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APPLICATIO�V FOR CONSTRUCT�ON PERMIT <br /> everett <br /> Ihe Evorgrean � <br /> CITY OF <br /> everett <br /> BUILDING DEPARTMENT <br /> 259-8810 TO BE COMPLETED IN INK—PLEASE PRINT <br /> I 1 DEMOLITION I I COMBINATION _�BUILDING i I MECHANICAL I I PLUMBING I I SIGN <br /> OWNEO MAILADPflE55 ���Y Z�� P������ <br /> M� Pakl I.Ja.ns uto� I'-rn�. s.t. E��-nErr 9�� 3s��- i.�a� <br /> TENANT MTIIAD�RE55 G7Y ZIP P�ION[ <br /> �RCMITECTORDESIGNER MAILADDRESJ CITY ZIP PIIONF . <br /> GENERAL LONTRRCTOfl MAIL AODOESS f.IIY ZIP PHONE IILENSE 1 I� <br /> LADDco Nr1N� B[a�� iuc. fioN� Io�Sf.J.f EI.f�Yc�/ 9��_ 3�S!`�H6o ���6/9SQd <br /> MECIIANICALLONiRaCTOB h1AI ADN1E55 CI7Y IIP i'uONF. IIf.ENS@� '. <br /> PWMBINGCONTRRCTOfi MAILADORESS CRY 21P PIIONE LICENSE� � <br /> GlASSOF WOfiN I <br /> �NEW I � AODITION I I ALTERATIDN I I REPNR i I DEMOI.ITION � � WOODSTOVE/FRPL INSERT I I BUILDING REIOCATION 'I <br /> TEN�NT IMPROVEMENT Ofi'V iENlOfi PEMUU[L rONLY CONIACi PE1150N AN�PIION[NO (, C�p <br /> CONiNACTPRICEOFWOFIt: i7� Ys0 _ V� � r�7 - DoOd - �I <br /> OESCRI�E WO�RN AND SOURRE FOOiAGL INVOIVED }� � <br /> PROPOSE�SEOfBUILDING O/ ✓ ✓U �l�. FT I <br /> I IIEREBV CERTIFY TfiAT I fiAVt READ AND EXAMINED THIS <br /> s���� APPL�CATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL I <br /> IEGALDESGRIPTIONOFPROPER1Y�5110WNOROWOeA7 mouncoi•ie51 PROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTYPEOF i <br /> �p�-T� /' WOFK WILL BE COMPLETED WITH WHETHER SPECIFIED HEflEIN OR �I <br /> toT B�OGN OOV D_ OF _ US�� NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVF <br /> AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY i <br /> OTHER STATE OR LOCA�LAW REGULATING CONSTRUCTION OH THE <br /> — — PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHOFIZED BY THE I . <br /> OWNCN OF TFIIS PROPERTY TO PEflFORM THE WORK FOR WHICH <br /> APPLICATIO�I IS MADE AND I COMPLY WITN THE STATE <br /> CONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br /> SIGNANREOFCONIfiAL10NURFU7110RRE0RGENT OAIE <br /> PfiOJECT�00RE55 �-- ��� I <br /> ,n s L --- — APPIIf.AMSLIIYIii�IICENS[f!O R'IOOIISM[SSN�ME <br /> ���0 S~�. �• .t�✓ <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TVPE OF EOUIPMENT FEE � <br /> WATER CLOSET(TOILET� NC—NHNDLG UNITS—N,P. <br /> BATHTUB FORCED AIR SYS7EMS--B.T.U. M E.A. ' <br /> I.AVATORY(WASH BASI�J) UNIT HEATERS—B.T.U._ M __� <br /> SHOWER CLOTHES DRYERS ' <br /> KITCHEN SINK 8 DISP VENTILATION FAN <br /> i RANGE I100D ' <br /> - DISHWASHER _ --.---- <br /> LAUNDRYTRAY ' � "'ATEfiHEATER ' <br /> CLOTHES WASHER � —� � WOOD STOVE � <br /> i URINAL � ' METAL FIREPLACE&CHIh NEY ---� <br /> � DRINKING FOUNTAIN _ FIREPLACE INSERT _� <br /> ��.� FLOOR DRAIN � __ I1EAT PUMP ' I <br /> BACKFLOW PREVENTFRS __i_ _ GAS PIPING � <br /> � ROOF DRAINS—RAINLEADERS � EXHAUST FAN ; <br /> SINK(SERVICE-DAR,ETC.) ' � <br /> __ __T _ � <br /> 1 <br /> I <br /> � 1 <br /> 1 � <br /> SUB TOTAL 5 ' SUB TOTAL $ ' <br /> PEflMIT $ --� PERMIT $ � <br /> TOTALFEE $ TOTAL FEE $ ' <br /> FHONiSETO LH FGRS[10ACN Si0E5[i�ACN PIA11CIi�GHNlII.IpER FEL RECEIPTNO. <br /> N ' S ' ��' � i� 5.�. � r 3z � �r <br /> usezorie ioraaen vFenNrsir� FEES VALUATION FEE , <br /> R"1 �'�'jUS � � i YES I i NO �7UILDING �� � I�j(((/' � <br /> tYPE0FtN1AL10WABlE 7TP[0lLONStAC7URl occiir�xcr uooiox'utMGunns - i <br /> - ouv I pLUM�ING � <br /> � <br /> FdE OF BIOG. NO OF STORIES OASEMENT MECIIANICAL � <br /> � _�__ i I YES I NO _ I' M�� <br /> Oi11E11 �Y �" <br /> OCGUPANCYLOAU RRESPRNNI[RSREO'0 M[IGlllllh!ITA�ON � a� � <br /> � % LY— i <br /> / I I YES I O STATE BUI DING EURCNARGE '� � <br /> � <br /> 1{EASON FOR SPRINKlERS i <br /> STATEENERGVEURCHARGE � <br /> — 1 <br /> APPUCATIONACC.OV PIRN�fi�EDOV CITY OF EVERETT PIIpLIC WORNS � <br /> LOCAL SALES � <br /> TAX COUE IS 3105 TOTAL <br /> _ � <br />