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�wy rw <br /> APPLICATIO��I FOR CONSTRUCToJN PERMIT <br /> �� ��,;�- everett <br /> the Evergrean � <br /> CITY OF <br /> everett <br /> BUILDING DEPARTMENT <br /> 259-8810 TO BE COMPLETED IN INK—PLEASE PRINT <br /> DEMOUTION i COMBINATIQN BUILDING MECHANICAL PLUMBING SIGN <br /> OWNER /�MAILADDFESa GTY ZIP PIIONE <br /> �oo��naVen (/OiNFS �(71�bY Ic.3.� �Yi�ifu/occ%C�/a qgOyG sy� - �y69 <br /> TENRNT MAIL�DCRE55 � CITV ZIP PHON[ <br /> pRCHITECTORUESIGNEF MAILPDDRESS GTY ZIP PMONE <br /> GENERALCONTFACiOii MFIL�OCilESS Citt 21P PNONE UCENSEM <br /> l�ooclha✓e�� Homes l��•��Oj,;j �� -ywo� (,t�p qsoyc S�/C. 39G9 I,Jaoal/dHl7�/aS <br /> M[GHANICALCONTRACTOR MAIL4�DRE55 —T GTY � 21P PMONG LICENSE♦ <br /> PLUM�INGLONTRRCTOF M4ILADDRE55 GTV ZIP PNONE LICENSE� <br /> CU55 OP WORK <br /> �NEW � .- ADDITION � ALTERATION . REPAIR D[MOLITION WOODSTOVE/FAPL INSERT '. BUILDING RELOCATION �I <br /> TENANTIMPROVEMENiORMTEPIORREM00ELONLY � ) "� GONTACTPCRSON�NDPHONENO/. I, / I <br /> CONTRRCTPRICEOFWONH: ��—_v`' � C �]Q n`^ 1,�_`f� /7 `L� /^ <br /> DESCRIBE WORN AND SOUA�IE FOOTFGE INVOLVED � p I <br /> pR�s ou�oFe �nwc /y7D I HEREBY CERTIFY3 HA� I/HAVE READ AND EXAMINED THIS <br /> S �� � '`u�i� APPLICATIOPJ AND KtJOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> �ec.+�oe iIPTIONpF PROPER ISHOWN OEIOW OR pTTFCH FOURCOPI[SI PROVISIONS OF LAWS AND ORDINANCES GOVERNING TNIS TYPE OF <br /> WOPK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> toT �o.� otocrc oF1P�cI�q� woo� 7er�ac e NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO G��E <br /> �UTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF AIJY <br /> OTI IER STAiE OR LOCAL LAW REGULATING CO��STRUGTION OR THE <br /> PERfORMAIJCE OF CONSTRUCTION.THAT I AM AUTHORIZED BV THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 1827 RCW AND 296.200 WAC. <br /> SIGNAlUFEOFCOtIiR�CTORORAUTHONZ[DAGENT DATE <br /> PR0.�E^.TAODRESS ���%S:<:V/ �/✓VX^� /�/�/ ! D <br /> pPPIICANitiCIiYOUSME55UCENSENO D�USNESSN4ME <br /> PLUMBING MECHANICAL _ <br /> NO. TYPE OF FIXTURE OR ITEM FEE N0. TYPE OF E�UIPMENT FEE <br /> WATER CLOSET(TOILET) � A�C—A�HNDLG UNITS—H.P. _ <br /> ( BATHTUB � FORCED AIH SYSTEMS—B.T.U. M E.A. ! <br /> LAVATORY(WASH BASIN) a(J' UNIT HEATERS—B.LU. M � I <br /> T <br /> �' SHOWER / CLOTHES DRYFRS ' I <br /> KITCHEN SINK 8 DISP � VENTILATION FAN <br /> / DISHWASHER RANGEHOOD <br /> LAUNDRY TRAY / WATER HEI1TEfl _ <br /> CLOTHES WASHER WOOD STOVE <br /> URINAL METAL FIREPLACE 8 CHIMNEY ' <br /> DRINKING FOUNTAM FIREPLACE WSERT � <br /> FLOOR DAAIN HEAT PUMP I <br /> BACKFLOW PREVENTERS � GAS PIPING � <br /> ROOF DR�INS—RAINLEADERS EXHAUST FAN � <br /> SINK(SERVICE—BAR,ETC.) i <br /> II� <br /> �a� ha�Uc n�pL GC� � <br /> SUBTOTAL S SUBTOTAL 5 <br /> PERMIT $ PERMIT $ �, <br /> TOTAL FEE 5 TOTAL FEE 5 '�� <br /> FRONTSETB,CN REARS'T"�K SIDESEIBAC� ���NCI ` �q3�B, � F .Cr RECEIPTNO. � �i <br /> GlJ GV �✓ � :.J � I i <br /> usezorv �otnnea VRCANi51iE FEES VALUATION FEE <br /> � a ' -� YES 1 NO BUILDING �7 � 'S <br /> ivPEOFCONSi'ALLpWpBIE TVPECFCONSi.ACII acarr.xcr xoorow[uucur:ne 'i <br /> \ ' /V V � °—' � PLUMBING I i <br /> V <br /> F2EOFOLDG NO.OFSTORIES BASEMENT MECHANICAL r�'C� <br /> ��93Pr�1z�1 q� ves No � <br /> OCCUPANCVLOAO FIPESPPNKLGRSREOD NEIGHTLII ITATiON OTHER — . <br /> `! B, <br /> � YES � .�yYO STATE BUILDING SURCHARGE ��(1 <br /> �1— <br /> RE�SONF RSPflMKLERS <br /> STATEENEPGV SURCHAR(:F <br /> APPLICATIONACC.�Y PIANSAPPROV[ODV CITYOFEVERETT PUBLICWORKS �1� <br /> �'�/ LOCAL SALES <br /> 9 iL TAX COUE IS 3105 207AL � � <br />