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APPLICATI6� FOR CUNSTRUCT JN PERMIT <br /> everett <br /> ��E��g,aa� e <br /> arv oF <br /> everett <br /> BUILDING DEPARTMENT TO BE COMPLETED IN INK—PLEASE PRINT <br /> 259•8810 <br /> � DEMOLITION I COMBINATION XBUILDING MECHANICAL PLUMBING SIGN <br /> pyMEq IAAILADDRESS GITY ZIP P��ONE <br /> 7 ,S/fp.?TPnN �� � �OS� /3U6 • ar�csv�/L y'ft�7C� 33F/ 3sr�a <br /> TENANT IAAILADDRE55 CITY ZIP �'NONE <br /> ARCHIT[CTCRDESIGNER M�ILAD�i1E55 QTY Z1P °MONE <br /> GENERAI GONTR�GTOR MAII A�ORE55 CITV ZIP PIIONE IICENSE� <br /> AIECHANICAL CONTRRCTOR MFIL ADDfiESS GITV ZIP PMONE UCENS[� <br /> PLUMBINGCONTRACTOR MAILAOORESS dT ZIP PHONE LICENSE� <br /> CUSSOF WORK <br /> �NEW G ADDITION � � ALTERATION . REPAIR I DEMOLITION �. � WOODSTOVE/FRPL INSERT . �� BUILDING RELOCATION <br /> iENPN'IMPflOVEMENT OR INiERIOR PEMODEL ONLY CONTRCi PERSON ANO PMONE NO. <br /> CONTRACT PRICE OF WORK: C F ��� <br /> �ESCRIBE WORK AND SOIIRRE FOOTPGE INVOLVED <br /> � <br /> PROPOSEDUSEOFBUIIDING I HEREBY CERTIFY TNAT I I�IAV[ RCAD AND E%AMINED THIS <br /> S'�� APPLICATION AND KNOW THE SAME TO BE TRUE AND CORREGT.ALL <br /> LEGALDESCRIPi1JNOFPROPER7Y�5HOWNBELOWORATTACHFOUflCOPIES� PROVISIONSOFLAWSANDORDW�NCESGOVERNINGTHISTVPEOF <br /> WORK WILL BE COMPLETED WITH YJHETHER SPECIFIED HEFEIN OR <br /> �oT�_ BLOCK oF — NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> � AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> �� ,� o�� -Tt � Y� � ,�� OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION,THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PEFFORM THE WOFlK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 18.27�CW AND 296200 WAC. <br /> SIGNATUREOFCONTR�GTOROR,WTHOBI2E GENT OATE <br /> '1 <br /> PRQIECTADORES � �^ <br /> ITY OUSME55 LIGENS NO.�NO OlI5iNE55 NAME <br /> � <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> � �. WATER CLOSET(TOILET) �— A/C—NNNDLG UNITS—H.P. <br /> BATHTUB �-- FORCED AIR SYSTEMS—B.T.U. M E.A. _ <br /> LAVATORY(WASH BASIN) UNIT HEATERS—B.T.U. M i <br /> J SHOWER '— � CLOTHES DRYERS ' <br /> / KITCHEN SINI<E DISP — L VENTILATION FAN � <br /> DISHWASHER RANGE HOOD <br /> LAUNDRVTRAY / WATER HEATER _ ' <br /> � CLOTHES WASHER �' WOOD STOVE � <br /> URINAL METAL FIREPLACE 8 CHIMNEY '� <br /> DRINKING FOUNTAIN FIREPLACE INSERT <br /> FLOOR DRAIN HEAT PUMF' ' <br /> BACKFLOW PREVENTERS GAS PIPING � <br /> ROOF DRAINS--RAINLEADERS � EXHAUST FAN � <br /> SINK(SEFVICE—BAR,ETC.) <br /> i <br /> ---r— <br /> SUB TOTAL $ — SUB TOTAL S "—' <br /> PERMIT S � PERMIT S `� <br /> TOTAL FEE $ �' TOTAL FEE 5 '� <br /> FRONTSE7f1�1LK REARSET9ACK SIDESEtOACK � P ANGN'C�(NJAiEfER � R[CEIPTNO. <br /> w z�� s ' • s 'K �--, <br /> usE r+e �ornaen vncaNrsire• FEES VALUATION FEE <br /> �'L $}� I.��. YES �� � NO BUILDING �r • �T I CSJ�_S1C1 <br /> iVPEOFGON5i.5L10\VABIE 71PEOFCONST. TUAL ottuo�ucv xaO�ewFwr6uxns — <br /> �V L9c3 � PLUMDING i � <br /> SIZEOF9LDG. NOUFSTOFIES BASEMENT �J,ECNANICAL � �^ <br /> �'SQ�3 ` � 7- �� YES NO — 1— <br /> OCCUPANf,YLOAO PIRESPRNKLEFSFEO'D HEIGMiIIMpiT�11 OTNER � <br /> f 1 YES �NO � O S7ATE BUILOING SURCHARGE � <br /> Y \ <br /> —�-- <br /> REASOM1FORSPRINHlERS \ i <br /> I .STATEENERGVSURCHAFGE � <br /> APPLICATIONACGBY PLNS PROVEDBY CITYOFEVERETT PUBLICWORK$ �� <br /> LOCAL SALES <br /> / � � C � TAX COUE IS 3105 �ar�� <br />