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APPLICA7101�1� FOR CONSTRUCTIu� PERMIT <br /> everett <br /> I�e Evc/green � <br /> OITV OF <br /> everett <br /> BUILDING DEPARTMENT <br /> 259-8810 TO BE COMPLETED IN INK—PLEASE PRINT <br /> I DEMOLITION I I COMBINATION � I BUILDING �MECNANICAL Cl PLUMBING ❑ SIGN <br /> OWNEIi MAILAODPESS � � CIiY '/ ZIP � PIIONE <br /> �1�'yJ./'/' �/%�/1(�/ S )y�� V/PiJ �f ii�;7r l�i. �"IiP/G7T ��)�C.-� 7r�7 — l0 3��,5 <br /> rew,Nr ranii nooness eirr zm rnor+e <br /> l <br /> �/'/J/P (� �/ � 7r" _ <br /> nncwrECTonorsicr�[n unanooness cirv zia PIIONE <br /> GFN[nn1.CONinnclon IAnILnDon[ss cltv zlr r110HE IICENSE/ <br /> ��c.Jl��/�t�.��o s�.���Ll�1 v�� ,��p��f� 9�ao�.�,��-syy� vf,u.��,53G l- <br /> IAGCIIANI �LCONIl1�CiOR MRIL�DORE55 CIiV 21P �INNG LIGENSE� <br /> PIUMpINGWtI1R�Gi011 MAIL�ODIl1i55 Gi1Y lIP 1'llulll LICfH9:• <br /> CLASS Of WORK <br /> i�1 NEW I.I ADDITION �ALTcRATION I I REPAIR CI DEMOLITION I 1 WOODS70VE/FRPL INSERT I ] BUILDING RELOCATION <br /> IENRIt IMPROVEM[Ili Ofl INiEflIOR B�LM�D1EI ON GONIACT PEfi50N AND�IIOIIE NO. <br /> C/C/bl <br /> COt1TR�Ci PRICE OF WORN: I �j y�� _ <br /> DLSLRIOE WORK�ND SOU�11E FOO AGf:INV(MA[0 <br /> �f���� <br /> rnoroseouseor[�miow I HEREOY CERTIFV iHAT I HM�E READ AND cXAMINEU THIS <br /> �� APPLICAiION AND KNOW THE SAME TO BE TRUE AND CORHECT.ALl <br /> �ecni.oescamnor+oFrnorennis��owNee�owonnnna�rouncoricsi PROVISIONSOFUWSANDORDINANCESGOVERNINGTHISTYPEOF <br /> WORK WILL BE COMPLE7ED WITIi WNETHER SPECIFIED HEREIN OR <br /> iot o�ceK oF NOT. TH[ GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �UTHORITY TO VIOLATE OR CANCEI THE PROVISIONS OF ANY <br /> OTHER STATE Ofi LOCAL LAN'RE:iULATING CONSTRUCTION OR THE <br /> -- PERFORMANCE Of CONSiRUCTION.THAT 1 AM AUTHOR12ED BY THE <br /> OWNER OF THIS PROPERTY l0 PEFFORM iHE WORK FOR WHICH <br /> APPLICATION �S MADE AND 1 COMPLY WITH 7HE STATE <br /> CONTRACiORS LAW 18.27 RCW AND 296200 WAC. <br /> SIGNNUREOPCONIRAG10f10114U1110RIZED4GENT D�TE <br /> PR(O�J[[/CiAD�RESS Q J� <br /> .����C.CY/4�---i��—JJI�iA� <br /> J7 � V�PL) �lf(� J/ . ���LIC�NISCILVOUSRIESSUf.ENSENO.ANOBUSINESSNA � <br /> PIUMBING MECNANICAL <br /> NO. TYPE OF FI%TURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET� � � ArC—NHNDLG UNITS—H.P. _�_ <br /> BATHTUB � fORCED AIR SVS7EMS—B.?. E.A. ; <br /> LAVATORY(WASH BASIN) � UNIT HEATERS—O.T.U. M i <br /> SHOWER CLOTHFSDHVERS <br /> —�— <br /> KITCIIEN SINK 8 DISP i VENTII.A7'ION Fl�N �_ <br /> DISIiWASHER � RIINGE I100D � <br /> LAUNDRV TRAY � �_ W�TLf?H[ATER <br /> CLOTHES WASHER WOOD STOVE i <br /> URINAL ' METAL FIPEPLACE 8 CHIMNEY � <br /> GRIhKING FOUNTAIN — --i— FIRGPLACE INSEIiT ' <br /> ---r— <br /> FLOOR DRAIN ' HEAT PUMP � <br /> BACKFLOW PREVENTERS i GAS PIPING ' <br /> T <br /> ROOF DR�INS—RAINLEADFRS ! EXHAUST FAN <br /> SINK(SERVICE—BAR,ETC.) � _ <br /> � <br /> --� <br /> — i — � <br /> — — —�— <br /> SUD TOSAL $ ' SUB TOTAL $ /�( ' <br /> PERMIT �� � PERMIT $ /_� � <br /> TOTALFEE $ TOIALFEE $ _�,'' <br /> 1"ROt115[iA�CK �E4RSETO�CK SIOESG10ACx PLANCHECNNUMAER FGL RECEIPTNO. <br /> useza�e �oTnnen vncnNrsir FEES VALUATION FEE <br /> I I YES I 1 NO OUILDING <br /> tYPfOfCONSI.�ILOWA01[ 7VfE0fCOt15t.AG:OAL Mcur�Wir �innMrtlux4U�ni5 -- — <br /> r.nour PLUM�I��G <br /> --�-- <br /> ;IZ[OF BLIXi. NOAF STOAIES fiASEMENT MECHANICAL l�' <br /> f_l VES IJ NO <br /> i <br /> OCCUPAKCYLO�D FIRESPRNNIERSREOD HEIGNTLIMITR710N OTIIER _ <br /> � 1 <br /> ❑ YES I NO STA'[DUILDING SURCHARGE � <br /> N[ASON FO�SP.1tt:HtERS -�-- <br /> STATELNERGVSURCHARGE i <br /> n�rii:nr,or+ncc ov r�nHsnrrnovener CITY OF EVERETT ruoucwonKs ; <br /> LOCAL SALES <br /> TAX CDDE IS 3105 TOTAL � � <br />