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f�?f''' <br /> , <br /> APPLICATI� FOR CONSTRUC�ON PERMIT <br /> � fMEverpreen everett ` <br /> ,� CITY OF � <br /> �, everett <br /> � BUILDING DEPARTMENT <br /> 259-BB10 TO BE COMPLETED IN INK—PLEASE PRINT <br /> ❑ DEMOLITION ❑ COM8INATION �Q BUILDING f�AECHANICAL �PLUMBING ❑ SIGN <br /> � ,OV/NER MAILADDRE55 GITY ZIP PMONE �r.��O� O <br /> �.A� �Poc� tvies �',u c. /bGo� �l /.��Q _S � lsor�e�c. 9so�a <br /> TEN�MT MUL�0�flE5Sr GIfY 21P PNONE <br /> ,� AyG111TiQDiiDE5lfiNER L _ 1.IAILAD�RE55 ��n' 21P PHONE <br /> ,a �/��� L�� ? 3/ - a "'� S�- �" B Mk�ir.7-Co 98��s 7 '�'S' �s6�i <br /> •� OENEMLCONTRI�CTOR MAILADDRESS '=�T�' ZIP PMONE UCENSE� <br /> j S�o-w" ,�s ocvN,v.r [.ARBCHr- �o� Kn. <br /> MECNMlIC6l.CONTPACfON MAILADDRESS CITY � '" 21P PNONE UCENSE� <br /> � {�o�!-�p�v [�C,at�a� 340/ /��S'�S'�'skJ .ry.uNwtoP 7�s 393o Ho,e/�HF/37Dr.�, <br /> ,� PLUMBINOCONTRACTOR MAILpD�RE55 Cltt ZIP PHCNE �ICENSE• <br /> ; l>ttb� Soa,c�P p«u+Bi.u� •�oa y� G4.SiNo Ct�r�fi £uee�i"' 7'f3 yS3'7 p�� �c-�SP <br /> ,:ussoFwoRK / ( 0� <br /> .� NEW O ADDITION ❑ ALTERATION [ I REPAIR I I DEMOUTION !1 WOODSTOVEiFRPL INSERT ❑ BUILDING RELOCATION <br /> �j iENR1TIMFflOVEMElNiOHINTERIORREMOUEIONLY CONT�CTPERSONANDVHONENO. ' <br /> � <br /> � CONTMCTPRICECFWORK: <br /> •� DESGR�BEWOPKAYD60WREFOOTA6EINVOW 0 <br /> :; S �2 I S � 7� 8af �'f'�� �1 �oc� �f-8'S 90 3 d <br /> �� Pf10PO5EDU5EGFBUILDIN� I HEREBV . � ITIFY THAT I HAVE REAO AND E%AMINED THIS <br /> S S�� APPIICATl01.AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> ;� LEMLDE6C TqNOFipOPERTY�SNOWNBELOWOflATTl1CHFWRCOPIES) PROVISIONSOFLAWSANDURDINANCESGOVERNINGTHISTYPEOF <br /> ,i WORK WILI BE COMPLETED WITH WHETHEH SPECIFIED HEREIN OR <br /> � �or e�ocK or NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> "� ' AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> � OTHER STATF OR LOCAL LAW RE6ULATING CONSTHUCTION OR THE <br /> PERFORMANC�OF CONSTRUCTION.THAT I AM AUTHORI2ED BY THE <br /> � OWNER 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 296200 WAC. <br /> SIGN EOFCQNTPACTONORAUiH RI2EDAOENi DATE <br /> � X �. 5�Y - 9 a <br /> P CTADDRE"3 ^J /q ,p <br /> � � ��J (p JO�— .(l�vSr APPLIC�NTSCIiYBUSINF.SSLICENSENO.ANOBU3ME55NAME <br /> MBINO MECHANICAL � <br /> NO. TYPE OF FI%TURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> �� WATER CLOSET(TOILET) y'��— A/C—lVHNDLG UNITS—H.P. , � <br /> •j BATHTUB o '— FORCED AIR SVSTEM�—B.T.U. M E.A. � <br /> .� LAVATORY(WASH BASIN) p �— UNIT HEATERS—B.T.U. M ; <br /> e SHOWER �= CLOTHES DRYERS � <br /> d KITCHEN SINK 8 DISP ( VENTILATION FAN ; <br /> '��� DISHWASHER � — RANGEHOOD � <br /> �� CAUNDRYTRAY ; J WqTER HEATFR � <br /> j CLOTHES WASHER �— WOOD STOVE i <br /> � URINAL ' METAL FIREPLACE 8 CHIMNEY � <br /> � DRINKING FOUNTAIN � FIREPLACE INSERT <br /> � FLOOR DRAIN � HEAT PUMP �^ <br /> �, BACKFLOW PREVENTERS � ; GAS PIPING ' <br /> HOOF DRAINS--RAINLEADERS ,f�— EXHAUST FAN � <br /> .� SINK(SERVICE—BAR,ETC.) . ; � � <br /> � <br /> a , � <br /> � <br /> t � � <br /> � � � <br /> i� <br /> SUB TOTAL $ ;� SUB TOTAL 5 ' <br /> ' PERMIT $ � PEFMIT $ ; <br /> TOTAL FEE $ � ' TOTAL FEE $ � � <br /> I FRONTSETBRCK REARSETBACK SIOESET CK PUNCHECKNUMOER FEE3 RECEIPTNO. <br /> ; �D � So ' s' ao ' o ayc r 3�'6s'z <br /> � uSEz LOTAREA VAC�Ni51TE FEES - VALUATI N FEE <br /> ' `Z i7 YES U NO i <br /> "i BUIL�ING � S6 <br /> 1YPEOfCUNSL�LLOWABIE 1YPCOiCONST.ACIUAL ottuou¢r xopowrtlmaunn5 <br /> ,�� �e� p� I PLUM�ING � � �y <br /> 52EOFBLDO. NO.OFSTORIES OISEMENT I T— <br /> '� � MECHANICAI 90 �OD <br /> � %YEe� O n � <br /> yOCCUPAN YL 0 FIRESPRNKLENSNEO'D HEIONTLIMIT�i O1HER A.y�. � '3 !Y/ <br /> d� --T <br /> ,� f� YES �IQ NO �D STATEUUILDINGSURCHARGE y isD <br /> � q FOqSPRINKlERS <br /> d <br /> 1 (��S b STATE ENERGV SURCHAi7GE � <br /> APPLIGATIONACC.BY PUNS�PPROVEDBY CITYOFEVERE7T PUOLICWORKS �D � <br /> j p LOCAL SAlES —:— <br /> /'� � TN(CODE IS 3105 rorn� <br /> ' 779� 9� <br /> . <br /> �. �...,.> ;..,,�,T..,..: : : � . , . . .. . : --_ � �••;, <. - - <br /> , .... . . .....:. ... ... _ . ._. . , ..._ <br /> :. . . . . . ,. <br /> � <br />