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�. <br /> i APRLICATIcIRI FOR C�ONSTRUC`r10N PERMIT <br /> everett <br /> ,�E��,�� e <br /> CI iY OF <br /> everett <br /> , BUILDI�G DEPAFITMENT TO BE COMFLETED IM INK—PLEASE PRINT <br /> � 259-8A10 <br /> ❑ DEMOUTION ❑ COMBINATION �l BUILDING I7 MECHANICAL I 1 PLUMBING ❑ SIGN <br /> ' OW'1ER M�ILADCRE55 Cltt ZIP PHONE <br /> DScA,�y �U . (v ' ,�✓E�'`�' ^n /` -- y.✓ '/ /� <br /> �7HMXY � /�Oq� l� ILADCORE�S� � �c� '' CI���'j� / A.�J(nNE ��V 37� X <br /> � <br /> ' ARCHI'_CTORDESIGNER MAllAU0RE55 CITV ZIP PNONE , <br /> � GEN/E�RQCO/P�'T��RRCTOR MAILAODI1E55 CITV ZIP PHONE LICENSE• <br /> —�"��— I� CITY ZIP �NONE L�CENSE� <br /> MECHANICALCONTPRCTON MRIUDORE55 <br /> ��ry ZIP �NONE IICENSE� <br /> PIUMBINOCONTRACTON MAILA�DRE55 <br /> �USS OF WORA i <br /> � NEW ❑ ADDIT�ON (_1 ALTERATION ��'.C' REPAIR I I DEMOLITION I I WOODSTOVE/FRPLINSERT I7 BUILDINGRELOCATION I, <br /> ' iEN�NT 1MPBOVEMEN70R INTERIOR REMO/��EL^ONLY CONTICi PERSON RND�HONE N0. <br /> ' WNTR�CTPRICEOFK'OflK: 'L' C+ 'I <br /> � DESCRIBE WORK AND rSOUARE FOOT�GE INVOLVE� I, <br /> �� n�p�0 " ` I <br /> PROPOS OUSEOFBUIIDING ( I HEREBV CERTIFY THAT I H�VE READ AND E%AMINED THIS <br /> �, 7L��' �!71 H I� 'T�2 �Yt/ 1 U APPUCATION AND KNOW THE SAME TO BE TRUE AND CORRECT.AlL <br /> � LE��LDESCRIPTIONOFfROPERtt�SN WNBEIOWORAITAGHFOURC riesl PROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTYPEOF <br /> � WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> � �oT e�aK oF NOT. THE GRAN7ING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> . AUTHOfiITV TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> � OTHER ST.4TE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PEFFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF Tk:S PROPERTY TO PERFORM THc WORK FOR WHICH <br /> ' APPLICATION IS MADE ANO I COMPLY WITH THE STATE <br /> � CONTFiACTORS LAW 18.27 RCW AND 296.200 WAC. <br /> SIGNATUf1EOFCONIli4CTO�OR�UiHORIZEDAGENT DRT[ <br /> PRQIECTAODP[55 T�' -Y����� <br /> �PPLICANTS GtV OUSINE55 UGENSE N0.�ND BUSME55 NAME <br /> � �� UL� • `J-G• 1 <br /> � PLUMB�NO MECHANICAL <br /> � NO. TYP'c OF FIXTUNE OR ITEM FEE N0. TYPE OF EQUIPMENT FEE <br /> � WATER CIOSET(TOILET) � A/C—A/HNDLG UNITS—H.P. ' <br /> � � FORCED NR SVSTEMS—B.T.U. M E.A. � <br /> BATHTUB � — <br /> � LAVATORY(WASH BASIN) _ UNIT HEATERS—B.T.U. M � <br /> SHOWER � CLOTHESDRYERS � <br /> KITCHEN SINK 8 DISP VENTILAiION FAN � <br /> DISHWASHER ' ! RANGEHOOD � �, <br /> LAUNDRY TRAV ' WATER HEATER <br /> YJOOD STOVE ' �I <br /> ' CLOTHES WASHER �T' <br /> URINAL METAL FlREP'_ACE 8 CHIMNEY : '� <br /> . DPINKING FOUtJTAIN FIREPLACE INSERT � <br /> � FLOOR DRA�N � HEAT PUMP � <br /> ; BACKFLOW PREVC-NTERS �_ GAS PIPi�:, � <br /> ROOF DRAINS—RAINLEADERS � EXHAUST FAN ' � <br /> � <br /> � SINK�SEFVICE—BAR,ETC.) �� � <br /> � --� <br /> , <br /> — � <br /> _ � — � <br /> � SUB TOTAL $ 1 SUB TOTAL $ ' <br /> PERMIT $ � PERMI7 $ � <br /> TOTAL FEE $ ' TOTAL FEE S ' <br /> PUNCHECKNUMBER FEE RECEIPTNO. � <br /> FNONTSETBRCN RERNSETBACK SIDESE7BACK i <br /> USEZONE �OTAREA VAGANTSIh FEES VALUATION FEE <br /> i <br /> ❑ YES U NO BUIL�ING ' <br /> TYPEOfCON57.ALLOWABIE IYPEOfLONSi.ACi11AL accure4n xoWOMwNtuxns � <br /> 4�DOP � <br /> PLUMBING � <br /> 6REOFBLDl3. NO.GFSTORIES B�SEMENT MECH�NICAL � <br /> I I YES f I NO i <br /> OTHER ' <br /> OCCUPANCY LOAO FIRE SFpNNLEHS HEO'0 H�IGHT IIMITpTION � <br /> f 1 YES I�I NO 51ATEBWL�INGSURCHARGE � <br /> ---i-- <br /> REASON FOR SPRINNLERS � <br /> STATEENERGYSURCNARGE <br /> APPLIC4TIONACC BV PUNSAPPROVE�BY CITY OF EVERETT PUBLIC WORKS � <br /> LOCAL SALES � <br /> TAX CODEIS 3105 TO7AL ' <br />