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... .. ; 4 . . '.. p- ' . . ' I • <br /> �Z . , � <br /> `` . ppPLICATI� FOR CONSTRUC�N PERMIT <br /> u"r <br /> n1 <br /> ..`t.' � everett <br /> �E� � e <br /> , cinoF <br /> everett - <br /> BUILDING DEPARTMENT TO BE COMPLETED IN INK—PLEASE PRINT <br /> 259•8810 <br /> ❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑MECHANICAL ❑PLUMBiNG ❑ SIGN <br /> � �/VIr1D(E��! /f�/�lU C�// ��L/W 1/(l� �HONE' 0'�595�-D , ,::. ', <br /> . �RCMIIECTOROESKiNER MAIIADDRE55 CITV ZIP P�N�I��, ,^^����1 � <br /> _ v„rr� Y <br /> .OENEMLCONTN�CTJH MAIL/�DDRESS CITV 21P PHOHE UCENSE/ <br /> � , �� . . <br /> CITV ZIP QMON� � 5��5�, /� // <br /> � MEClUN CONTMCTOII IL ADUflE � . <br /> �l�n+il�a���0 �(JU� /(a�� � /.��c0 1/�O.cc- 5 <br /> � �f� <br /> RUMB CONTMCTON MAIL�OOPE39 CITY ZIP F40NE UCENSE� <br /> CU58OFY/ORK <br /> ❑ NEW ❑ ADDITION LTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVEIFRPL INSERT ❑ BUILDINa RELOCATION <br /> 7EIUNTIMPROVEMENTORINTEflIONREMODELONLY CONT�CTPERSONA PMONENO. � N <br /> � // <br /> CONiIUCT PRICE OF WOF�K: <br /> � . pEg�pigEWORKANO50UAflEFOOTAOEINVOLVED _ 1 c �� / <br /> /T7 i/ J <br /> C.IW�-- <br /> ouseoFeui u+a I HEREBY CERTIFY THAT I HAVE READ AND E%AMINED THIS <br /> � � APPLICATION AND KNOW THE SAME T!:BE TRUE AND CORRECT.ALL <br /> �'���au.o RIPTqNOFPROPERTV�SHOWNBELOWOR�TTACHFOURCOPIES� PROVISIONSOFLAWSANDORDINANCeSGOVEHNINOTHISNPEOF <br /> WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> �,�, �pT &,oc�c ov NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO QIVE <br /> AUTHORITY TO VIOLATE OR CANCEL THE PHOVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORI2E0 BY THE <br /> � � OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> � APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br /> SIGILINREOPCONTRACTONOR�UTHORIZEDAOENT ��TE <br /> X _�Q�A � /�/� <br /> PRO.IECTAODPESS APPUC NTSCITYBUSiNESSIICENSENO.ANDeUSINE55NM1E <br /> iG � � . <br /> PLUMBINO � MECHANICAL ' <br /> � . NO. TYPE OF FlXTURE OR ITEM FEE NO. TVPE OF EOUIPMENT FEE <br /> i WATER CIOSET(TOILEn � NC—NHNDLG UNITS—H.P. � <br /> i � FORCED AIR SYSTEMS—B.T. ' <br /> BATHTUB � <br /> � ,�� LAVATORV(WASH BASIN) � UNIT HEATERS—B.LU. M � <br /> � � � SHOWER ' CLOTHES DFiYERS � <br /> � ���� �� KITCHEN SINK 8 OISP � VENTILATION FAN � <br /> ��.,' � � <br /> DISHWASHER � RANGE HOOD <br /> !`�'' �^ - - 'LAUNDRYTRAY ; WATERHEATER <br /> .+��"� � � CLOTHES WASHER � WOOD STOVE _T_ <br /> '� � METAL F�REPLACE 8 CHIMNEY : <br /> � 4t;;-r � DR NKING POUNTAIN � FIREPLACE INSERT ,�_ <br /> � ,'',�d� �� FLOOR DRAIN � HEAT PUMP � <br /> BACKFLOW PREVENTERS ; GAS PIPING <br /> ROOF DRAINS—RAINLEADERS � EXHAUST FAN ' <br /> i <br /> ,� �' � ' SINK(SERVICE—BAR,ETC.) � � <br /> i ' <br /> � i <br /> i ' <br /> ; � � <br /> � --�-- <br /> I SUB TOTAL $ ' SUB TOTAL S ' <br /> PERMIT S � PERMIT S � � <br /> TOTALFEE $ ' TOTALFEE E ' <br /> �FI10NT6ET&1CK REARSETBACN SIOESETBACK - PLANCMEGNNOMBER FEE flECE1PTN0. <br /> useza+e �oT�n� wcu+rsrte FEES VALUATION FEE <br /> . � ❑ YES ❑ NO BUILDING � <br /> lYp[OFCONSi.KLOWABIE TYPEOfCONST.ACTU0. �vu1tr MO.OiOW[lliNOUFt� i <br /> 4R0°P P� +MBING � <br /> _ �j � � <br /> 61ZEOFBLIXI. NO.OFSTORIES BASEMENT MECHANICAL J O � <br /> ❑ YES ❑ NO ; <br /> OTHER � <br /> OCCUPANCYLOAD FIRESPRNKLERSREO'� HEIGMTLIMITATION � <br /> ❑ YES ❑ NO STAiEBUILDINGSURCHARGE � <br /> pEA50N FOR SPRINNLEPS � <br /> STATEENERGVSURCHARGE � <br /> � <br /> �PPLICATIONACC.BY PIANSAPPROVEDBY CITYOFEVERETT PUBLICWORKS i <br /> ' LOCAL SALES � � <br /> TAX CODE IS 3105 TaTp� 3 d ' <br /> ��14.?���F� :�. .�.� <br />