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APPLICATIG�J FOR CONSTRUCT . JN P�t��7? ,? ��'� <br /> rno Eve����wn TO BE COMPLETED IN INK—PLEASE PRINI' LJ l l MA� ` <br /> CITV OF <br /> everett � � <br /> HEATINGSYSTEM: ❑GAS DELECTRIC U \ CITv nc"�";�"` -•^— <br /> BUILDING DEPAPTMENT --���i; <br /> 259-8810 <br /> Public Works Dept. <br /> f I DEMOLITION I 1 COMBINATION I I BUILDING �ECHANICAI 17 PLUMBING f7 SIGN <br /> OWNER MAIL�DDfiE55 GIfY ZIi' PNONE <br /> �,,�r�r� 145 C-.�'d. ������,z <br /> TENRNT M�ILAU�RESS I1V ZIP PNONC <br /> QJ L�l Sd C.� �� <br /> APCIIITEGTORDESIGNER MRILRDDRE55 CIiV 21P PIIONE <br /> `�/�,lfc '"17rz' h.� 1263� � �'-sT� � CK� � �O ��7•0334, <br /> GENEHM CONiR�CTOR MRIL ADDRESS CIiY ZIP PIIONE LICENSE 1 <br /> � LAklt�2Fs� co.�s �dll S�J�zT,P LA.l�� ('lr,v."�- �.�0 9�.,7�� �sYl -��Ds <br /> MEGNRNIC4LCONiRApOR M�RAODRE55 CITY ZIP PNONE I.ICENSE� <br /> A�A�.1U� �!?i't ��-if�os.f f'.c�. '13cd IS�'.� W�oOiNJ�cuE �4A. 4°.ArZ y83-565-7 f��lA��F�i�19Rln <br /> PLUMBINGGONTR�GTOR MAItAU�RESS GITY ZIP PIIONE LICENSEI <br /> CLASS OF WORK <br /> : . y!NEW Il ADDITION LI ALTERATION I I REPAIR I. 1 DEMOLITION I I WOODSTOVE/FRPIINSERT ❑ BUILDINGRELOCATION <br /> . CONTRCT PEfi50N�ND PNONE NJ. "� <br /> cor+ra�ct rn�ce oF woa� 2 SS�." YN�L�L4Fi_ 13v�c siF� y g 3 -S 4�5�I <br /> DESCRIBE WOR1(pND SOUARE FOOTA[E INVOLV[D 1 <br /> �1145/t.c �C�t �ia1K;[ S 57E�^ .c� a 1$�3 �p b�o�s.�. <br /> PROPOSEDUSEOfBUII�ING I HEREBY CERTIFY THAT t HAVE FiEAO AND E%AMINED THIS <br /> G�(��c •Fa�,y� �g��r�(�� APPLICATION AND K��OW THE SAME TO DE TRUE AND CORRECL ALL <br /> �eea oeswirrior+oF rnorcnn�s��owN oe�owonnrinci+rouncovies� PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> �or oiocK oF NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANV <br /> OTHER STAT[OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.TNAT i AM AUTHORIZED BY THE <br /> OWNEfl OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH � <br /> APPLICATION IS Mi DE AND I COMPLV WITH THE STATE <br /> � 2 CONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br /> � � J SIGNRTUREOFCONTR�GIOt10RRU1NOR2EDAfENT DRTE <br /> �O�(15 `3l-D �f �L rJF<iT u:�0. X�� n�� , � � � <br /> PfiOJ[Ci�DORE`.i ��r� J�-��'-<- <br /> APPLICRNTS CITV BUSM[55 LICENSE NO.ANp BUSINESS NRME <br /> PLUMBING MECHANICAL <br /> NQ. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) � A/C—NHNDLG UNITS—H,P. � <br /> BATHTUB FORCED 11R SYSTEMS—B.T.U. M E.A. <br /> LAVATORY(WASH BASIN) UNIT HEATERS—B.T.U. M i <br /> SHOWER ' CLOTHES DRVERS <br /> KITCHEN SINK 8 DISP V[NTILATION FAN ' <br /> �-- <br /> DISHWASHER RANGE HOOD <br /> LAUNDRY TRAV ; WATER HEATER <br /> CIOTHES WASHEP � WOOD STOVE � <br /> URINAL ' METAL FIREPLACE 8 CHIMNEV ; <br /> DRINKING FOUNTAIN � FIREPLACF.INSERT � <br /> --�— <br /> FLOOR ORAIN _� HEAT PUMP � <br /> BACK�LOW PREVENTERS ; G�S PIPING �_ <br /> ROOF DRAINS—RAINLEADERS � E%HAUST FAN � <br /> SINK(SERVICE—BAR,ETC.) I� Sr�� K�ic' � S ' <br /> � � <br /> � <br /> — � <br /> SUOTOTAL $ SUBTOTAL $ <br /> PERMIT $ � PERMIT $ �_ <br /> TOTAL F[E $ ' TOT�L FEE $ � <br /> FOR OFFICE USE ONLY: <br /> FRONTSEiBRGN PEMSELOAGK S�D[SETOACK PLANGIIECNNUMU'� fEE RECEIPTNO. <br /> y �2U <br /> us�ionE LOTAAErI VACRNi51TE FEES VAlUAT10N FEE <br /> OUILDING <br /> IYPCOfCONIS.ALLOWRBtE IYf[OfLON51.AC1UAt Octun�uGv unroowuU�x.uxus i <br /> �"��" PWId�ING i <br /> SIIEOfOLD(S. NO.OFSIORIES O�SEMENT MECHANIC�L � <br /> occu�nNcviono rinesrnr+Kier�sneon NEIGH7I.IMIlAlION ADDI710NnLPLANCHECK �(j; <br /> � <br /> .AT��- _'�,,�tu - • /D; <br /> n�nsor+ronsrmr�niens <br /> STAT[�UILDING SURCIIARGE i <br /> MTANE BY PL�45�PI'ItOV[D OY CITY OF EVERETT rUouc woRrcs ' <br /> LOCAL SALES , <br /> � c'� gLj TAX CODE IS 3105 rorn� �!•� � <br />