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APPLICATICi�.'`F�'� FOR CONSTRUC7�3DN PERMIT everett <br /> me Ewrpn�n TO BE COMPLETED IN INK-PLEASE PRINT � . � <br /> CITY OF }} <br /> eVerell HEATINGSYSTEM: QAS QELECTRIC ❑ " <br /> BUILDINQ DEPARTMENT <br /> 259-8810 <br /> '7 DEMOLITION Cl COMB�NATION [7 BUILDIN(3 � �MECHANICAL PLUMBINO ❑ SIQN <br /> ADpRF � C � IF E i <br /> 1" � ' / � <br /> T N T MAM1A E99 CITY 21P ' E <br /> ' � . ,���-lt� �?,;i" 1�I '.i• � <br /> �RGHITECTORDEBqNER MAILADDRE55 GITY ZIP i11pNE ' . � " <br /> .�J.i.: v�� _.�� Ir.� <br /> OENEMLCONTR/�TOR IMILMDREl3 Cltt 21P PNONE L1CiNN1 �'' ' "' ' <br /> t .._. <br /> ,.I <br /> r�n� ��P���" � i y�`Pa�.r ��i�n '�i � Ave. �.°vP.�#{- »ES.�i ' o►'�uah�a.�. <br /> FIUMlINOCpITMCTOq MAl�Dp1E59 CIfY 21P PMq/E .• �11a1N{� ' <br /> � LAS90F W011lf • . . . � <br /> NEW ❑ ADDITION ❑ ALTERATION CJ REPAIR I..� OEMOLITION �7 WOODSTOVE/FRPL INSERT ❑ BUILDINO RELOCATION <br /> CONTACT PERSON AND PHONE N0. <br /> CONTMCT/RiCEOiWORK I i <br /> DESCPI! {OUARE F AOE�NVOlVEO \ <br /> �:1_ � ' � § � ' (',Y <br /> raQvoseo euti I HEREBY CERTIFY THAT I HAVE READ AND EXAMINEO THIS <br /> APPLICATION AND I;NOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> i[a�o[sc qNOFP110PERTY�S WN ELOWOMATT�CHFWRCOPiES� PROVISIONSOFLAWSANDORDINANCESOOYERNINOTHI87VPEOF <br /> WORK WILL BE COMPIETED WITH WMETHER BPECIFIED HEREIN OR <br /> �or eioc■ oF NOT. THE GHANTINO OF A PERMIT OOES NOT PREBUME TO AIVE <br /> AUTHORITV TO VIOLATE OR CANCEL THE PROVI810N8 OF ANY <br /> OTHER STATE OR LOCAL LAW REQUUTINO CONSTAUCTION OR THE <br /> . � PERFORMANCE OF CONSTRUCTION.TMAT I AM AUTHORIZED BY THE <br /> � OWNER OF THIS PROPERTV TO PEFFORM THE WORK FOFi WHICH <br /> � APPLICATION IS MADE AND 1 COMPLV WITH THE STATE <br /> CONTRACTORS LAW 78.27 RCW AND 298200 WAC. <br /> BqN�TUREOfCONTR�CTONOR�UTHOPIZEDAOMT WT! <br /> PNWECl/�D11! � v / / <br /> MK�CN/TBCITYlU91NESSlICEN5EN0./JI� INEltNM1! <br /> PlU I MECHANICAL <br /> N0. TYPE OF FII(TURE OR ITEM FEE N0. TVPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOIlET1 NC—NHNDLG UNITi—H.P. <br /> BATHTUB ' FORCED AIR S:'STEMS—B.T.U. M E.A. � <br /> UVATORY(WASH BASIN) � UNIT HEATERS—B.T.U. M ; <br /> SHOWER � CLOTHES ORYERS � <br /> KITCHEN SINK 6 DISP � VENTIUTION FAN � ' <br /> ' DISHWASHER � RANOE HOOD � <br /> IAUNDRYTRAY ; WATER HEATER � <br /> CLOTNES WASHER � WOOD STOVE , <br /> URINAL ' METAL FIREPLACE 8 CHIMNEY � <br /> DRINKING FOUNTAIN FIREPUCE INSERT ; <br /> FLOOR DRAIN HEAT PUMP � • <br /> BACKFLOW PREVENTERS � GAS PIPINO ' <br /> ROOF DFAINS—HAINLEADERS � EXHAUST FAN � <br /> SINK(SERVICE—BAR,ETC.) ; ' <br /> � i <br /> � r <br /> i <br /> i i <br /> � i <br /> � SUBTOTAL S � SUBTOTAI i ' <br /> PERMIT S � PERMIT S <br /> 'fOTAL FEE S ' TOTAL FEE { � ' <br /> FOR OFFICE USE ONLY: <br /> Fqq�TSETl�CK PE�R6EiBACK SIDESETB�CK PIANCHECNNUMBER FEE RECEIPTNO. ' <br /> uSEior�E LOTAREA V�C�NT91TE FEES VALUATION FEE <br /> BUILDINO i <br /> �rV[OfCONtf.lLLlOWMIF 7YIf01CON5T.IyfWl OCNn.xcr waoMttnwWnl � <br /> °�0w PLUMBINO � ' <br /> � <br /> SREOFll00. NO.OfSTORlES B�SEMENf MECHANICAL � oU <br /> OCCUP�NCY�O�D FIRESPRNRLERSReO'0 NEIOHTLIMIfAT10N ADDITIONALPUNCHECN � <br /> OTHER � <br /> i <br /> i <br /> �EASpN FOR 6PRINIQERS <br /> STATE BUI�DINO SURCHARGE � <br /> i <br /> �NI�ItEBY FUHSAPPROVEDBY CITYOFEVERETT PUBLICWORHS � <br /> LOCAL SALES <br /> TAX CODE IS 3105 TOTAL �- � e� <br />