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APPLICATIC�N FOR CONST�iUC1�N P�RMIT <br /> everett <br /> Ina Eve�green � <br /> CITV OF <br /> everett <br /> BUILDING DEPARTMENT TO BE COMPLETED IN INK—PLEASE PRINT <br /> ' 259-8810 p <br /> DEMOLITION : COMBINATION : BUILDING MECHANICAL PLUMBING SIGN <br /> OWNEN MAILADDRESS GTY ZiP PHONL <br /> �,�;, �� �s��iy il�+�� ni � A�1���1�- agzZ � 7�i > � s c� � <br /> TENTNT MRiIADDRE55 GiY 21P PMONE <br /> s/��t�� .� � ' �S� -�• �� x, �. �<a, - _ ac9 <br /> PRCNITECTORDESIGNER IdAILADDRE55 CITY ZIP PIIONE <br /> ��y GENEPALCONTPRCTOR IARILADDRESS CITY 21P PHONE LICENSE/ <br /> ,o x � NGN o • � - y �'As <br /> ay� M[CHANICPLCONiRALTOR MAILADORE55 Citt ZIP PIIONE IICENSE• <br /> H �"�' C�tt ZIP PNONE UCENSE• <br /> F3 H PIUMBINGGONTPAGTOR MAILADORE55 <br /> K n <br /> H xl <br /> O x0 c�nssoFwoaK � <br /> � f/�H x NEW �._. ADDITION �_ ALTERATION � REPAIR ..� OEMOLITION - WOODSTOVE/FRPLINSERT _�. BUILDINGRELOCATION <br /> H z r CONiRCT GERSON AND PHONE NO. <br /> 3 ,�I TENANT IMPROVEAIENT OR INT OR REMODEL ONLY <br /> � y�b �� CONTRRCiPR�CEOFWORK: SU UvO <br /> Q H DESCRIBE WORK AND SOUAPE FOO1AGEiNVOlVEO <br /> H �g �' �o S f <br /> �" nq PPO SEOUSEOfB io•,. I HEREBV CERTIFV THAT I HAVE READ AND E%AMINED THIS <br /> '~L' N 3 �' ���, - or e�� APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECL ALL <br /> -�iy y LEGALOESCflIPT101 OFPROPERiY15 nee�owoanrrncHvouncoPies PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS NPE OF <br /> H y /. � � _;_ WORK WILL BE COMPLETED WITH WHETHER SPEGFIED HeREIN OR <br /> �y y Ir' iot �I S� 9lOCK 00 ov�-+-+*-�--c�r�•�. � NOT. THE GRANTING OF A PERMIT �OES NOT PRESUME TO GIVE <br /> n/� I AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANV <br /> � �N Sr ��,1 'f'f�/�S I C� - � 7� OTHER STATE OR LOCAL LAW REGULATING CONSTfiUCTION OR THE <br /> � �� PERFOFMANCE OF CONSTRUCTION.THAT I AIA AUTHORIZED BY THE <br /> OWNEF OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> 2 Hp) APPLI'ATION IS MADE ANO I COMPLV WITH THE STATE <br /> y 0 y CONTFlACTORS LAW 182i RCW AND 296200 WAC. <br /> - � 9G�lAT� PLO�CC'QPaCiO�OPnUiMORit[DAGENi �AtE <br /> ��'�� � � <br /> � PROJECTR�DqE55 ) qpp��� iiSGiVpU51NE551�G 'NOANDBUSINESSNAMF <br /> 7 � f� /Y , /_� <br /> PLUMBING MECHANICAL <br /> �_i NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EOU�PMENT FEE <br /> WATER CLOSET�TOILET� A�C—A�HNDLG UNITS—H.P. <br /> BATHTUB FORCED AIR SVSTEAIS—B.T.U. M E.A. <br /> �� LAVATORV�N'ASH BASIN) UNIT HEATERS—B.T.LL M <br /> ' � SHOWER CLOTHES DRVERS <br /> �► <br /> KITCHEN SINK 8 DISP VENTILATION FAN <br /> DISHWASHER RANGE HOOD <br /> LAUNORV TRAY _ WATER HEATER <br /> �� CLOTHES WASHER WOOD STOVE <br /> URINAL METAL FIREPLACE 8 CHIMNEV <br /> � DRI�IKING FOUNTAIN FIflEPLAC�INSERT <br /> !, � FLOOR DRAIN _ HE�T PUMP <br /> BACKFLOW PREVENTERS ; GAS PIPING _ <br /> ROOF DRAINS—R�INLEADERS ---� EXHAUST FAN <br /> ` ��' SINK(SERVICE—BAR,ETC.) � <br /> —� <br /> r� <br /> SUBTOTAL S SUBTOTAL 5 <br /> PERMIT S PERMIT S <br /> TOTALFEE S TOTALFEE 5 <br /> Fq01:T5ET8ACK PE4RSETLiAGN SI�ESE78ACK }}!�!C [�J($U����ER FE[�� �j REC TNO.�Q^ <br /> '.(7 ) ���' / X <br /> ' i � Ili v <br /> usc zoNe �ot nnen VACANT SItE FBES VALUATION FEE <br /> � � VES : � NO eWLowG �13 TfJ1n , �L'--. <br /> ttP(OlLONSf.pLl01YA81E iYPEOiC NS7.AGiWI o-Cur�Kr rmovo:v[w4cv5'�R --� <br /> w1 � � '°a �- PLUMBING � <br /> � 'W � ' <br /> SRLOFOLDG. NO.OFSTOfiIES ORSEMENi MECHANICAI. <br /> 5 2� 'L ! YES NO ( � � . <br /> OCWPANCYlORO FlRESPRNNLF.RSPEOD MEIG/Hi�ItMlif�lON OTHER � � <br /> Z 5 V YES � I NO �✓ STAiE OUILOING SURCH�RGE <br /> /� <br /> f1EA50N VOR SPRiNNI[RS <br /> STATE ENERGY SUf7CHARGE <br /> APPUC4TIONACC 9Y PLANSRPPf�pVE�DY CITY OF EVERETT PUBLIC WOflN$ <br /> /%�_ LOCAL SALES � JC <br /> �CV+�/ TAX CODE IS 3105 T�Tp� <br /> 5�pp� l6q—�`1 <br />