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i ... _., . <br /> APPLICATIbN FOR CONSTRUCI-�a�N PERMIT <br /> everett <br /> rrre ewroreen � <br /> CITV OF <br /> everett <br /> BUILDING DEPARTMENT TO BE COMPLETED IN INK—PLEASE PRINT <br /> 259-8810 <br /> ❑ DEMOLITION �I COMBINATION ❑ BUILDING f 1MECHANICAL f_1PLUMBING SIGN <br /> OWNER MAILRODRESS / Q �CyI]TY I2'iF PNONE /� 7 <br /> , TENAN , A' MAIL DD E55 �X IV CJ /��/�LySUII� W/L R�L�O ' (D��� �L�� <br /> ��n. / z�p PHONE <br /> (,1�,T� f)_,,, �J .s �V�t� x�-,-1'vtcl ZSdB i�'c1{�ic �lu+a ��za..� W+� 41�IL�/ r(22-�571i <br /> ' cirv zir vHor+e <br /> �RCNITECTOFDESIONER MM�ADDRES> <br /> �+-- <br /> ��T� =�p PHONE LICENSEI <br /> OENERALCOtfTR�CTOR MMLADORESS � <br /> MECNANICALCONTNACTOR Mn��ADOR[SS Cltt ZIP PNONE IIGENSE• <br /> � <br /> PLUMBINOGONTRACTOR MlIIA�OPE55 :.�TY 21P PIIONE LICENSE� <br /> CI,ASSOFWORK ' <br /> I 1 NEW O ADDITION �ALTERATfON I I REPAIR I I DEMOLITION I I WOODSTOVE/FRPI INSERT 1 1 BUIIDING RELOCATION <br /> CONI�C7 AERSOF77{1D PI(NE NO. <br /> TEN�NTIMPHOVEMENTORINTE REMCDELONIY � �� � �-y/ <br /> �DDo°% �SiS'`� '� <br /> CONTR�CiPRICEOF\'ORR' � — <br /> $CRIBE K�ND SOU RE FOOTA INVOIVE � <br /> y�„� W <br /> rRo eou eoFeui iNc I HEREBY CER7IFY THAT I HAVE READ AND EXAMINED THIS <br /> , �/� APPLICATION AND KNOW THE SAME TO BE TFUE AND CORRECT.ALL <br /> LEOALDESGRIPTIONOF ROFERTY�S�OWN BELOW O��TT� NF U1iCOPIES� PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> �� � WORK WILL BE COMPLETED WITH WHETNER SPECIFIED HEREIN OR <br /> . �p,� /•7 ; y�seL�H oF G- � NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> '`-Y�'Y� AUTHORITY TO VIOLATE UR CANCEL THE PROVISIONS OF ANY <br /> � OTHER STATE OH LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE Of CONSTRUCTION.TI1AT I AM AUTHORIZED BY THE <br /> � OWNEIi OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH TNE STATE <br /> -- CONTRACTO S�6.27 CW AND 296200 WAC. <br /> � SIGN�TMEO ONTPFCIO OB H0:112'DAGENT D�TE <br /> j lC �(,� J87� b7�o/8s v�� (/.fZ i3 �bi �/1/u�. <br /> P�CT AODRESS ppPLIC�NTS CITY BUSME55 LICENSE NO.AND Al a�NE55 NAME <br /> PLUMBINO MECHANICAL � <br /> � FEE NO. TYPE OF EGUIPMENT FEE <br /> N0. TYPE OF FI%TURE OR ITEM . <br /> WATER CLOSET(TOILET) � AIC—A/HNDLG UNITS—H.P. ' <br /> BATHTUB FORCEO AIR SYSTEMS—B.T.U. M E.A. ' <br /> LAVATORY(WASH BASIN) � � UNIT HCATERS—B.T.U. M � <br /> SHOWER ' CLOTHES�RVERS ' <br /> KITCHEN SINK 8 DISP � VENTILATION FAN �_ <br /> DISHWASHER � RANGE HOOD � <br /> � LAUNDRYTRAY ; WATERHEATER __i— <br /> CLOTHES WASHER � WOOD STOVE ' <br /> � URINAL ' METAL FIPEPLACE R CHIMNEV ' <br /> DRINKING FOUNTAiN � FIREPLACE INSERT � <br /> FLOOR DRAIY � HEAT PUMP �— <br /> � BACKFLOW PREVENTER� ; GAS PIPING � <br /> ROOF DRAINS—RAINLEADERS � EXHAUST FAN ' <br /> � SINK 1SEFlVICE—BAP,ETC.) � � <br /> � T <br /> 1 <br /> � <br /> 1 1 <br /> � <br /> 1 <br /> � , SUB TOTAL $ ' <br /> � SUBTOTAL $ � � <br /> PERMIT S � <br /> PERMIT S � TOTAL FEE $ ' <br /> TOTAL FEE $ neceirr Ho. <br /> ' PLRNCHEGNNUMFIER FEE <br /> ' FRONTSETB�CK RE�RSEIBACK SIOESE78ACK <br /> � wcnrvrsire FEES VALUATION FEE <br /> � USEZONE LO�AREA � <br /> j � 1.1 YES ,-� N� BUILOING � <br /> acurervcr r�oamvm�xauens � <br /> , TYPEOFCONS7,�LLOWA6LF IYPEOfCON51.RG7UAL 6nauv � <br /> � PLUM�INO ' <br /> SREOFBLDO. NO.OFSTOPIES O�SEMLNI MECIIANICAL <br /> ' I I VES NO — I <br /> OTHER � <br /> OCCUPANCVLO�U FIPESPR RLERSOE00 NEIGNTLIMIT�71 N � <br /> �_ YES f I NO STATE BURDING SUIiCHARG[ � <br /> i <br /> REASON FOR SPNINNLEPS STATE ENERGV SURCHARGE ' <br /> APPUCAiIONALC.BV PUNSAPVROVED� CITYOFEVERETT PUBLIGWOPK$ �_— <br /> LOCAL SALES � <br /> TAX COUE IS 3105 Tor�� ' <br /> - ,.: - <br />