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APPLICATI�N FOR CONSTRUC7 �ON PERMIT <br /> everett <br /> N�Evergreen � <br /> CIl'OF <br /> evere�t <br /> BUII.DING DEPAR'(MENT <br /> 259-8810 TO BE COMPLETED IN INK-PLEASE PRINT <br /> I i DEMOLITION i ! COMBINATION _ _ BUILDING � MECHANICAL �PLUMBING ! I SIGN <br /> OWNER MAllA11f1RE5S--- ' '� - —'CIIV---- �'��- �ZIP����--'��-"-" 1'IIOHE <br /> • L u;r,�YtL ��3cK.11`f� _ �J�u-'tiJN_ `/`t�1o6_���_ .�y£� -G,�S;. � <br /> TEN�NT MAII ADDRLSS CIIY t'i� P�IONE <br /> .T�'al�z L��//-��hr<:S .r�n.A-�Il�•e.-- �:��..i �L�aLUG--- <br /> AF^.HRIiCTORDESIGNER MMI.ADD(iESS�K� nL��[,Z�t.�L`�TY ZIP PIION: <br /> GENER>LCONTR�GTOR AIMLAODRESS CITY 21P P110NE IICENSE� . <br /> 7.s� ��. �.� �y�s;� n����c s�.�lf�� G�%�zC�.2,.2 T�sc:��-xi.�a.4�. <br /> MECHANICALCONTPACTO MRILAODRE55 GIiY// ZIP P11ONE IILENSEI , <br /> �+�rN:� nl �''lY.< �-.F�L� <br /> PLUMB:NGGONTRAGT MpILAODRESS GTY ,' ZIPt)[� PIIONE LICENSE� ��1, ,1 � <br /> �� �• �.�>. T/.� �CGAI./�iif:n L��r:.`+�- !L•�% � ( �yST�/ ��Yl.'7CJf�u2�AlR � I <br /> CLA55OF WORK <br /> �NEW l.I ADDITION I I ALTERATION i I REPAIR : I DEMOLITION I i WOODSTOVE/FRPL INSERT ! I BUILDING RELOCATION I <br /> TENUiT IMPROVEMENT OF INTEflIOR P(F�.MO�FL ONLY COtliACi PEBSCN AN01'lIONE NO. <br /> CONTNACT PRICE OF WORN: %j��Q)� J _ -- <br /> ,p IBENOFK(�NDSOWREf00T�(i�INVOIVED <br /> � �.• . � � .� i _ ' <br /> PROPOSEDUSEOFBu�iN� k` /..` 1 HEREBY CERTIFY THAT I HAVE READ AND EXAMWED THIS ; <br /> I�YA: ' � � -[ � d�%__ APPI.ICA(ION AND KNOW TI1E SAME TO BE TRUE AND CORRECT.ALL <br /> lE0AL0E5CRIPTIONOFPROPENTVISHOWNG[lOWOO�TTAC11F01111COPIES� PROVISIONSOFLAWSANDOftDINANCESGOVERNINGTHISTYPEOF i <br /> WOFiK WILL BE COMPLETED WITH WFIETHER SPECIFIED HEREIN OR I <br /> �ot e�ocK �r _ NOT. TNE GRANTING OF A PERMIT DOES NOT PRES'JME TO GIVE <br /> AUTHOFITY TO VIOLATE OF CANCEL THE PROVISIONS OF ANY � <br /> OTHER STATE OR LOCAL LAW REGULA71yG CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE � <br /> OWNER OF TNIS PROPERTY TO PERFORM THE WORK FOR WFIICH <br /> APPLICATION IS MA�E AND 1 COMPLY WITH THE STATE ' <br /> CONTRACTORS I.AW 1827 RCW AND 296.200 WAC. � <br /> 9GNPIURE01'CONIPAG70fiOHRUTMOR12E0AGENT [1�1E <br /> . � � � <br /> ��= �1�3,z �� . :,�Cl.e_ 3�s-� r � <br /> PRO.IEGT�DDHESS I <br /> I �, } � r1PPLICANI6 �BUSIT 'CENSE NO RNO BIISINESS NAME <br /> i� � �:3C'� f�C C f� ���f�l - <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TVPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) � ArC-NIINDLG UNITS-N.P. � ' <br /> BATHTUB '' FORCED AIR SYSTEMS-E.T.U. M EA. —�— <br /> LAVATCRY(WASH BASIN) - -� UNIT IIEATERS-B.T.U. M I <br /> --�' <br /> SHO'NER �_ _ _ _CLOTHES DRYERS ! <br /> ' KITCHEN SINK 8 DISP � VENTII.ATION FAN � <br /> DISHWASNER � R'.NGE HOOD � <br /> LAUNDRY TFAY ' WATER IiEATER ' <br /> CLOTHES WASHER l r WOODSTOVE � <br /> URINAL � METAL FIRE-PLACE 8 CHIMNEY ' <br /> DRINKING FOUNTAIN � FIREPLACE INSERT � <br /> �— --- -- --T— <br /> FLOOR DRAIN 116AT PUMP ! <br /> "' —__�.._ ____ _ __. .. _— <br /> BACKFLOW PREVENTERS GAS PIPMG ' <br /> ---�-- - -----�---i— -�- -- -GXIIAUST FAN ---� <br /> ROOF DRAINS-RAINLEADERS _ <br /> — 4_ ._ ___ ___ _ <br /> SINK(SERVICE-BAR,ETC.) ' __ <br /> ----T— ---- — <br /> — -- ' - - — -—�----- ---T_ <br /> -- —_i—--- ' ---r— <br /> SUB TOTAL y' i SUD TOTAL $ ' <br /> PERMIT $ -�— PERMIT $ � <br /> TOTAL FEE $ ' TOTAL FEE $ ' <br /> _t_ <br /> FRONTSEIDnCK REARSETOnCH SI[1LSEl0ACK PlANG1ECK1�uME1ER FEE REC[IPiNO <br /> USEZONE iotaeen VACAIlTSITE FEES VALUATION FEE <br /> � <br /> i i YES i I NO ���II�ING ' <br /> IYPEOFLONSi.All0�4191E IYP[OFCONSIAL7�AL onurwa i,nmo�muveumns _—---- i <br /> �xnm � <br /> PI I IIdBING � <br /> —__ __'__— �—i— <br /> SIZEOFBLIX'i NOOFSIONES �ASEIA[t1I h1ECIlANIGAL <br /> '� YES � i NO -- <br /> OCCUPANCVLOAU FIPGSP4iHNIPf5HhU0 ��FI(:��;i16117�iIDH O111LR _ � <br /> _____"—"_"_ i <br /> I I YES i � NO _ g�p�t��IIII UING SIIHCIIAHGh ' <br /> . . ._._ . . . ._ i <br /> -____ . __. __ -- ---T— � <br /> il[ASON FOR SPPINNL[NS -'�- -�� �� � i <br /> 51A1 E ENERGY SURCIIANGE � <br /> _— — _ _--_ � <br /> APPIICATIONACC BY PIANSAPP170V[�pY CITY OF EVERETT PUI3UC WORKS i <br /> LOCALSALES � <br /> TAX CODE IS 3105 TUTp� ' <br /> i <br />