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APPLICATION FOR COPISTRI➢CTIalN PERMIT <br /> �,-<<�« <br /> . � e <br /> ��rv�� <br /> everett <br /> BJILDING DEPFlRTMFNT TO BE COMPLETED IN INK—PLEASE PRINT <br /> 25&8810 �N(ECHANICAL PLUMBING SIGN <br /> DE(dOIITION COMBWATION BUILDING _._ _ <br /> ����q AIAIL ADDRESS <br /> CItY l�P Pr101�F <br /> 7�",�• c, �¢ �31 ti ��F�, (l�,l,� ,;�.. FUt �-�P���'Z" <br /> 11 qNR <br /> MAM1 AD�P[SS ��tY �V <br /> ro�U��iEC10R�E51GNER MAIIADDRE55 <br /> Gtt ZiP PIIONE <br /> GU;CRALCONiRACiOR MAR�DDRESS G�TY 2iP PNONE LiCENSE• <br /> !'�CG!AniC�LCONIRPCTOR MARADDRF55 I � GITV ZiP PnONE LiCENSEt <br /> � � '° N ul �1r��r �e�.�e�Xh� 3Un Fii � A�l EJt 9X2�� 2S`l-�331 /J�•-`�7,d�. 13"� K�— <br /> ���. 1 f'MONE UCENSE <br /> p��,nABirvGCOuiBAC1011 MARP��PESS <br /> ��r"t'i <br /> � �� nnssoFwonK <br /> C, !c}! NEW . ADDITION ALTERATION REPAIR DEMOLITION WOODSTOVEiFRPL INSERT � BUILDING RELOCATI <br /> H c �'�' 1(IN��LIMPPOVEMENTORMtERi0RRE1A0�ELONIY CC`liRCiPE1150NAN�PNONENO <br /> H �H � 10L� <br /> F'C O CONiRACTCRIL[OfWORN: <br /> y� pE5Lf11BE WOPKAN�SOIIRR[f iPGE INVCLVE� <br /> �y H 1�f rn, bks �u.n, � <br /> y x� r�l�roseouseocamioie� I HEFEBV CERTIFV THAT I HAVE READ AND EXAMWED THiS <br /> [x O APPLICATION AND KNOW THE Sf.M6 TO�E TRUE AND CORREC7.ALL <br /> O H � irr,n�oescniarior+ovraovenTvisHowneeiowoan**ncHFouawP�e51 PROVISIONS OF LAWS ANG OPDINANCES GOVERNING TYIS TVPE OF <br /> WOPK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> H �(y „�r a�p�K oF NOT. THE GRANTING OF A FERMIT DOES NOT PRESUME TO G�VE <br /> O AUTNORITV TO VIOLATE CR CANCEL THE PROVISIONS OF ANY <br /> �` nC O7HER STATE OR LOCAL LAW REGULATING CONSTRUCTION OH THG <br /> =� I--1 3 FERFORMANCE OF CONSTR�CTION.THAT I Ah1 AUTHOR'ZED BY THE <br /> Y H Lz OWNER OF THIS PROPERTY TO PERFOFM THE WOHK FOR WHiCH <br /> t� <br /> Hy �pPLICATION IS M11ADE AND I CO�dPLY WI7H iME STA7- <br /> � p1 CONTRACTORSLAW 182%R;W AND296200 W�C. <br /> H Gieun�uncoFcou*ancrononnun.oF¢tonaeut onrr <br /> C'� C[/� <br /> ��y n _ — X_�.� w� � - -- <br /> H] � [Q PPOJCGiMDF65 /' �j q�-r,ifANi5CI1Y01151N SUCENSENOANOPUSi4E55hn6�E <br /> � 73� . /� Vl('tV I[�' . O/ L' l�/ <br /> PLUMBING MECHANICAL <br /> � FEE NO. TYPE OF EOUIPMENT FEE <br /> NO. 7YPE OF FI%TURE OP ITEM <br /> WATER CLOS[T ITOILET� A C—A HNDLG UNITS—H.P <br /> � 6ATHTUB � FORCED AIR S�SiEMS—B.T.U. M E.A. <br /> � ��� LAVATORV IVJASH�ASINI UNIT HEA7ER5—B.T.U. M _T <br /> ��I SHOWER CLOTHF.S DRYERS <br /> KITCHEN SINH 8 DISP _ VENTILATION FAN _T_ <br /> DISNWASHEf7 RnNGL HOOD_ <br /> � LAUNDRY7FAV WATEFiHEATER _ <br /> � �� CLOTHES WASHER WOODSTOVE <br /> ' URINAL METAL FIREPLAGE 8 CHIMNEV <br /> DRINKING FOUNTAIN fIREPLACEINSERT <br /> FLOOR DRAIN HEAT PUMP <br /> �� GAS PIPING <br /> � BACKFLOW PREVENTERS <br /> � EXHAUSTFAN <br /> ROOF DRAINS—RAINLEADERS <br /> SINK ISERVICE—BAFi.ETC.) <br /> '01=� -- <br /> � '� — SUBTOTAL 4 PERMOTAL 5 % �� <br /> 1_1 PERMIT 5 � <br /> TOTAL FEE S TOTAI FEE S S �Cv <br /> � PLAN CHECe NU1AOER i CC RECEIPT NO <br /> I BONT SETPACN RE4R 5[TBPCN SIpE 5E10ALH <br /> �sezoNe �oraRen vacn�+�srtE FEES VAI.UA7ION FEE <br /> . YES NO pUItDING <br /> rvff0(�OXS1.AltOWRBIF ��«UNS1.ACtIIAI n[nm�ya xno�n:�.•.i•i;u•;is � -- ---- <br /> wm�� p�U�.�pING <br /> SC[OfBI�G NO.OFSTORiES OASEIAENL MECHANICAL �S � _ <br /> VES NO <br /> OCGUPANCYLOAD FIRESPNNKL[RSR[OO HEIGMiLII.UTRTION OTHER _ <br /> � �. YES NO STATEOUILDINGSURCHARGE <br /> � <br /> frt n50N FOR SPRINKLEflS <br /> 51ATL[NERGYSURCH�RG[ <br /> nrrucnrior�ncc or ruNsnvrr�o�•Enor CITY OF EVERETT ruoucwOaKS <br /> LOCAL SALES <br /> TAX COOE IS 3105 t�TA� �' � <br />