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.. ..: .�� _'.... � :-. ..' .: .:.:.� ' . . .. . . . � _... . .. :.'.. .:.: .._ .:. . . . ._ .. . . .�.. . • _ . .. ... ., .. . a . .t.5. <br /> •'4 . . '. ',. . <br /> APPLICATION FOR CONSTRUCTIt�N PERMIT <br /> ' everett <br /> �haE��,ae� e <br /> CITV OF <br /> p�� everett <br /> BUILDING DEPARTMENT <br /> 259-8810 TO BE COMPLETED IN INK—PLEASE PRINT <br /> ❑ DEMOLITION f 1 COMBINATION I�BUILDING I I MECHANICAL I I PLUMBING I 1 SIGN <br /> OWNER MpILADDRESS CI1Y 21P PIIOIIE <br /> L y�t r r3�Fr,vF' P�' dt-,r aal'G �(�=�F rT ��Y��� .�'�� '.�,�a� I <br /> TEN�NT MAILAOORESS LIN ZIP PIIONE ' <br /> ARCHITECTOROESIGNER MAllA00RESS CITY ZIP PMONE <br /> GENEPAL CONTP�CTOR MPIL AUURE55 GTV ZIP PMONE UCENSE t <br /> !Y/�EB��NK P�'' ,�',r��l� �-[�E'�F'T�" .`l'�'-.��� �s�-�3�� /3�i�NKf3l'��y1GL . <br /> MECHANIC�LCONTRACTOR MAILADDPESS GITY 21P PHON[ IIGENSE� . <br /> PWMBINGGONTRRGTOR MRILADDPESS CITV ZIP PIIONC LICENSEII <br /> CUSS OF WORN <br /> ❑ NEW �ADDITION I 1 ALTERATION l I REPAIR 1 I DEMOL�TION I I WOODSTOVEIFRPL INSERT I 1 BUILDING RELOCATION _ � <br /> TENANT IMPPOVEMENT ON INTEQRIOR REMOOEL ON/LY � CO/NTACT PE/FSON RND PMONE NQ ' � -� <br /> GONTRACTPflIGEDFWORK:y��� � /1-� _ ._1 <'ti.. 7 SS�O ^ (_ l` C ���� ���-��� <br /> DESGFIBE WOHK AND SOU�RE FOOTAGE INVOL\'EO <br /> Crt�e/��r T "' s o - � — �- <br /> PPOPOSEDUSEOFBl11LDING � HEREBY CER?IFY THAT I HAVE READ AND EXAMINED THIS <br /> C'����Q�?' APPIIC.�TION AND KNOW THE SAMc TO BE TRUE AND CORRECT.ALL <br /> LEGALDESCRIPTIONOFPROPEflTV�5110WN0ELOWOAATiACNFOIIliCOPIES� PROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTYPEOF <br /> WORK WILL BE COMPLETED WITH WHETHER SPEC�FIED HEREIN OR <br /> �or� eiocK � oF NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> p 'L / AUTIIORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> .Vlr l/FsR�Y l�nsJ/C f/2N�'y� �l V��S/O/✓ 1 OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OH THE <br /> PERFORPdANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> �� OWNER OF THIS PROPERTY TO PERFORM THE WOFK FOR WHICH <br /> �S /'E'/' �/¢ E'-C!'r'�e«�//✓ ��lCiil7r- /L� qppLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 1827 RCW AND 296.200 WAC. <br /> nr ��Q�J � � ( r �:F SIGNQUREOFWN7RACiORONRl1i110RIZE�RUENi DATE �, <br /> i� <br /> . 1 <br /> �Sn/nNosll/srf �C�[�i7tY l�t�i�`.� /NG � , t '�Q'' L " / f'// L1 ,�i <br /> PRQIELTADDRE55 i � � ' <br /> y /�� �f�y ,� /�/ � nP CANTSGTYBUSINE%LICENSENO AN�BUSMESSNAME <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TURE OR ITEM FEE N0. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) � A�C—NHNDLG UNITS—H.P. � <br /> BATHTUB ; FORCED AIR SYSTLMS—B.T.U. M E.A. ' . <br /> LAVATORY(WASH BASIN) UNIT HEATERS—B.T.U. M _�_ . <br /> SHOWER � CLOTHES DRYERS : �. - ;� <br /> KITCHEN SINK 8 OISP ; VENTILATION FAN � �. <br /> DISHWASHER � RANGE HOOD i ' <br /> LAUNORY TRAY ; WATERIIEATER <br /> CLOTHES WASHER � WOOD STOVE _ � <br /> URINAL _ METAL FIREPLACE 8 CHIMNEY � ' <br /> DRINKING FOUNTAW � FIREPLACE INSERT �_ - <br /> FLOOR DRAIN � HEAT PUA7P : , <br /> BACKFIOW PREVENTERS i GAS PIPING � <br /> ---'— EXNAUST FAN —�— � <br /> � ROOF DRAINS—RAINLEADERS _ —— i <br /> SINK(SERVICE—BAR,ETC.) � , <br /> � <br /> --T— <br /> � <br /> — <br /> — � <br /> ; —�-- <br /> SUB TOTAL $ ; SUB TOTAL $ ' <br /> PERMIT $ —� PERMIT $ <br /> TOTAL FEE $ ' TOTAL FEE 5 !,_ <br /> FqONTSETBAGK REARSET��CK SIOh5E1pACH Pl4NCHEC NUI.I�ER FEE RECEIPTNO <br /> 20 5 ' ' 9/ a7ac� y�.�� y'9�s�6 <br /> use zor+E� �or�en,!1,., � VACANT SIiG FEES VALUATION FEE . <br /> � �w I I VES NO OUILDING SPJY R/ '� <br /> iYPf Of CON51.AtIOWpBLE TYPE OF CON57.ACt11AL occuvarvtr bo ar owuuxcuqns ' i <br /> GPp°P pLUM�ING i ' <br /> -N -iv N-I <br /> SIZEOfBI�C. NO.OFSTORIES �ASEMENT 1 . •.�� <br /> MECHANICAL ' <br /> 469 Sf � I_I YES I I NO ' � <br /> OCCUPANCYLOAD FIRESPRNNLERSIlEbO IIEIGMTLIM17P71D� OTHE� 7 � � � � <br /> / � <br /> ��j f! YES M NO I S STATE BUILOING SURCHqRGE ' L� <br /> RE�SON FOq SPRINKLEPS � <br /> STATEENERGYSURCHARGE ! � <br /> � �.� <br /> APPLICATION�CC.BY PLFNS APPROVEDOV CITY OF EVERETT PUBLIC WORHS i <br /> /- LOCALSALES � � <br /> �/� TAX CODE IS 3105 TOTAL <br /> �I � <br />