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, APPLICATI� _J FOR CONSTRUCT�4P1 PERMIT <br /> everett <br /> Me Evergreen <br /> f�. CITY OF � <br /> � everett <br /> � BUILDING DEPARTMENT <br /> 259-8810 TO BE COMPLETED IN IPIK—PLEASE PRINT <br /> I I DEMOLITION I I COMBINATION i BWLDING i i MECHANICAL � i PLUMBING I I SIGN <br /> - ---- -- -__ ----- --- <br /> OWNER MRII Af10RE55 CIIY LIP PIIONC <br /> ��� Weew��e I oz- �e�k��oll����---Lsh�yvY� <br /> TENANT �AAILAO�RE55 CIlY ZIP PII�Nf- <br /> ARCHITECTOf10E51GNER MAILp�DNE55 GITY 21P PIIONC <br /> GENE��LLONTRALTOR M�II.AODR@SS CITY 21P PIIOtlf. IICf.tlS[� <br /> _ —"___". _"_ .____—_"_ "_ _" '____ _ __ _ ._ _—'_ ___ <br /> MECII�NICALCENl70RCiOH MNIA�UBCSS LIIv IIP Puull[ I�CLNSE� <br /> N.W. w4���h�to—�f��-�'�----�r —9�lwr----�s-�_s��� —�������l ►<� <br /> PLUMBING CONTRFCTOR IA41L FDURE55 CIiY ZIP PIIOHE ;ICENSE� <br /> CLASS OF WORK <br /> I-.l NEW I i ADDITION I I ALTERATION I �� REPAIR I I DEMOLITION I � WOOD:i�'vE/FRPLINSERT � I BUILDINGRELOCATION <br /> TEN�kT IMPROVEMENT OR IIIIEPIOR(IEMODEL ONLY GONIAGT PERSON nNU PMONE NO <br /> CONTfl�GT PPICE OF WORN: <br /> /2 3 5 `+ ----- — <br /> �GES IBE WORK AND SOUARE FOOTAG INVOIVED <br /> dl�ct G+ti F4.,, 5,��;k���tat� <br /> rno EDUSEOFOUILD c I HEREBY CERTIFY THAT 1 HAVE HEAD AND EXAMINED THIS <br /> � � (�„„�( APPLICATION AND KNOW THE SAME TO BE TRUE.4ND CORRECT.ALL <br /> iEc��oesc PTIONOFPROPERTY� IIOWNOEIOWORATfACHFOUqGOPIES� PROVISIONSOFLAWSANDORDINANCESGOVERNINGTHIS7YPEOF <br /> WORK WILL BE COMPLETED WITH WHETHER SPECIFlED HEREIN OR <br /> ioT ui.ocK oF ___ NOT. THE GRANTING OF A PERMIT DOES NOT PHESUME TO GIVE <br /> AIITIIORITY TO VIOI.ATE Oq CANCEL THE PROVISIONS OF ANV <br /> O771E�7 S1ATf_OH I.00AL LAW REGULATING CONSTRUGTION OH THE <br /> — �- � � � � PEHFOHMANCE OF CONSTRUCT�ON. THAT I AM AUTHORIZED BY THE <br /> OWNER OF Th11S PROPERTY TO PERFORI.� THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTHACTORS LAW ,8.27 RCW AND 296200 WAJ. <br /> SICIIAl11NEOFWNIHRCIf�NONAlI1110RIZEDAGENT O�IE <br /> I PROJECT��DflES,S, , '-- � „ • ���N� �_ _ <br /> � ��e�n I(I `/' _�� ( �p APPLICANiSCIIYl3i1511lE'�iLICCNSENOAH0AU5MES5N�AlE <br /> �r �/�'� I�v1 <br /> PLUMBING MECHANICAL <br /> N0. TVPE OF FIXTURE OR ITEM FEE NO. TVPE OF EOUIPMENT FEE <br /> � WATER CLCSET(TOILET) � A:C--A'IINDLG UNITS—H.P. � <br /> — ----- -----__--'--�--- -- -- — '— <br /> BATHTUB ' FORCED AIR SYSTEMS—B.T.U. M E.A. ; <br /> � LAVATORY(WASH BASIN) __ —T— , _UNIT HEATERS—B.T.U. M � <br /> SHOWER � CLOTHES DRVERS � <br /> --- --�— ---- ------ <br /> KITCHEN SINK 8 DISP i VENTILAI'ION FAN � <br /> C!SHWASHER � FANGE NOO� <br /> — —'— -- <br /> LAUNDFY TRAY � � WATER HEATER <br /> CLOTHES WASHER — �— WOOD STOVE I <br /> --+— <br /> URINAL ' METAI.FIREPLACE 8 CHIMNEY ; <br /> �RINKING FOUNTAIN i FIREPLACE INSERT i <br /> FLOOR DRAIN --- -� ___'_ --� HEAT PUMP�--- ____ —� <br /> AACKFLOW PREVENTERS ; GAS PIPING ' <br /> ' �_ _�'� '____--- --T <br /> ROOF DRAINS—RAINLEADERS � EXIIAUST FAN <br /> -- ' -- --- --•— <br /> SINK(SERVICE—BAR,ETCJ ; ; <br /> — �— -- <br /> � <br /> ------ --- ---- — --- ---- — � <br /> --�— — -- <br /> — ---- —�— — —'— <br /> SUB TOT�I. $ SUB TOTAL $ 'OO <br /> PERINIT $ --� ---- —�—� PERMIT S / i OD <br /> TOTAL FEE 5 TOTAL fEE $ � U2'� <br /> FRONfSETOAGK NEFRSEIBFCK 5111E5[713RCH PIANGIEGNHIIMOL❑ 1[[ 11ECEIPiNO. <br /> usezoNe IOTAflEA VACANTSIIE FEES VALUATION FEE <br /> � I YES I I NO OUI�DING � <br /> 7VPFOFGONSTAl10WABlE lVCEOILOHS7AGIUAL ncarurtr uOWUwLUMGunnS � <br /> GPDIIP � <br /> PLUM�ING <br /> —i— <br /> S2EOPBLOG. NO.OFSTORIES �ASHMENT � <br /> MECHANICAL � <br /> i i YES I I NO � <br /> OCCUPANCYIORD FIRESPPNNlERSREOD HEIGIIilI1.1ITATION <br /> OTHER � <br /> I 1 YES I I NO STA7E 13UILDING SURCHARGE ' <br /> i <br /> REASONfORSPRiNKI[RS — — --r— <br /> � STATE ENCfiGY SURCHARGE i <br /> arruca�oi�ncc uv rinNsnrrr�oveuur CIiY OF EVERETT i�uianr.woi�Ks ' <br /> LOCAL SALES � <br /> TAX COOE IS 3105 TO7AL � <br />