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� APPLICATIOI�1r'FOR CONSTRUCTi�I RERMIT evereu <br /> � TO BE COMPLETED IN INK—PLEASE PRINT � <br /> '� tM EverDreen y <br /> CITY OF <br /> ! everett HEATING SYSTEM: GAS ❑ELECTRIC U � <br /> BUILDING DEPARTMENT - <br /> 259-8810 <br /> " ❑ DEMOLITION I I COMBINATION IXBUILDING IxWECHANICAL i � LUMBING i7 SIGN <br /> � L�SSCFU C'ons,M�17i�E/820� �helll�7c+u heZU g$OIZ PH0�8188�-� <br /> , <br /> , <br /> TENANT M�ILpODRE55 ITY 21P PHONE <br /> No►� <br /> � ARCHITECTOqDE51GNER M�II�DDPESS CIiY ZIP —PMOr E <br /> ; ��.�J1J C�OnSUC.7�laJTS "Xf5'�Sb`� <br /> ' GENE CONTR�ICTOR � D MAILAOOR� CIiY z�p PHONE �C SSG T LI O�K <br /> L Q uill � <br /> � MEC1tNlIG4CONTR CTCN M�ILA��RE55 CI7Y ZIP PHONE LICENSE• <br /> . �D�°lZOAI ��'RT71JCj 3(opl -/21 sT Su) Lunn �'J8�37 75�5-343� H�l�l Z�� %)'�7DZ <br /> : P UM01N0 CONTR�CTOR ML R�ORESS C Y ZIP PMONE LICENSE/ <br /> � ���.-r Sou►�� ��.m� x an��l ��no W Firt- 5 08�� 7�3-9537 Pu4�.rs � i 4►oz <br /> � SOFWORN <br /> � - NEW I�I ADDITION I�I ALTERATION I I qEPAIR I I DEMOLITION I I WOODSTOVE/FRPL INSERT ❑ BUILDING RELOCATION <br /> , <br /> i �S/G�5��� ^_ ` CONiAGi PERSON�ND PI/ONE NO. , <br /> 1 CONTR�LTFRICEOfH'ORK <br /> w�i <br /> � OE6CRIBE WOfiN AND SOU�RE FOOT�OE INVOIVED <br /> ; - 6 zo � �- �-lo �']-SS`��o <br /> �� PIIOPOSEDUSEOFBOilOING <br /> � I HEREBV CERTIFY THAT 1 HAVE READ AND EXAMINEO THIS <br /> 1 _ � APPLICATION AND KNOW THE SAME TO BE TRUE AND COFiRECL ALL <br /> : LEMLDESGRIPTqNOf PROPERiV(SNOWN BEIOW OR�ilA' rOURCOPIES� PROVISIONS OF LAWS AND ORDINANCiS GOVERNING THIS 1YPE OF <br /> WORK WILL BE COMPLETED WITH WHEIIIER SPECIFIED HEREIN OR <br /> -y �or eiocK oF _ NOT. THE GRANTING OF A PFRMIT DOES NOT PRESUME TO GIVE <br /> � (�` c���-�/� ,p ,.�^ AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANV <br /> �7 �I lJ�C7clM.V D �C �J'7i�� ��V Z OTHEF STATE OR LOC.AL LAW REGULAT�NG CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORI2ED BV THE <br /> ' OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> � APPLICAT�ON IS MADE AND I COMPLY WITH THE STATE <br /> y CONTRACTORS LAW 1827 RCW AND 296.200 WAC. <br /> ) w SIGNRIUREOFCONIRACTORONAOTHORIZEO�GENT DQE <br /> 4 <br /> 9 <br /> a , � X <br /> � PROJECTADDRESS G�ss�s ti �nnSr1°ue�o��srx+ nl 8cx� <br /> � �'V�I�£� <br /> � APPLICANTSCITV USINESSLILENSENO �N09USINESSNpME <br /> �y PLUMBINO MECHANICAL <br /> �i NO. TVPE OF FIXTUqE OR ITEM FEE NO, TYPE OF EOUIPMENT FEE <br /> � WATER CLOSET(TOILET) / � A/C—IVHNDLG UNITS—H.P. , <br /> ;i Z. BATHTUB D; FORCEDAIRSYSTEMS—B.LU. M E.A. � <br /> � LAVATORY(WASH BASIN) UNIT HEATERS—B.T.U. M � <br /> ,? SHOWER � CIOTHES DRYERS , <br /> � _ KITCHEN SINK 8 DISP ; VENTILATION FAN � <br /> DISHWASHER � RANGE HOOD <br /> � LAUNDRYTRAY ; WATER HEATER � <br /> 9 CLOTHES WASHER WOOD STOVE � <br /> � URINAL � METAL FIREPLACE 8 CHIMNEY �--- <br /> DRINKING FOUNTAIN � PIREPLACE INSERT � <br /> FLOOR DRAIN � HEAT PUMP � <br /> �: BACKF�OW PREVENTERS ' GAS PIPING � <br /> ROOF DRAINS—RAINLEADERS � EXHAUST FAN , <br /> , SINK(SERVICE—BAR,ETC.) � � <br /> .i NCN Noc�5iN6 ND ODDs i— <br /> i � <br /> i <br /> � i <br /> � <br /> � i <br /> , SUB TOTAL $ S,S; SUB TOTAL $ � <br /> � PERMIT $ � PERMIT a <br /> • TOTAI.FEE $ "� — TOTAL FEE $ �— <br /> � FOR OFFICE USE ONLY: <br /> FqONTSETBAGN RE�RSElOACK SIDESEIBACR /�PLANC E �MO[ I FEE,� _ � �(� pEGEIPTNO <br /> �� ZC1� S' � "I�.� �i� o�l L �C(L <br /> ' USEZONE �oTnnEa vncnNrsire FEES VALUATION FEE <br /> 'Z 5 5 <br /> � BUILDING -�3 59q- 52,2 �50 <br /> IYPEOfCONIS.AIIOwABIE IY�EOfCONSt.ACtUAt vccur�rrcr r,oaow[uixcuxns <br /> ' S�� �p�n PLUF101NG - C�� <br /> Y - tJ R-3 � � <br /> '. SIZj OFfq�W F t ND.OFSiORIES BASEMENT <br /> 0 <br /> � � 4405F 6AC Z NO MECHANICnI G�� ; <br /> � OLCUPANCYLOR� FIRESPRNNLERSREOD NEIGNTLIMIGtION AODITIONALPLANCHECK �.�Q <br /> t <br /> � n�/a No zS� <br /> OTHGR ' <br /> ± NE�SONFORSPRINNLENS � <br /> STAT[BUIL�ING SUFCHARGE /�- i 50 <br /> � INTAREOv P.nNSnPPROVEDeY CITY OF EVERETT PU9LIC WORNS 2O� <br /> ' _ q�t LOCAL SALES <br /> „�f TAX CODE IS 3105 TOTAL � � <br /> 1 � <br /> .. ._ .._ .� .....__..�._�. ... <br /> - ,._...-.._�._�- _... .-. -�r..�..�+.�,��....-� <br /> '(' <br />