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� � � �S. <br /> APPLICA710Hr FOR CONSTRUCTIUN PERMIT � <br /> NOEvergreen everett ` <br /> CITY OF � <br /> everett <br /> BUILDING DEPARTMENT <br /> 259-8810 TO BE COMPLETED IN INK—PS,EASE PRINT <br /> ❑ DEMOLITION COMBINATION �j(BUILDING 1AHCHANICAL ��'F'LUMBING � SIGN <br /> ��O MqILADDRE55 CITY ZIP PIIJNE <br /> �c€�.�trr ��� /�9ri,S�. �..�F'v�,-���'� �/--�"''-�6�� <br /> T NANT ldAILADDRESS GiY ZIP PMDNE <br /> ----�_� <br /> ARLHITEGTORDESI NER � MAILAO�FE55 LITV 21P PHONE <br /> �i��� Conlsvc��n�;� 1�7� fi�c/=�K/�����_iz�n ��75 �795-65�,� <br /> GENERALCONTRRCTOR MAILADORE55 CI(Y 21P PMONE ��%ENS�/� � <br /> MEC ANICAL CONT AC�MAIL ADOPESS GTV 21P PHOHE IL�E� � I <br /> /10,��� �6�/ ��IS� �� ,���A�ll�r�a�a ��� 745 ��h��IzNI I���r� <br /> PIUMBINGCONTRACTOA MA�Lr1��E55 qtV ZIP � PMONE LICENSE� <br /> �x��-`�r� ,, � ��� 2�za r{l,� s��,v �� �{�.�--� -'��-�s���.r,�� <br /> �`LlffAc50F WORK <br /> �NEW '.-' ADDITION �.- �� ALTERATION REPAIR . � DEMOLITION WOODSTOVEiFFPL INSERT . . BUILDING RELOCATION <br /> � TENANT tMPROVEMENT OF INiERIOR FEMODEL O/NIY CONiACT PERSON AND PHONE NO � <br /> CONTRpCT PRICE OF WOAI:: �^� fj- � ( �f��� �.��f��,J� . �� <br /> DESC��WSRK�NO S" AFC F T�GE INVOIVED <br /> ���'; - . s � � 1°I J F� <br /> PROPOSED Is'e eu . - � I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> S�np�(/� �. �r(�J a APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECL ALL <br /> LEGALDESCPIrr�r�oFrROPeRttisNo NBELOWORATTACNFOIIRCOPIES� PROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTVPEOF <br /> � WORK WILL BE COMPLETED WITH WHETHErI SPECIFIED HEREIN OR <br /> iot /-p/J�h� e�ocK oF NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �' AUTNORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> �(, , �--� �/L�-��� OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PFOPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICAT�ON IS MADE AND I COMPLY WITH THE STATE <br /> CONTFACTORS LAW 18.27 RCW AND 296.200 WAC. <br /> SIG'IATUREOFCONT ACTO. Ofi� F2EDAGENT [IAiE <br /> �y�c x ,,, <br /> PP0.1EGTrtODRE'55I ` � 1 I�1L�� G.r//.C_! .�- <br /> C�C�I 1 I � �Y C �PP��CANiSCITYBU51NE5511 EN .ANDBU MESSNAME <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FI7(TURE OR ITEM FEE N0. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) FUC-ArHNOLG UNITS-H.P. � <br /> BATHTUB FORCED AIR SYSTEMS-B.T.0 � E.A. � <br /> � LAVATORY(WASH BASIN) i� UNIT HEATERS-B.T.U. M <br /> SHOWER CLOTHES DFYERS <br /> KITCHEN SINK 8 DISP VENTILATION FAN <br /> DISHWASHER RANG[HOOD �— <br /> LAUNDFYTRAY WAiER HEATER <br /> CLOTHES WASHER � WOOD STOVE <br /> URINAL METAL FIREPLACE 8 CHIMNEI' — <br /> DRINKING FOUNTAIN FIFEPLACE INSERT ; <br /> FLOOR DRAIN HEAT PUMP � <br /> BACKFLOW PREVENTERS i GAS PIPING -�- � � ; <br /> ROOF DRAINS-RAWLEADERS EXHAUST FAN �— <br /> SINK(SERVICE-BAR,ETC.) <br /> � <br /> i <br /> i <br /> SUB TOTAL 5 SUB TOTAL 5 — <br /> PERMIT 5 -'-� PERMIT $ 'y <br /> TOTAL FEE S — TOTAL fEE 5 T" <br /> FRONTSEIBACK qE4R5ETBAC�( SIDESETBACF � PLANCNECKNUTABER FEE REf.EIPTNO. <br /> ZU ' 2U S ' : � jo >v u 37'� 7 t� �.3n J'S <br /> usezoryp� LOT0.REA vncnNrsrte FEES VALUATION FEME <br /> "�_Z �YES �. � NO BUILDING � ��� �y,�.7�M <br /> TYPE OF CONST AIlOWAOI[ iYPE OF CONST ACiUAL ec[uvANCr HO ot on[`urvc urn5 l!� <br /> �p�uP / PLUMBING � <br /> SRE OF BIDG. N0.OF STORI[5 BASEMENT t� �-1\ <br /> Z MECHANICAL �� 1 i/ / } <br /> i YES NO k�;���� <br /> OCCUPqNCVLOPO FlRESPNNKLERSREOD NEIGNTLIM1IIiAGT10N OTHER <br /> '�_! YES . ' NO Z D r STATE BUILDING SUfiCHARGE <br /> R[ASON FOR SVRINNLEFS <br /> STATEENERGVSURCHARGE <br /> qPPLICATIUNACC.BY PlANSAPPPOVEDBY CITYOFEVERETT PUBLICWORKS <br /> /f.� LOCAL SALES <br /> 7' TAX CODE IS 3105 TOTAL ' <br />