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� y�; � �J ��+� N Q..T <br /> , ti „:. <br /> �, APPLICATION FOR CONSTRUCTION PERMIT <br /> � everett <br /> �E���� e _ <br /> ? cmoF <br /> '; everett <br /> BUILDING DEPARTMENT <br /> � 259-8610 TO BE COMPLETED IN INK—PLEASE PRINT <br /> i <br /> i ❑ DEMOLITION f 1 COMBINATION I 1 BUILDING I 1 MECHANICAL I I PLUMBING ❑ SIGN <br /> Q�Ep MAILAO�RESS GITY 21P PNONE <br /> ! Wood I�laucN Now�cs � U �3ov io3 z 1.yv�uwo.�/ t.�A, SYo�6 S �{6 - 3969 <br /> �� TEN�NT MMLADDRE55 CITY Z�� � PMONE <br /> Y <br /> ��1 �PCMITECTOR�ESIGNEfi M�IL�ODRE55 CIiY ZIP PIIONE <br /> 1 <br /> , GENER�ICONTR�CTOR M�IL�ODRE55 GITY 21P PMONIi LICENSE� <br /> w�(�quFW ��orruS l�m 73car /03z- .C��vww�a.� � 5'�osF6 -55�6-3t69 ooc{k�H/7�/o, <br /> 'i AIEGHFNICALCONTR�CTOR MRIL�OORE55 —� ��n' � ZI CYONE UCENSE� <br /> PlUA181NGCCk1TR�CTOR M�RAC�RESS CI7Y IIP �IpNE LICENSE� <br /> �� CLASSOFNYIRK <br /> '� � NEW I 1 ADDITION I I ALTERATION I�I REPAIR 1 I OEh7qLITION I I WOODS70VE/FHPL INSERT f I BUILDING RELOCATION <br /> ; TEIUNTIMPROVEMENTORINTERIORREMOOELONLY �jJ� �(/AC�Q CONtACLP[`O�SpNRN9 P110NE/N0. <br /> � CONTRACTPRICEOFWORK: O MO „(CNAA-A �'_��.WF/L <br /> � �ESGRIBE WOfiN AN�SOUARE FOOTAGE INVO VED <br /> ' �.JFw S o SSld ^396� _ <br /> PHOPOSEOUSEOF unoir+a I HEREBV CERTIFY THA7 I HAVE READ AND E%AMINED THIS <br /> ,� Si�t+�� Fq»�� � APPLICATION ANU KNOW TH�: S� ��E TO BE TRUE AND CORRECT.ALL <br /> lEML0E5CRIPTIONOF PROPERtt�51 0WN BELOW ORAtUCHFOUfI WPl[5� PROVISIONS OF LAWS.4ND C�' '�NCES GOVERNING THIS TYPE OF <br /> I �ot 4+� eiocn oF �d '1' WORK WILL BE COMPIETED ti� ' WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PE�.MIT DOES NOT PRESUME TO GIVE <br /> AUTHORITY TO VIOLATE OR CANGEL THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL lAW REGULATING CONSTRUCTION OR THE <br /> � PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PPOPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> j CONTRACTORS LAW 18.27 RCW A�D 296200 WAC. <br /> 'j SIGNAiIIPEOfCONiR�C10RORFUTMOR2EDAGENT ORTE � <br /> � PRQIECTADDRE55 � _ /LL�•��✓/ ����— ///L�i ZI <br /> �� /�_ 'nv�C APPUCRMSCITY�USINESSUCENSEN0.4NOBUSM�N�ME <br /> �i �X <br /> ' PLUMBING MECHANICAL � <br /> ',i NO. TYPE OF FI%TURE OR ITEM FEE N0. TYPE OF EOUIPMENT FEE <br /> " WATER CLOSET(TOILET) ' A/C—NHNDLG UNITS—H.P. � � <br /> _� BATHTUB ; FORCED AIR SYSTEMS—B.T.U. M E.A. ' <br /> � 3 LAVATORY(WASH BASIN) � UNIT NEATERS—B.T.U. M � <br /> ,� .Z SHOWER � CLOTHESDRYERS � <br /> .� KITCHEN SINK d DISP i VENTILATION FAN i <br /> DISHW�SHER 1 RANGEHOOD � <br /> �� ' 1 WATER HEATER � <br /> VIUNDRVTRAY i <br /> �{ CLOTHESWASHER � WOODSTOVE � <br /> . URINAL METAL FIREPLACE 8 CHIMNEY ' <br /> ' DRINKING FOUNTAIN i FIREPLACE INSERT i <br /> FLOOR DRAIN � HEAT PUMP ' <br /> �� BACKFLOW PREVENTERS ; GAS PIPING I <br /> .. ROOF DRAINS—RAINLEADERS EXHAUST FAN � <br /> --� <br /> � SINK(SERVICE—BAR,ETC.) ; � <br /> a-.�2�.. 2ea�r _�o—� <br /> - � <br /> � <br /> � � <br /> , —� <br /> , <br /> SUB TOTAL $ (� ;� SUB TUTAL $ p ' — <br /> ', PERMIT $ � PERMIT $ � <br /> TOTAI FEE $ a ' TOTAL FEE $ U ' � <br /> FRONTS�ET�BA.,CN REAfiSETBAGK SIDESET09CK PLANCN[CKNUMOER FEE ,�YY• 73s.jC ^•��EICiNO. <br /> � useza+�, iornn� ' vncn�ire FEES VALUATIO FEE <br /> . �-7j ��p �0 � �ES I.I NO BUILnING S'��.$� 'S 9S � <br /> � lYPEOFCONSf.AIIOWABIE iVPE01CONS1.AC1VAl otNrarvn xoOrDWnUxGUNnS — i <br /> , . /_ v' N r�on3 / PLUM6I�N�G��� _ /a i� <br /> V /� � � <br /> i <br /> SIZEOFBLDG. NO.OFSTOf11E5 URSEMENi MECHANICAL �� <br /> �' O <br /> � f frF t Y>y 3'� �. I I YES Y'�No � <br /> OCCUPANCYLO�D FIRESPRNKLERSRE09 HEIONTIIMIIf�110N OTHER i <br /> ,� q. I J YES I Lf�O STATE BUILDING SURCHAtiGE C, „� <br /> � HE SON FOR SPRINNlERS � <br /> i <br /> �k 6TAiEENERGYSURCNARGE � <br /> � <br /> .j . PLqNSAPPROVEDBY CITY OF EVERETT PUOLIC WORNS ,O � <br /> ��� %!�h^' �� r� TAXCODE SL3105 TOTA� o '3 <br /> � . . .. _.. _ , _ . . . - . - <br /> _.,. <br /> ,�. <• � ,.;�, ,.�r--, . . :, , .: �. .. ,r�.. . <br />