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APPLICATIOrI FOR CONSTRUCT.JN PERMIT <br />Rre Erergreen <br />CITV OF <br />everett <br />BUILDING DEPARTMENT <br />259-8810 TO BE COMPLETED ItJ INK—PLEASE PRINT <br />DEMOUTION SL COMBINATION BUILDING MECHANICAL PLUMBING <br />OIYN[R N�PILAODfiESS CITY ZIP PMONE <br />' Coi,iST �12b �L/�G/E2 PK Fve��� 9J'zo�' Q93-�F590 -- <br />TENANT MAILADDRE55 CITV 21P PHONE <br />nRC11RECTOfl�ESIGNER MAII.pDDR[55 CITV ZIP PHONE <br />.�MP/�ESSio�✓ lkSv.s� zz�9 ��k[�San� EvQre� yP�v � 3� S- 3�Do <br />GEN[R�LCONTflACTOR MAILF�DRE55 CITY ZIP PHCNE UCENSF� <br />7G CO/VST 312U �T�pClpr Pk �„v�ef� 9fzbg 9�f3-4570 JGeoN��z3di�G <br />MECMINICALCONTRRCiOR MAILADI�RESS CITV ZIP PHDNE UCENSE• <br />PUIMBINGCONTRFCTOR MAILADD�IE55 GITV ZIP PHONF LILENSEa <br />everett <br />e <br />SIGN <br />uFw �� anninnN '� ALTERATION �. . REPAIR f� DEMOLITION �_ � WOODSTOVEiFRPL INSERT ', ; BUILDING RELOCATION <br />TENANT IMPqOVEMENi OR MTERiOii REIAODEL OI LY ^�1 / <br />CONTRACTPRICEOFWORN: ��/_ <br />OESCRIBE WORK AND SOUARE FOOtAGE INVOW E0) <br />�SNOWN <br />LOT_�_ BLOCn OF <br />aaaecr <br />CN7 <br />BAl <br />KITCHEN SINK 8 <br />DISHWASHEF <br />L:IUIJORY TRAY <br />CLOTHES WASH <br />URINAL <br />DRINF;ING FOUN <br />FLOOR �RAIN <br />BACKFLOW PRt <br />FOOF DRAINS- <br />SINK (SERVICE- <br />CONTACT PEFSON AND PHDNE NO. <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AIJD ORDINANCES GOVERNING THIS NPE OF <br />WORK WILL BE COMPLETED WITF' NHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NO.T PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATc OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANC�� OF CONSTRUCTION. THAT I AM AUTHORRED BY THE <br />OWNER OF T41S PROPERTV TO PERFORM THE WORK FOR WHICH <br />APPLICATIOiJ IS MADE AND I COMPLV WITH THE STATE <br />CONTRACTORS LAW 1827 RCW AND 296200 WAC <br />SIGN�TUREOFWNiFnCTORORAUTMORREUAGENT DAiE <br />���� 1 I -I'1 h� <br />FPP ICRNiS CI . 1iU51NE55 UCENSE NO. A`JO BUSINESS NAME <br />OR ITEM FEE NO. TYPE OF E�UIPMENT FEE <br />; � j - !UC-A�HNDLG UNITS-H.P. <br />� �- � FORCEDAIRSYSTEMS-B.T.U.4FM E.A. <br />��� -- UNITHEATERS-B.T.U. M <br />°- �� - I CI niuFC f1RVFRS <br />FANGEHOOD <br />WATER HEATER _ <br />WOOD STOVE <br />METAI FIREPLACE 8 <br />FIREPLACEINSEFT <br />HEAT PUMP <br />GAS PIPIIJG <br />SUB TOTAL S .` �!-1; - __ <br />PERMIT $ 'T- <br />TOTALFEE S �l` �'•- <br />FRONTSETBr1CK REARSETBACH SIOESEI�ACK P�A,CNLKNU��}�,,� <br />�D / <br />A � � � Gl� 1 l <br />USEi'1NE LOTAFEA VACANIS�Ih FEES <br />'�� i_.�-YES : �. NO BWLDWGfX�`� -,��•. <br />iVPE7�LOtISi.ALLOWABIE 7YPEOFCON57ACiUAL tttursucv rvooro��iui,nLurvas <br />`� T M eAoua I p�UMBING <br />JL <br />SREOFBIDG. NOOFSTORIES BASEMENT MECHAN�CAL <br />�`i9� 4�� Z i�. YES I`�-NO <br />OGWPANCYCOAO FIFESPFNNLERSFW'D HEIGMTIIMQITAT�ON OTHER <br />��. -. YES .yNO �O STATE Bl11LDING SURCHARGE <br />BERSON FOR SPRINKLERS <br />STATEENERGVSURCHAFGE <br />APPLIC4TIONALCOY PL�NSAPPROVEDOV CITYOFEVERETT PUBLICWORN$ <br />�y� � IOCAL SALES <br />`-•�U4 ----�' ti`� TAR CODE IS 3105 TOTAL <br />SUBTOTAL S C: C.' — <br />PERMIT $ � <br />TOTAL FEE $ (r'�' � <br />FE��� Q� RE����' I <br />Cl- 4 <br />VALUATION FEE <br />J <br />__ ✓o.��� ���.��_ <br />' �l��c� ���!`cii(l ��,�r' clr<<��1;/����<</l1(��) <br />� �_ t � "(� i {, -�lC — r �i � �! � � �� � <br />� <br />f✓1 <br />_'�1:?i' �C <br />� �� /i'�,�i . <br />� r�- ;,����. <br />