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APPLICATIOrd FOR CONSTRUCTIu�N PERMIIT <br /> everett <br /> I�e Ew•priy�n � <br /> CIIY OF <br /> everett <br /> BUILDING DEPART�v1ENT TO BE COMPLETED IN INK—PLFASE PRINT <br /> 259-8810 <br /> DEMOLITION COMBINATION BUILDING �MECHANICAL __i pLUMBING i � SIGN <br /> owr+en n+nn nu�m:s.` -. _ i�.uv .. . :u, rnom: <br /> �' �_��9�(�/��f - �c.c.,��C1Z_"1-l� .., l_—���2=��s�'� <br /> iFN� i MRII AfMIREtiv <br /> . " ' —_—"_—_ <br /> _ . _ �-.__�--_---_'" 1'110t1E <br /> APG111EGTOf1�[SIGN(11 IA�IIADP1165 ��� ' GtY ZIP <br /> GENER�lU1NIR�GtOR R�A�l�0I1pL55 —���V z�� �Ib��� LICFNS[1 � <br /> M[GHMliCA1.CO:ILP�C1pR FI�ILA�D11855 GtY ./�-_— IIP —�—"_— PIIOf1G IIJEFS[/ <br /> A'J.� f �„�JP�. lkn'I�-3llu—�1Ll�/JLL' _�Z'J_ — 9f`'u� �—�f�.3j�/�� l-L�setlol��-J <br /> VWMBINGGONTR�GT�O MA1I.ADDRESS <br /> cirr zm ruonc LIG[N_E� <br /> CLASS UF NI�RK <br /> I � NEW �. �� ADDITION �_ i ALTERATION i REPAIR � ! DEMC"_ITION I I WOODSTOVHFRPL INSERT I I BUILDING RELOCATION <br /> TENFNI NAVRUVEMEN7 OR IMERION PUAJOEL ONLY CONI�GI PGRSON AND f1�ONE NO <br /> Q��,�.,OFJ <br /> CONTR�GT PRIGE OF WOAR: (�[�.J - -- <br /> DESCRiOE WOR1t l�ND SOUME fOOI�G[RlV01 V Wt� <br /> �7y�� (',� l.�-�)7!`r'�IIC�� �GI�Nk4't' _ <br /> rn000se�,niNc I HERGFV CER7IFV THAT I HAVE READ AND E%AMINED THIS <br /> C �� / �t� _ ____ APPI ICA710N AND KNOW THE SAME TO BE TPUE AND COHRECL ALl <br /> v�� �l PROVISIONS OF LAWS AND ORDINANGES GOVERNiNd THIS TYPE OF <br /> ieau SCR�PTIO�OFPHOPE 15110WN0ElOWOR�11�G11fd�NCOV��S� yyORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> ��T-- 81�N ^F AlO17HOR1 YRTOTV OLATEAOR CANCEOLE HE PROVIS ONS OF AINY <br /> O7HER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORI2ED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 1027 RCW AND 296200 WAC. <br /> SIGNAIUNf:JFCONIIiACTOflO11dUTHO1UIED�GENT DATE <br /> ��� r�e� �� _.�"L _— X .,�_�L � -`�'- TG <br /> PRQIlCfADOHES ppp1lC�YiSLIIY0U5ME551i� SEkOANDBUSINESSN�ME <br /> PLUMBINO MECHANICAL <br /> Np, ri'PE OF fl%TURE OF ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TC��ET�_ A�C-AMNDLG UNITS-H.P. �T_ <br /> BATHTUB ; �- FORCED AIR SVSTEMS-B.T.U. M E.A. � <br /> UNiT NEATERS-B?.U. M � <br /> LAVATORV�WASH BASM) _ �- — CLOTHES DRYERS � <br /> SHOWER �— ; <br /> KITCHEN SINK 8 DISi' � VENTILATION FAN _ <br /> - '--'— RANGE HOOD _ ' <br /> D�SHWASHER _`- -- � <br /> � WAfER HEATER <br /> LAUNDRVTRAV ' ' <br /> -- — --� WOOD STOVF ' <br /> CLOTHES WASHER , METAL FIPEPLACE 8 CHIMNEY ' <br /> URINAL — ' <br /> URINKING FOUNTAIN i __ FIREPLACE INSERT �_ <br /> o �'—_' � <br /> FLOOR DRAIN .___ ___ _______L_ - � ,HEAT I UMf .'______ ___"____ ___ <br /> B0.C{<FLOW PREVENTERS , _� GAS PIPING _—�-- <br /> ROOF DRAINS-RAINLEADERS --�--' ___ _EY,HAUST FAN ___ <br /> SINK�SERVICE-BAR.E7C.1 �— - ------- ' <br /> __ ____ -�— __'_ �_ <br /> _____-_-. .. . . <br /> - -____ _ _ �_ _- � <br /> - - ___-i-- <br /> - - � <br /> SUOlOTAI $ ; __ SUBTOTAL $ �Q y��,y' <br /> ---�— --- — PERMIT $ %.�5�_sG_ <br /> — PERMI' $ ___- -- -- TOTALFEE $ �� <br /> TOTALrcE S qELEIPTNO. <br /> FRONTSEiB�CK REARSE7B�LH <br /> SIpE 5[ipAGN Pi AN LMCLK NlIlAOf R FEE <br /> vnr.nwT sre FEES VALUATION FEE <br /> USE 204E lOT ARU � <br /> i i YES I I NO_ Bll�l D�NG ___ _,__ ' <br /> nu.�mui�r unamvmir,uxns - � <br /> TrIT Of CON9.PIIOWRNIt hPL ot Cot151 ACIlI�1 yxm r PLUMUING �— <br /> �O.OI'Si0RIE5 OASEMCN� MECIIANICAI � � �— <br /> SREOFOIDG ___— — -- <br /> I I VES I i NO —- � <br /> - OTIIER _� <br /> OCGUPANGYLO�D FIRESFRNNI[RSRGO'D BE�G��Tllidli/710N -- i <br /> I I YES I I NO _ STATE OUILOING SURCHAf7GE __�_;_ <br /> '___--- � <br /> qEASON FOR SPFIIINI[RS STA1 @ GNE�GV Sl1RCNAllGE ' <br /> _�-- <br /> —_— i <br /> erruc�nor+nccer r�v�r+snrPNuwuiav CITYOFEVERETT PUI311CK'ORKS _.�� <br /> LOCAL SALES ,� <br /> _�iX CODE IS 3105 tota� <br />