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APPLICATItiN FOR CONSTRUCT�ON PERMIT ����p« <br /> ure E�erpreen TO BE COMPLETED IN INK—PLEASE PRINT � <br /> GTV OF <br /> everett HEATING SYSTEM: ❑GAS ❑ELECTRIC ❑ _� <br /> BUILDING DEPARTMENT - <br /> 259-8810 <br /> DEAIOLITION COMBINATION BUILDING MECHANICAL PLUMBING SIGN <br /> Ow�Jy,�R / MAILADDRE55 QTY ZiP [� PNONE <br /> d�/ i.!- J�L.r„R,pi ..�C'l t72 �t��n n)a�lYr� �O� -- `�,'"�� ,s+� <br /> flFi�NT MAILADDRE55 CITV 21P. PNONE �� <br /> / '-- <br /> ARGHITECTORDESIGNER MULAD�RESS CITY ZiP PHONE <br /> GENER l ONTRACTOR M ApDRESS CIiY 21P PMONE LIGENSEI <br /> X ��(� <br /> w Aw A <br /> MF.CHqNICALCONTNACTOR M�ILADDRE55 QtY 21P PHONE LICENSE� <br /> PLUMBiNGCdJTR�CtOR MNIADDRESi CITV 21P PNONE UCENSE� <br /> CUSS OF WORK <br /> �. ' NEW ' � ADDITION �. � ALTERATION � REPAIR �. � DEMOUTION . � WOODSTOVEiFRPL INSERT � : BUILDING REIOCATION <br /> CONiAGT PERSON AND PHONE NO. <br /> CONTR�CT PqICE OF WORN <br /> � DE IBE WORN�NO 50 E FOO E INVOLVED <br /> ' ' Dd ,- <br /> rao seouseoFe aai I HEREBY CERTIFY THAT I HAVE FEAD AND EXAMINED THIS <br /> APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> cao cnirnoNOFrRoreatt� WNBELO oAnitncHFouAcoPies� PAOVISIONSOFLAWSANDORDINANCESGOVERtlINGTHISTYPEOP <br /> „ WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> ior��� BLOCN _��� or NOT. THE GRAN7ING OF A P[RMIT DOES NOT PRESUME TO GIVE <br /> AUTHORITY TO VIOLAT[ OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR IOCAL LAW REGULATING CONSTRUCTIOP�OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE N�ORK FOR WHICH <br /> — APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTO LAW 1827 RCW AND 29Cy2��WAC. <br /> SIGNRiUPEOF O RnCTORORAUTMORREOR�� DRTE <br /> X / <br /> PROJEGT�DDRESS <br /> APPLICR p ESSLIC ENO.ANDBli51NE55N4ME <br /> PLUMBING MECHANI <br /> NO. TVPE OF FIXTURE OR ITEM FEE N0. TVPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) NC—NHNDLG UNITS—H.P. <br /> 6ATHTUB � FORCED Alp S`!STEMS—B.T.U. M E.A. <br /> LAVATORY(WASH BASIN) UNI7 HEATERS—B.T.U. M <br /> SHOWER CLOTHES DRYERS � <br /> KITCHEN SINK 8 DISP VENTILATION FAN <br /> DISHWASHER RANGE HOOD � <br /> LAUNDRVTRAV WATER HEATER <br /> CLOTHES WASHER \NOOD STOVE i <br /> URINAL METAL FIREPIACE 8 CHIMNEY <br /> ORINKING FOUNiAIN FIREPLACE INSERT ; <br /> FLOOR DRAIN HEAT PUMP � <br /> BACKFLOW PREVENTERS GAS PIPING <br /> ROOF DRAINS—RAINLEADERS i EXHAUST FAN <br /> SINK jSERVICE—BAR,ETC.) <br /> i <br /> i <br /> SUB TOTAL $ SUB TOTAL $ <br /> PERMIT $ PERMIT $ <br /> TOTALFEE $ TOTALFEE $ <br /> FOR OFFICE USE ONLY: <br /> FRONT SETBACK REAN SEtBFCN SIDE SETBAGN PLAN LHECH NUMBEF FEE RECEIPT NO <br /> usezor+e �otnRen VACPNTSITE FEES VALUATION FEE <br /> BUILDING <br /> fVFE Of CONIS AILOWABLE iYPE Of CONSI AGIDAL acw�xC� NO ar VMwrvGuxrtS <br /> �P0°v pLUMBING <br /> SREOFBLOG. qO.OFSTOR�ES BPSEMENT MECHANICAL <br /> OCCu�ANCY loAo FlRE SPRNKtEnS�Eo'D N[iGNi urniTnrioN ADDITIONAL PLAN CHECF <br /> OTHEN <br /> R[ASON FOq SPRINKLERS —T— <br /> STATE BUILOING SURCHARGE <br /> MTpKE 0�FLpNSAPPRO r CITY OF EVERE7T PUBLIC WORK$ <br /> l <br /> LOCAL SALES <br /> 'j�i� S ���� TAX COOE IS 3105 TOTRL <br />