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,�w ,.w� <br /> APPLICATION FOR CONSTRl1CT�ON PERMIT <br /> �ns llquT everett <br /> (he Erergrcen � <br /> GTY OF <br /> everett <br /> 13U�LDING DEPARTMENT <br /> 259-8810 TO BE COMPL�TED IN INK—PLEASE PRINT <br /> ; DEMOLITION ! COMBINATION ' BUILDING MECHANICAL PLUMBING I : SIGN <br /> OWNER MAIL ApDRESS QTY 21P PHONE <br /> I,Jooa�hu✓cw �ci��e PO•L�X /�'�,✓ynu�occ/, U/��. 93oyc ��5'6 3 � <br /> TENANT MRIL pDOPE55 / GTV ZIP PHONE <br /> AFCHITECT OR DESIGNER MAIL ADDRESS CITY ZIP PHONE <br /> GENERAL GONTflFCTOR MNL AD�PE55 �iTV 21P PMONE �ICENSE� <br /> c�o�,���u�.�„ i�o��, �S �o. r�oy io3—��i ,,—,,,�w. 00d. �4. ��a�� S%G3969 �,�oad//yi75'as' <br /> MECHANICALfONTRACTOR hIqILADDRESS / ppy � IIP PHONE UCENSE� <br /> PLUNBING CONTRACTOR AIAIL AODRE55 CITV 2�� PHONE LIGENSE• <br /> CLASS OF WORN <br /> xNEW �i ADDITION . . ACfERATION . . REPAIR �. ��. DEMOlITION �_� WDODSTO.E/FRPL INSE(7T -. � BUILDING RELOCATION <br /> TENANT IMPROVEMENT OR MTEPIOR REMO�EI ONLV CONiACT PERSON RND PHONE NO <br /> CONTRRCT PflICE OF WORK: � � � G�a 1 C <br /> DESCRIBE WORK ANO S�UARE FOOTAGE INVOLVE� <br /> � W r s�a s��� 3qc9 <br /> PROPOSEOUSEOF IIDIhG I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> S) h e Fctl»/ ��� APPIICATION AND KNOW THE SAME TO BE TRUE ANU CORRECT.ALL <br /> LEGALOESCRI ONOFPROPERTV�SH�l10Y OELO'NORATTACHFOURCOPIES� FROVISIONSUFLAWSANDORDINANCESGOVERNINGTHISTYPEOF <br /> ior �a�— R ulOo WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> BLOCK oF i�I �g i•rac - NOT. THE GRANTWG OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AUTHORITV TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORidANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWN[R OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br /> SIGNRTUREOFCONTRAC70RORqlITNOflILE�AGENT ORTE <br /> PRO,IE TqpDRE55 � �'�%�/Cp// / � �/I�/7O <br /> �aal - l� �,� sc APPLICRNTSGiVBU51NE55LICENSENOA BLISINESSNAME <br /> PLUMBING MECMANICAL <br /> NO. TYPE OF FIXTURE OR i fEM FEE N0. TYPE OF E�UIPMENT FEE <br /> WATER CLOSET(TOILET) NC—A/HNDLG UNITS—H.P. <br /> 1 BATHTUB ( FORCED AIR SVSTEMS—B.T.U. M E.A. <br /> LAVATOFY(WASH BASIN) UNIT HEATERS—B.T.U. M <br /> Z SHOWER / CLOTHES DRYERS � <br /> � KITCHEN SINK 8 DISP �� VENTILATION FAN <br /> DISHWASHER r RANGE HOOD <br /> LAUNDRV TRAY % ViATER HEATER <br /> CLOTHES WASHE� � WOODSTOVE ; <br /> URINAL METAL FIREPLACE 8 CHIMNEY <br /> ORINKING FOUNTAIN � FIREPLACE INSERT ; <br /> FLOOR DRAIN HEAT PUMP <br /> BACKFLOW PREVENTERS � � GAS PIPING � <br /> ROOF DRAINS—RAINLEADERS EXHAUST FAN —� <br /> SINK(SERVICE—BAR,ETC.) i <br /> �. i.. <br /> i <br /> SUB TOTAL $ � SUB TOTAL S ' <br /> PERMIT $ PERMIT 5 <br /> TOTAL FEE S -- TOTAL FEE $ (�'< -•— <br /> FRONTSETBACK PERRSEiBACH SIDESEiBACK P NCH CKNUM9ER FEE � RECEIPTNO. <br /> z0 2.G 5 / �2 <br /> USEZONE �oraaea vncnNtsire FEES VALUATION FEE <br /> z 6 3« YES No BUILDING � ��� <br /> rvrc ov consr.nimwneu tr�=.ar cor+sr.ncmai ac�r.vc. No ormn uxcu�;rts <br /> // � o�!/(/ cn�uo } <br /> ( PLUMBING �� <br /> SIZEOFGLDG. � NO.OFSTOFIES BRSEVENT i <br /> /�7�.r�I yZ S � � 1 YES �p MECHANICAL � <br /> OCCIIPRN"G/Y LOAD FlRE SPRNKLERS REO'0 HEIGMT LIMQITATION OTHER � <br /> � r <br /> y /} I �. YES NO � p STATE BUILDING SURCF:4RGE `�iS�I <br /> REASON FOR SPRINKLERS <br /> STnTEENERGVSURCHARNE <br /> APPLICATIONACC.BV PLANS�PPROVEpBV CITYOFEVERETT PU�LICWORKS Z i <br /> �� LOCAL SALES <br /> u �z iAX CODEIS 3105 70TAL <br />