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APPLICATIV�1 FOR CONSTRUCT �ON PERRlIIT <br /> everett <br /> 1/re Evergieen � <br /> CITY OF <br /> everett <br /> BUILDING DEPARTMENT TO BE COMPLETED IN INK—PLEASE PRINT <br /> 259-8810 <br /> DEMOLITION COMBINATION BUILDING MECHANICAL PLUMBING SIGN <br /> OWNER �MRILADDR[SS CIiV ZIP PHONE <br /> . z4o7- /y��pr, SB 7u>!l P.�ea�( (..zy 4Bo/z 7 yS-oo8�0 _ <br /> / � CITY ZIP PHONL <br /> TE A(NT� MAII ADDRE55 <br /> /4�r-- PHONE <br /> qRGHITECTOPDESIGNER MAILADDR[SS ��TM Z�P <br /> N � �� . 21P PMONE LICEASE� <br /> GENEPP!CONTRACTOH MRIL AOCRESS <br /> D'�I 11../n �20 L ifl �1V C. - <br /> MECMANICALCONTRACTOR Mf.ILRODRESS <br /> CIN 21P PMONE LICENSEI <br /> M� CITY ZIP PMONE LICCNSE t <br /> 'IU�BINGGONTRFCTOR MAII.FDDRE55 <br /> A� /� <br /> cuss oF wonK <br /> � ! NEW !_-. ADDITION . � ALTERiTION . �. REPAIR XDEMOLITION �. WOODSTOVE/FRPLINSERT .-�: BUILDINGREIOCATI <br /> TEN�NT IMPROVEMENT OR MTERION REMODEL ONLY <br /> CCNTACT PERSON AND PMONE N0. <br /> CONTR�CT PRILE OF WORK: <br /> DESGRI9E WORH�ND SOUARE FOOTAGE INVOlVEO <br /> PPOPOSEDUSEOFBUILDING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> C �� APPLICATION ANO KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> / PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEGAL�ESCRIPTIONOfPROPERTV15110WNBELOWORPTfACNFOURCOPIE51 yyORK WILL BE CONPLETED WITH WHETHER SPECIFIED HEREIN OF: <br /> �oi�_ ��aK uF _ NOT. THE GRAMTING OF A PERMIT OOES NOT PRESUME TO GIVE <br /> `I�Qc'I S AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF AN�r <br /> L or 'F�G' IS�=� ;«-'� A't- � I'S S OTHER STA�i E OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> / PERFORMANCE OF CONSTRUCTION.THAT I AM AU?HORIZED BY THE <br /> �-8�1i s9 OWNER OF THIS PROPERTV TO PERFOFM THE WORK FOR WHICH <br /> Jdfjt�n�,pi� fµ VIM.. !O OF tt+�'� t APPLICATION IS MADE AND I COMPLV WITH THE STATE <br /> CONTR�CTORS LAW 18.27 RCW AND 296.200 WhC. <br /> w�nf 7�E /�ko:ro c�F <br /> SMQ� C1�� 6�/I SIGNATUREOFCONiRFCTORORRUTHORiZEDAG[NT OAT <br /> ///��� X � � � `� ►� . <br /> PRQIEG`TR�DPESS � qPPIICA SCITVBUSINESS IGENSENO. ME NA ]�11� � <br /> �J !���� MECHANICAL <br /> PLUMBING FEE <br /> NO. TYPE OF FI%TURE OR ITEM FEE NO. TYPE OF EOUIPMENT ' <br /> WATER CLOSET(TOILET) NC-A/HNDLG UNITS-H.P. ^__ <br /> BATHTUB ! � FORCED AIR SYSTEMS-B.T.U. M E.A. <br /> LAVATORY(WASH DASIN) i UNIT HEATERS-B.T.U. M /� _�_ <br /> SHOWER � CLOTHES DRYERS � � <br /> KITCHEN SINK&DISP <br /> VENTILATION FAN � - <br /> DISHWASHER RANGE HOOD <br /> LAUNDRYTRAY WATER HEATER - <br /> CLOTHES WASH 1� WOOD STOVE <br /> URINAL ' METAL FIREPyA E 8 CHIMNEY _ <br /> DRINKIIJ �OUNTAIN FIREPLA INSEHT ' <br /> FLOAR DRAIN ' HE UMP � <br /> ACKFLOW PREVFNTERS i S PIPING ' <br /> ' ROOF DRAINS-FlPINLEADERS EXHAUST FAN <br /> i <br /> SINK(SERVICE-BAR.ETC.; � <br /> � <br /> � — <br /> � <br /> SUB TOTAL 5 SUB TOTAL $ ' <br /> PERMIT $ PERMIT $ ^_ <br /> TOTALFEE $ TOTALFEE 5 <br /> FRONTSEiBACN REARSETBACK 510[SEIOACK PLANCNECKNUMBER <br /> FEE RECEIPTNO. <br /> USEZONE LOTFREA <br /> VAGPNTSITE FEES VALUATION FEE <br /> f_': YES � � N� BUILDING � r <br /> 1VPEOfLON4.ALlOWA6LE n'�[Of:ONi1.ACiUAL OUu>u¢r xa0�[mRwxr.uxils ; <br /> t4auv p�UMBING <br /> -•— <br /> SREOFOIDG. NO.OFSTOFIES BASEMENT MECHANICNL <br /> �-. YES ��.-] NO <br /> OCCUPANCYLOAO (IRESPPNKIEFSBEO'U HEIGHTLIMITFTION �J, <br /> OTHER � <br /> .-' YES �- NO STATE BUILDING SURCHARGE —1� <br /> REpS�N FOR SPRiNKLERS <br /> STATEENERGVSURCHAFGE <br /> APPUCATIONACC.BY PLANSAPPROVEDBY CIiYOFEVERETT PUBLICWORK$ <br /> LOCAL SALES ; � <br /> TAX CODEIS3105 rara. <br />