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��. <br /> APPLICATI�nI FOR CONSTRUCTiDN PERMIT <br /> � everett <br /> (hs E�nrpresn <br /> CIiY OF <br /> � everett <br /> BUILDING DEPARTMENT TO BE COMPLETED IN INK—PLEASE PRINT <br /> � 259•8810 <br /> O OEMOUTION I 1 COMBINATION f i BUILDING I�MECHANICAL I ! PLUMBING ❑ SI(iN <br /> pyMEq M�IL�DDRESS LI7Y ZIP PNONE <br /> /y�' E•� � s �,��'�u•� Aue E�,��% �tsYr- rz3y ' <br /> TENnj7� M�ILADDRE55 cirr zm PNGNE <br /> i <br /> �qCHITECTORDESIGNER MAIl�DDOESS GiY 2�P PIIONE <br /> OENEMLCONTMCTOR MAIL�DDRE55 CIIY ZIP PIIONE LICENSE• <br /> I <br /> i4MECHANIC'-AIIC TP�CTON �/'M�II�UDRE55 GIIY 21P G(� PHONE A'LIGENSE� ( )//v <br /> � I����N�CT��T�+ fMIlADD1iE55 �/�V'�1/Ll �� ��' /6111� ZSZONE); I /vl�'E�f✓�I �J (F� <br /> 1 <br /> 1 <br /> CUSS OF WOFN <br /> � ❑ NEW I 1 ADDITION I I ALTERATION ' I REPA�R I I DEMOLITION I I WOODSTOVE/FRPL INSERT I -I BUILDING RELOCATION <br /> + TENANT IMPROVEMENT OR INiERIOP PEA10DE1�(�1�Y CONLPC7 PERSON AND PNONE NO. <br /> j CpiTR11LTVRILEOFWORN: �a <br /> d pE9CRplM�ORNANDSOUAREFOOTAGEINVOLYED <br /> 'r si�KL �"ht �rH — <br /> yv�sEooc�oFeuaom+a 1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED 7HIS <br /> S �/� +�+ `/',�+ APPLICATION AND KNOW THE SAME TO 9E TflUE AND CORRECT.ALl <br /> ,� �pkpe �pT0.YlOF'vaoPenrv�5 WNBELUWORAtt�CNfOUOCOPIES� PROVISIUNSOFLAWSANDORDINANCES(iOVERNINGTHISTVPF:OF <br /> ,� WORK WILL BE COMPLETED WITH WHFTHER SPECIFIED HEREIN OR <br /> � : � toi• e�ocK oF NOT. 11iE GRANTING OF A PERMIT DOES NOT PRESUME TO 31VE <br /> AUTHOFITY TO VIOLATE O(i CANCEL T�HE PROVISIONS OF ANY <br /> 7 OTHER STATE OR LOCAL LAW HEGULATINC,CONSTRUCTION OR THE <br /> + PERFORMANCE OF CONSTRUCTION.THAT I Atd AUTHORIZED BV THE <br /> � OWNER OF TNIS f'FiOPERTY TO PERF4NM THE WORK FOR WHICH <br /> y APPLICATION IS MADE AND 1 COMPLY WITH THE STATE <br /> ' CONTRACTOPS LAW iB27 RCW AND 296200 WAC. <br /> j SIGN�TURE Of CONiR�CTOR Ofl�UTHOR2C0 AGENi UATE <br /> 3 y <br /> 1 PRQIECTADORESS ^ , ~ � � '�! <br /> �� � �p '{�� IL L / APPUCANTS CITY BU9NE55 �ENSE NO.AND BUSINESS YMAE <br /> s r� ��.,�. • <br /> PLUMSINO MECMANICAL � <br /> NO, TYPE OF flXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> 1 WATER CLOSE?�TOILET) � AI�A/HNDIG UNITS—H.P. � <br /> i � FORGED AIR SYSTEMS—B.T.U. M E.A. ; <br /> � BATHTUB _ � <br /> LAVATORY(WASH BASIN� � _ UNIT HEATERS—B.T.U. M i <br /> � SHOWER ' CLOTHES DRYERS ' <br /> �E KITCHEN SINK 8 DISP � VENTILATION FAN �_ <br /> j DISHWASHEA � RANGE HOOD ' <br /> � LAUNDflV TRAV ; / WAtER HEATER � <br /> i CLOTHES WASHER WOOD STOVE _�_ <br /> � UFi1NAL ' METAL FIFEPLACE 8 CHIMNEY ' <br /> i DRINKINO FOUNTAIN FIREPIACE INSERT � <br /> r� FLOOR DRAIN � HEAT PUMP � <br /> ' BACKFIOW PREVENTERS � GAS PIPING <br /> 1 ROOF DRAINS—RAINLEADERS —� EXHAUST FAN � <br /> � SINK(SERVICE—BAR,ETC.) ' �— <br /> i � <br /> f ' <br /> � ' <br /> — � <br /> � ' �_ <br /> � ' <br /> � ' <br /> = SUBTOTAL $ ' SUBTOTAL $ Yb ' � <br /> PERMIT $ PERMIT $ / � � <br /> � TOTAL FEE $ ' TOTAL FEE $ S ' <br /> I FRONTSETBACN REARSE7B�CR SIDE:ETBRLK PUNCHEGMNUMBEN FEE AECEIPTNO. <br /> { <br /> � VALUATION FEE <br /> USEZONE IOTME4 �pCANT51iE fEES _ <br /> � (1 VES I I NO BUILDING ' <br /> I ryP[piCON51.ALlOWABtE 7Vi'EOfCONSi.AC111AL aNn4[� uoabMluxGUnns -- i <br /> i cawr pLUMBING � <br /> T <br /> I � l <br /> SI2EOFBLOG. NO.OFSI0RIE5 BRSEMENT MECHANICAL � <br /> 1 I YES I i NO � <br /> � <br /> 1 OCCUPANCYLO�� PIRES�PNKLEfi5RE00 ME�GNiLIMIT�TION OTHER � <br /> I J YES ! I NO STATE BUILDING SURCH�RG[ ' <br /> i <br /> �- <br /> REASON FOH SVNINNLE85 <br /> SiATE ENERGV SURCNARf,E � <br /> i <br /> i �Pr��cenor+�cc.er PUNS�PPROV@OBY CITYOFEVERE7T PUULICWORKS ; <br /> LOCALSALES —T— <br /> TAX CODE IS 3105 TOTAL ,st'; — <br /> i - - — <br /> , -,r . . <br /> �., ,,- . �, ,., „r : <br />