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1 <br /> AF"PLICAT14n1 FOR CONSTRUC7 �Ohi PERMIT <br /> ��«�« <br /> �.��.E.�„a,��,,, e <br /> SITV OF <br /> �"� everett <br /> A�� _ BUILDING DEPARTMENT TO BE COMPLETED IN INK—PLEASE PRINT <br /> 259-8810 \j � <br /> �y y DEMOLITION COMBINATION BUILDING /�MECHANICAL �LUMBING SIGN <br /> �"��� owuen nini�aooaess aiv � ti� w�or+E <br /> Ky� <�/����J l /lF/ /'%1 C�i,•J �503 k�1L�i' '�� 'lr��- f�L' .�e.i�.l��.-t:iqY�lc. b J�cC. _:.;� —�-.8✓Z L <br /> 1[NPNT MAIIAD�RE55 CIiY 21P �HONE <br /> �N�+J <br /> y <br /> �z ARLHITEGTORDESIGNER AIAILADDflE55 CITV ZiF PMONE <br /> ONd GENER4LCONiRRGTOR IANLAOORE55 CITY 21P PHONE IICENSE• <br /> � �� MECHANIC4LGONiRACtOR M1IAIIAD�PE55 GITY ZIP PHONE LICENSE� <br /> �v n�! <br /> ~ aa .�A/i!%' iK✓ic! fk�%�>r,� `Lc/ '�/uF`ST S tu%�A �/7hG.�-DS=c� i�Gec .���c.-i'fS�Y�,`L—,�i!!A/"C'5 ,��/17it1 <br /> 9 1-3 [�] PLUMBiNG CONTRPC70R M�IL ADORESS� dTV ZIP PIIONE IICENSE� <br /> r� z _ <br /> �H C,i-i$..f�i/J'�- <br /> ����yyy cLnSs oF woRK <br /> d y . NEW . � ADDITIOW �' ALTERATION REPAIR . DEMOLITION WOODSTOVE/FRPL INSE9T . � BUILDING RELOCATION <br /> � r[t� iENRNi IMPROVEIAENT OR INiERiOfyi RyEMO��O�EL OHLY CONtACT PERSON 4ND PNONE NO. <br /> y y CONLt1ACT PRICE OF WOPN: ti// (J <br /> F] O � �ESCRiBEWOiiNANDSOU�B[FOOTPGEINVOLVEO <br /> fu-, c,�. ,l � -h .��_z,�__ <br /> rnoaoseo -ocAmiowc I HEREBV CERTIFY THAT I HAVE READ AND EXAMINED 7H15 <br /> S.�� APPLIGATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> LEGAlOESCRIPTIONOF PROPERTY 15110WN6ElOW ORATT�CM FOUPCOPIESI PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS Tl'PE OF <br /> WORK WILL BE COMPI.ETED WITH W!I�THEH SPECIFIED HEREIN OR <br /> �oT BLOCK oF NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME i0 GIVE <br /> AUTHORITV TO VIOLATE OR CANCEl. THE PROVISIONS OF ANV <br /> OTN[R STATE OR LOGAL LAW REGULATING CONSTHUCTION OR THE <br /> - PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORh1 THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> � CONTRACTORS LA1N 18.27 RCW AND 296200 WAC. <br /> SIGNAIUti[OFCONiRPLiORUNAUT110RiZEDAGENT DATE G ' � - ��' <br /> . x fvr�i�,- s sr,�z.,� r/`iy�r�iK <br /> PHQIEGTADDf1E55 ����.���,��� G-'��� �L"`�� _G <br /> '�1 ��D � �PPIC TSCIivpUSit1E55F� NSENOANOBU �ESSNAME <br /> PLUMBING MECHANICAL <br /> '�I NO. TYPE OF FIXTURE OR ITEM FEE NO. TVPE OF EOUIPMENT �EE <br /> WATER CLOSET�TOILET� A�C—A�HNDLG UNITS—H.P. <br /> ' ' BATHTUB _ FORCED AIR SYSTEMS—B.T.U. M E.A. <br /> LAVATORY�WASH BASIN) UNIT I�IEATERS—B.T.U. M � <br /> 1�' SHOWER CLOTHES DRYERS �— <br /> ' KITCHEN SINK 8 OISP VENTILATION FAN <br /> DISHWASHER RANGE HOOD <br /> ' LAUNDRY TRAY _ WATER HEATER <br /> CLOTHES WASHER WnODSTOVE _ <br /> f_1 URINAL METAL FIREPLACE 8 CHIMNEY i _ <br /> DRINKING FOUNT�IN FIREPLACE INSERT �_ <br /> ' FLOOR DRAIN HEAT PUMP <br /> BACKFLOW PREVENTERS GAS PIPlNG <br /> '� ROOF DRAINS—RAINLEA�ERS EXHAUST FAN __ <br /> �' SINK(SERVICE—BAR,ETC.) <br /> � <br /> '' ' SUBTOTAL 5 ' SUBTOTAL 5 / <br /> PERMIT 5 —� PERMIT $ 1 I T_ <br /> TOTAL F[E 5 TOTAL FEE S 30 ' <br /> FR04iSETB�CN �EARSET�4GH SiUESETp�Crc HL�NCNECNNlIM1lC.R FE[ H[LEiPTNO <br /> use zor�e IOTRREA VPCANi SR[ FEES VALUATION FEE <br /> . VES � NO BUILDING <br /> nCi 04 WNSi AIIOWABIE iVP[Of LONSi AC10Q Omure�sr no o�nwfu�xc ux�is — ' i <br /> ceouo pLUM�ING <br /> S¢EOFpL�G NOOFSTORIES BASEIA[NT MECHANICAL �v � <br /> YES NO <br /> OGGUPANCYLORD FIRESPRNNLERSpEO'D HHGIrtliIRiATION OTHER <br /> � YES � NO STATE BUILDWG SURCHARGE <br /> � <br /> RCAtiOHfOPSPRMKlERS <br /> ST�TEENENGYSURCNARGE <br /> APPUCnllONAGCI�v P�RNSAPPROVEDOY CITYOFEVERETT PUOUCWORNS <br /> LOCALSALES <br /> TAX CODEIS 31a5 TOTAL <br />