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APPLICATIt�N FOR CONSTRUCI �ON PERMIT <br /> , ...� _ . . ��,•�«« <br /> �_/il ,;.'.,,� � � <br /> InC Erer9iren ' <br /> CITV OF <br /> everett <br /> BUILDING DEPARTMENT TO BE CONPLETED IN INK—PLEASE PRINT <br /> 259-8810 <br /> DEMOLITION COMBINATION BUILDING MECHANICAL PLUMBING SIGN <br /> O�YNER nuRnnOro[55 .l ci�r .'�r in�Cr:� <br /> M¢C�DY_JLTle K�c,.�rn ('�/Frl,��- �lS2ai ,%Z�-7.7�'y�' <br /> / ����qj � MARAD�R�EJ55 C�TY ZIP PNONG <br /> /�y�-J!'T I�l� �r�� ,V�� V.-(,�G-ll ' <br /> •i ppG�11TELiOR�ES�GNER MAILAO�PESS CIiY ZIP PHONE <br /> s ��a'T �1� C°oY � /�J3n�c- <br /> GR�ERJ/LCONiRPCiOR MPILRDDPE55 GIiV TIP PHONE LICENSE• <br /> �) ��j�%���� C�y �-s ��,3v�c <br /> lnCCNAN..n,COWR�CiOR MAILr1DDRE55 QTY 21P PHONE LILENSE� <br /> ��� ���-�i�l�' cz��' �e �r3o�� . <br /> PIUA'9iNGC�NiRACiOR MAILAOJRE55 CiTY liP PMONE LIGENSE� <br /> O � x <br /> S y y CLRSSOFWORK - � <br /> NEW ADDITION r��� A TL ERATION REPAIR DEMOLITION WOODSTOV6FRPL INSERT BUILDING RELOCATION <br /> y �M iE11FNLIFIPPOVEAIENTORINiE,,PyORBEMODELONLY USP� ��V� (' �ONiRQ iP50NANDPNONEI�7 <br /> K n CONiRACTPRILEOiWORM: <br /> `�f,a=6tsA �70��- — � /1\ t,o .,,?5 c� - �j`!S <br /> y� DESCRIBE WORRANOSWAAE FOOtAGE INVOlVEO T <br /> �H� .�Lf-'" �-�J��i4'�'% <br /> y N~r vr���:ousEOFewinrt+c � I HEREDV CERTIFV THAT I HAVE READ AND EXAMINED THIS <br /> x "'.ej 3 —n A��— APPUCATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> �s�Q��'� �-•^1" PROVISIONS OF LAVJS AND ORDINANCES GOVERNING THIS TYPE OF <br /> l7 u:cAioescnmuor+orrnoremris�o}srvu[iowonnrrncr�rouecovies yyORH WILL BE COMPLETED WI7H NJH[THER SPEpFIED HEREIN OR <br /> ��g �or �J''�-i�L oiocK . /� ov VC - +�. NOT, THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AUTHORITV TO VIOLATE OR CAMCEL THE PHOVISIONS OF ANV <br /> Hy ��^ '„L,S� ¢(p � �f��,;������.M OV� S OTHEP S7ATE OR LOCAL LAW REGULA"�ING CONSTRUCTION OR THE <br /> 7, y 3 � f PERFORIdANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> ty � OWNER OF 7Hi5 PROPERTV TO PERFORM THE WORK FOR WHICH <br /> �yy _ _ APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> C7 N CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br /> �O,�Qy s�cHaivaep:cor+3nncrononnun�on¢ronccNr cnrc <br /> � ��U � x. � ��� <br /> H tn /.�� UC ��"vc • / �k' -- <br /> y p y rno�ectnooaEss �_ <br /> aucnr�rscrtreus - actns�:�:� A�mmisn�css�+Ai!c <br /> PLUMBING MECHANICAL <br /> � NO. TYPE OF FI%TURE Oli ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) NC—RHNDLG UNITS—H.P. <br /> � BATHTU� ' FORCEDAIRSVS�IEMS—B.T.U. M EA. <br /> � --� UNITHEATERS—B.CU. M <br /> �� LAVATORY�WASH BASIN) _ <br /> SHOWER CLOTHESDRVERS � <br /> KITCHEN SINK 8 DISP VENTILATION FAN � <br /> �— <br /> DISHWASH[Fi RANGE HOOD <br /> • —� __ LAUNDRY TRAV �_ PdATER HEATER <br /> I L CLOTHESWASHER WOODSTOVE <br /> URINAL METALFIREPLACEB CHIMNEY <br /> OFINKING FOUNTAIN FIREPLACE INSERT <br /> FLOOR DRAIN HEAT PUMP <br /> I �1 1 BACKFLOW PREVENTERS GAS PIPIWG <br /> � ROOF DRAINS—RAINLEADERS E%HAUST FAN <br /> SINK(SERVICE—BAR,ETC.) <br /> ���1 <br /> _ -�- <br /> SUB TOTAL S SUB TOTAL S <br /> L'� PERMIT 5 PERMIT S <br /> � TOTALFEE S TOTALFEE 5 <br /> fROMSEiBA P[PRSETBA^ S��ESETOACN �LANCHECk I1p[R fL! "]) /I�) AECLIPiNJ <br /> h �Q � `� <br /> use zor+e �or na[n vnenr�r sire � FEES VALUPTION FEE <br /> �1 Cr� i <br /> —I� S� TA! �. VES �'. � NO BUILDING � ` <br /> IY�COfCOH61RllOWABIC iWEO! SidLIpPL a�P�M1Gr x00�IM01iuocx�5 <br /> z2 .�_ �,� � , <br /> caove . ll p�UMBING <br /> � ^ / .C> <br /> 5iZ[OFBLDG NOOFSiOqiEs �AS[MENT MECMANICAL ' <br /> Z� S F � YES O � „!-"� <br /> OCCUPANGYLOAO FIRESPPNKLERSA[00 MEIGMiL11.11tAilON OiH@R f <br /> � <br /> �. YES x NO IS STATE BUILOING SURCHARGE <br /> � nGA50NFOR5PRINKLERS <br /> STATEENERGYSUFGHARGE <br /> nrrucanoNncc �v r�nNsarrr�oveum CITY Of EUERETT Pl1�UCVlORKS <br /> �y�_ LOCALSALES n� � <br /> � <br /> TAX COOE IS 3105 roTn� / <br />