILATION FAN ` �"��� <br /> . DISHWASHER RANGE HOOD -�`,,',p� <br /> LAUNDRV TRAY ' WATER HEATER � --'°� <br /> .. CLOTHES WASHER WOOD STOVE <br /> � URINAL ; METAL FIREPLACE 8 CHIMNEY � � ����, <br /> DRINKING FOUNTAIN I FIREPLACE INSERT �•-"' 1 <br /> FLOOR DRAIN HEAT PUMP �— � � � `����r <br /> E, ^� `. <br /> BACKFLOW PREVENTERS GAS PIPING � _ <br /> ROOF DRAINS—RAINLEADERS EXHAUST FAN � �-,;�j - <br /> SINK(SERVICE-9AR,ETC.) � � ��:��.� <br /> iF:} <br /> I �'���. <br /> I � ��- <br /> � 1 1 ' . <br /> I T'''11 <br /> SUBTOTAL $ ' ���:-� <br /> SUBTOTAL $ (y � •.,�.:,, <br /> PERMIT $ PERMIT S /r� � ��:ti.} �, <br /> TOTALFEE 5 TOTALFEE S 7 ��`-�S'+q <br /> FOR OFFICE USE ONLY: �':(;-:y� <br /> FFONT SETBAGK REAR SETBACK SIDE SETDALN -�4`Y � <br /> PLANCMEGKNUMBER FEE RECEIPTNO. l <br /> ����� <br /> usezoNe tornaen VACANTSITE FEES VALUATION FEE �� ��''��� <br /> .r <br /> BUILDING <br /> i y <br /> lYPE01CON75AllOWABIE iYPFOiCONSTALTUAL aCV�an[r Moorov:[umGUHrts � � •'F- <br /> 49W� � <br /> PLUMBING � '-� <br /> i <br /> 512EOFOlDG. NOAFSTORIES BFSEMENT MECHANICAL � �_'^4'? <br /> OGCUPANCI'�pRD FIpE SPRNKLERS REOD NEIGMT UMITATION �DDITIONAL PLAN CHECK � ""^� <br /> i ���n.�., ' <br /> OTHER '��.fj:�.:� <br /> REASON FOR SPqiNKLERS . <br /> STATE BUILDING SURCHARGE <br /> INTANF pV PLANS FPPROV[p BY CITY OF EVEREIT � <br /> LOCAL SALES PUBLIC WORNS � <br /> TAX CODE IS 3105 TOTAL � <br />