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� � <br /> A,PPLICAI rON FOR CONSTRU�.TION PERMIT <br /> everett <br /> tlre[vergreen � <br /> GITv OF <br /> everett <br /> BUILDING DEPARTMENT <br /> 259-8810 TO BE COMPLETED IN INK—PLEASE PRINT <br /> i i DEMOLITIOiV ! i COMBINATION p�BUILDING D�MECHANICAL i(PLUMBING SIGN <br /> pµ�pEq MAILRODRE55 GIiY ZIP PHONE <br /> ���,G�-y�r?/�U�.- L3a�e-,cc.. ca3 y SE �Fia9 �lic� c,�rc. �oiz 3 3£9�/4�8� <br /> TEN�Yt MAII.ADDRE55 GITY 21P PHONE <br /> pRCHITEp OR[[SIGNER MAIL A�DRESS CITY ZIP PNONE <br /> �iEHER�LGONTRRGTOH MAILADDNE55 CITY ZIP FHONF UCENSE� <br /> M�,¢�rF C2�'�c� �',�„e _ ,�/orl T,�c,��58��b¢ <br /> MF.CHANICpLCONiRACTOR MFILAD�R[55 CITV ZIP PHOtlE UCENSEe <br /> �2/20)1 {.�tTL� <br /> PLUMBINGCONiBAGTOR MAILADORESS Citt ZIP PHONE LICENSE• <br /> /�c6�T.�uriD ��uu���lz— _ <br /> CIASS OF WOHK <br /> SLNEW � ' ADDITION CI ALTERATION . � REPAIR �. � DEMOLITION WOODSTOVE;FRPL INSERT L I BUILDING RELOCATION <br /> iENANT IMPROVC.MENT OR RlTERIOR REMOOEL ONtV [/ CONIACT PERSON AN'O'P,NO�NE^N0-. `� p Q- <br /> CONTRACT PRI�[OF WOP1c: � rW d�� b 7 � J�'I G� M1�-�/I� /�O�I�V � _ <br /> DESCRIBE WORK AND SOUARE FOOTRGE INVOLVED <br /> �inTx.�F' F�.ic.y �s�D�rr-._� _r�v�3it�) 3'Fk-117� <br /> PROPOSEDUSEOFBUIIDING I HEREBY CE(iTIFY THAT I HAVE REA� AND EXAMINED THIS <br /> �t�s � APPLICATION AND KNOW 7HE SAME TO BE TRUE AND CORRECT.ALL <br /> LEGRLDESCflIPiIONOP PROPERTV I5HOW118ElOW OtiATTACH F09RCOPIES) PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> WORK W�LL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OF <br /> ior�� eia:rc oF NOT. THE GRANT!NG OF A PERMIT DOES NOT PRESUME TO GIVE <br /> * AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> �Q.�Dr.ILJt�(� 'T�I�/Q.�tE dJ(�• OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR Ti�E <br /> PERFORMANCE OF CONSTRl1CTION.THAT I AM AUTHORI2E0 BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPIICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 78.27 RCW AND 296200 WAC. <br /> SIGNAiUFEOFCONiRRCTORORRUTHORIZEOFGENi OATE <br /> � x �Z,'r,�. �P .�. �--- �/Z� lyo <br /> PRQIECTR�ORE55 <br /> 3� _ �_ � `� pPPLIf1NTSCITYBU5WE55LIC[NSENOANOBOSMESSNAME <br /> PLUMBING MECNANICAL � <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> VJATER CLOSET(TOILET) A/C—NHNDLG UNITS—H.P. <br /> Z BATHTUB FORCED AIR SYSTEMS—B.T.U. M E.A. <br /> LAV�TOP.Y(WASH BASIN) UNIT HEATERS—B.T.U. M i <br /> SHOWER / CLOTHES DRYERS <br /> KITCHEN SINK&DISP VENTILATION FAN � <br /> --T <br /> DISHWASIIER RANGE HOOD <br /> LAUNDRY TRAY WATER HE�TER <br /> CLOTHES WASHER —T WOOD STOVE <br /> UP.INAL METAL FIREPLACE&CHIMNEY ' <br /> DFiINKING FOUNTAIN FIREPLACE INSERT � <br /> �- <br /> FLOOR DRAIN HEAT PUMP � <br /> BACKFLOW PREVEN7ERS / GAS PIPING <br /> ROO�DRAINS—RAINLEADERS E%HAUST FAN <br /> SINK(SERVICE—BAR,ETC.) <br /> PW k�.,LL p,�� .� S �O <br /> � — <br /> � <br /> � <br /> SUB TOTAL 5 D SU8 TOTAL $ <br /> PERMIT 5 PERMIT 5 �� <br /> TOTALFEE 3 TOTALFEE 5 � <br /> FRONT SETBACK FEAR SE�K SIDE SEiBACJ( PIAN CME K NUMBER n FEEs7 RECEIPT NO. <br /> I � S� Q � �/�6 / J65'_ .F� �Sy <br /> usezo LOTAR A VACFNTSITE FEES VALUATION FEE <br /> � ��� � VES �1 NO pUILDING �Q �q i � <br /> iVPEOFCONSTAtI�WABLE iYP[OfCON57.ACipRL oaursxtv xaO�o/nuvGUNuS �� ; <br /> enouv pLUM�ING <br /> 5R[O�ALDG. NO.OFSTJRIES BASEMENT MECHANICAI //� ��7� <br /> ! 1 VES NO ��] �/ � <br /> OGCUI'eNCYLOAO FlRCSPRNNLERSREOD HEI.3HiLiMi1AUTI0N OTHE(i T7 T`— <br /> � � YES � NO Z p, STATE BUILDING SU�CHARGE '"/' !�� <br /> RE450NFORSPp�NNLERS — —�-� <br /> STATEENERGYSURCHARGc i <br /> APPUCATION�CG.BV PLANSRPPROVEDBY CITY OF EVERETT PUBLIC WORKS <br /> ILOCAL SALES p � <br /> TAX CODE IS 3105 TOTAL p � � <br />