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\ 1 U . � <br /> J\� (1_ r�'✓�� ��:�'h '�'r; <br /> �(�9 �PPLIC�TIOi� FOR CONSTRUCTI�N PERMIT <br /> � everett <br /> meEvergree^ . � <br /> CITY OF <br /> everett - <br /> BUILDING DEPARTMENT TO BE COMPLETED IN INK—PL ASE PRIN7 <br /> 259-8810 <br /> i I DEMOLITION Cl COMBINATION I I BUILDING MECHANICAL ❑ PLUMBING ❑ SIGN <br /> /`!ER AIL�DDRE55 ,�' K� ZIP ^ � � <br /> � ^^ - ��S�o � ,�5�-2�- <br /> ,�,C � E� r ►� � , <br /> EN/ !I /� ^ �MAIL�DDOE55 CIiY ZIP 1110NE <br /> f /C l. <br /> 'P'� CItY ZIP P�IONE <br /> �RGHIiECTORDE5IGNER MAILADORE55 <br /> fFNkRALCO iRr1C70N MAi ADDReSS �' f{TY /_ _ . �n,� � „�9,�E_ �/ �CFNS �J,= <br /> L�t V%( S /�xff//' �ii �.Sy'SY <br /> ics.r ��7l v <br /> AIE 11 NCALCON70 TOii M41L�DDfiF55 ��TY , � ^ ,/��/ ��CEN, r']r /�' <br /> /1 /f�� � j C� <br /> \�V <br /> PLUMBI4GCONTRAC70(7 IA�ILAUUOESS CIfV ZIP PIIONE LIC SEt <br /> CLASS OF W O�F <br /> I -I NEW I.I ADDITION _, LTFRATION i 1 REPPIR l J DEMOLITION I.I WOODSTOVE/FRPL INSERT � BUILDING RELOCATION <br /> IEN�NTIMPPOVEMENTORMT�I REM DELON� LONTACTPERSONTNDP410NEN0. <br /> CONTR�CT PI110E Of WORK: <br /> DESC WOJ�(��(}�/�E F TAG INVOLV[D <br /> C.1 �Ci <br /> rnoroseovseorowioir+c I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> APPLICATION AND KNUW THE SAME TO BE TRUE AND COfiRECT.ALL <br /> iecn�oescniNrior+oF rnoaenrv is�owr+eeiowon nnna�rouncoriesi PROVISIONS OF U1WS AND ORDINANCES GOVERNING THIS TYPE OF <br /> WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> �a� BLOCK oF NOT. THE GRANTING OF A PERMIT OOES NOT PRESUME TO GIVE <br /> AUTIIORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> - PERFORMANCE OF CONSTRU^•TION.THAT 1 AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPEPiJ 10 PERFORM THE WORK FOR WHICH <br /> APPLICAT�ON IS MAIiE AND I COMPLY WITH THE STATE <br /> CONTHACTORS LAW+P.27 RCW AND 296200 WAC. <br /> SIGNATUREOFCONTNAC701�OflAUT110RIZE0AGENT DQE <br /> A /'� � c��v�d�L� � �����/ <br /> PRQIECiPDDRE55 � I I��fy/�l IA pppUCANTSCIiYBU51NE55LICENSENO.ANDBUSINE55NAME <br /> � LJ% �d�� <br /> PLUpIBING MECHAHICAL <br /> Np, TYf E OF FIXTUHE OR ITEM FEE NO. TYPE OF E�UIPMENT FEE <br /> WATER CL(SET(TOILET) � A/C—NIiNDLG UNITS—H.P. � <br /> BATHTUB ' FORCED AIR SYSTEMS—B.T. E.A. ' <br /> LAVATORY(WASH BASIN) �— UNIT HEATERS—B.T.U. M _T <br /> SHOWER ' CLOTHESDRYERS ' <br /> KITCHEN SINK 8 DISP ' VENTILATION FAN � <br /> � <br /> OISHWASHER � RANGE HOOD ' <br /> WATER HEATER � <br /> LAUNDRYTRAY � , <br /> CLOTHES WASHER �— WOOD S70VE � <br /> URINAL ' METAL FIREPLACE&CHIMNEY � <br /> DRINKING FOUNTAIN i FIREPLACE INSERT i <br /> FLOOP DRAIN <br /> � HEAT PUMP ' <br /> BACKFLOW PREVENTERS ; GAS PIPING � <br /> ROOF DRAINS—RAINLEADERS � EXHAUST FAN ' <br /> SINK(SERVICE—BAR,ETC.) � � <br /> i <br /> — � <br /> _ — � — � <br /> � — ' <br /> � ' <br /> � ' <br /> SUB TOTAL $ ' SUB TOTP,L 5 O ' � <br /> � , <br /> PERMIT $ � PERMIT S � - <br /> TOTAL FEE $ ' TOTAL FEE $ S� ' � <br /> ff?JNf5ET0ACK f7EA0SE70�CK SIDESEI�ACK PLANCHECNNUMOEO FfE PECEIPTNO. <br /> DSEZONE �otnnen V�CANi51IF FEES VALUATION FEE <br /> I-_I YES 1 1 NO OUILOING ' <br /> Ivff�ICONSf.AIIOWAPI[ IYPEOfLONSI.PCIWI ttaat5r xammvuunGUHnS � <br /> r,nwr p�UM01NG � <br /> i <br /> i <br /> SIZEOFOLUG. NO.OFSTONES O�SEMFNT MECHANICAL �� � <br /> I:I YES I I NO ' <br /> OCLOPANCYL040 FIPESPRNKLERSREO'0 NEIGMTURIItATION OTHER � <br /> i <br /> ❑ YES I I NO STATEBUILDINGSURCHARGE � <br /> RE�SON FOO SP(1INKLEO� � <br /> STATEEN[RGYSURCHARGE � <br /> i <br /> nrrucnnw+ncc.or r�nNsnrrnoveoov CITYOFEVERETT PU�LICWORKS __� <br /> LOCALSALES T�iAL Sf' �'U <br /> TAX COOE IS 3105 <br />