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�� :�:. <br /> APPLICATIO'r� FOR CONSTRUC �IidN PERMIT <br /> c' •� everett .. <br /> I�o Erergreon � • <br /> CITY OF � <br /> everett <br /> BUILDING DEPARTMENT <br /> 259-8810 TO BE COMPLETED IN INK—PLEASE PRINT <br /> f 1 DEMOLITION IJ COMBINATION �'BUILDIN� �(MECHAIJICAL k1�LUMBING i i SIGN <br /> oE�I/�(�!:�C 1' ypA�DReSS 4� ��F��CTS.C. �EZ'fJl��?'� /��(�Il.0 -�CJ�`.�7E�fC� <br /> ��� <br /> �p1CH-I�TECTORO[SIG P MRIIADDRESS � CIIY ZIP nB PHONE <br /> �K-/r� �� ���F`� �.(/j r,nX ��� �IL�K/C iT(� TCJ�?i.`� ��2�'-•-���_`>�j�-- <br /> GENE CONTRACTOR MNL pOpOF55 CITY ZIP PHONE LICENSE I <br /> �`�c���c� — � C��NN�/����._��, <br /> ^��MANiC�LC R�C�Ty R � MRILpODfiE55 CIN 21P PIIOIIE LICEN EI <br /> ,l� �'� i`f�"Nr/�l�s �F,n1 lY/s;��)�qlao� �lh�7 s ��./; <br /> �P BINGCONTPACTOR �"�ILAODRESS QiV ZIP PI10NE LICENSE� <br /> ¢,h!��nrI�UDYU.�,�1�3 1�L5� ���/l..SiA1D �CJJ �+�����'82,75�'95J7�X.�ETS 1�L <br /> CU53 f.F WORK <br /> ��''�rEW I.l ADDITION I.1 ALTERATION � I REPAIR I-.I DEMOUTION I I WOODSTOVE/FRPL INSERT I�.I BUILDINCa PEIACATION <br /> TENANTIAIPROVEMENTORINTEPIORREMWELONLY CO/NTA�CTP[RSON�NDP ONENO <br /> CONTPACTPRICEOFW08H: —+ _ ( �t" ���j <br /> SGflIBEWORRANDSWAREFOOTAGEINVOIVCC ��� ��� <br /> �� <br /> Pnor�asEo � eoveuacir+ �� ' J/ I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> Sf�L� ��JIL/JL Y Y/II.�F_L�-f/�ICA _ APPLICATION AND KNOW THE SAME TO BE TRUE AND COPRECT.ALL <br /> IEGALDESCRIf'� PERTY�SIIOIVN�EIOri'ORATTACHFIXIRCOf'IES� PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> �or� e�ocrc cF ___ NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> � AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> - PGRFORMANCE OF CONSTRUCTION.THAT 1 AM AUTHORIZED BY THE <br /> ��`P 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 /> SIGNAIUREOF NTRn TOIlO TIIORIZEDAuENT D�7E <br /> ��.: ��yr6 X ' <br /> PNQIECT�DORE55 ,/�� c �+ � (.G(,..L..[���— _ <br /> /� _� �l/`1 �� Y `� � RP^uCn TSCITYBUSW[SS �NSENORN�OUSMESSNRME <br /> l� OC(_l %�-�1 <br /> PLUMBING MF.C,IANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TGILET) —' A/C—NHNDLG UNITS—H.P. I <br /> BATHTUB ;�' FORCED A'R SYSTEMS—B.T.0 jj E.A. —��— <br /> �� LAVATORY(WASH BASIN) � �� UNIT HEATERS—B.T.U. M ; <br /> SHOWER CLOTHESDRYERS � <br /> KITCHEN SINN 8 DISP ^ �_ VENTILATION FAN ' <br /> DISHWASHEF � � RANGE HOOD �— <br /> LAUNDRY TRAY ; _I WATER HEATER <br /> CLOTHES W45HFR �� WOOD STOVE i <br /> URINAL � METAL FIREPLACE 8 CHIMNEY �� <br /> DRINKING FOl1NTAIN FIREPLACE INSERT � <br /> FLOOR DRAIN � HEAT PUiA�P � � <br /> UACKPLOW PREVENTEF:S _T__ GAS PIPIN3_r�(f� J�__�_ <br /> ROOF ORAINS—RAINL!_1D[RS � E%IiAUST F.14 i <br /> SRJK(SF.RVICE-8Ai',ETC.) ; <br /> — —�— <br /> � <br /> — T <br /> — — — ; <br /> � — <br /> SUB TOTAL $ ;� SUB TOTAL $ � <br /> PERMIT $ —r" PERMIT $ '-y� <br /> TOTAL FEE $ G""L; ' TOTAL FEE $ � <br /> FRONT SETORCK flEAR SETBFCK StOE SETORCK PI nIJ CII[CK NIlAlOEfl FE �N �FCEIPT NO. <br /> ZU 2o S' : 5 .�vC,�f �°: �/G 3.� � 5 <br /> useza+j�� ioranen p} VqtC,p,.N7S11[ FEES VALUATION FEE <br /> (('Z 6936 S•�• 'pYES I t NO p�ILDING /�/5�� G ;��� <br /> 7YP[OfCONSt.AILawAULE tYMOfC01151.AC1UAl ocaru¢r imauwuurN,unns - 11 <br /> GPWP / PLUMf3ING �� <br /> 7 <br /> SRE OP OIDG. NDAf SiORIES BASEMENi MECHANICAL I /! � � <br /> � � ��_ <br /> i <br /> OCCUPANCYLORD FIR[SPIINHlEI15f1E0'D H[IGHiLIMy(]p�I�N OTIIER ���n � I�_r�L,�3� <br /> I � YES I 1 NO Z u STATG UU LDING Sl1RCHARGE L�!✓j' ) <br /> RGSON FOR SPRINKLERS ��i'�" <br /> S7ATE[NEHGYSURCHARG[ <br /> nrrucnTionnec.or Puusnrrnoveonv CITYOFEVERETT puoucwo��ks � <br /> 9�- LOCAL SALES ' <br /> TAX CODE IS 3105 rorai �j � <br />