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APPLICATIO�� FOR CONSTRUCTIJN PERMIT <br /> everett <br /> �h�E.e.a���,� e <br /> ��T��F <br /> everett <br /> � �y � � BUILDING DEPARTMENT <br /> y 259-B8+0 TO BE COMPLETED IN INK—PLEASE PRINT <br /> c��H OEMOLIT�ON COMBINATION BUILDING MECHANICAL PLUMBING SIGN <br /> �y y y OWNER MAIIRDDRE55 CI1V 21P PI104[ <br /> y �� ��u,� l-�E'h �-ru �Disr �ozo �u�kc-x r4� v�az� ��c.,� �'8zo I <br /> TENANi MAIIpDDRE55 CITY 2i� PHCNC <br /> oxo �sS��G� ¢��� r- . MARI' I��_Y sG�g� ��4-r' 3 <br /> L W1F 5o u�n t��L- 7_3 ¢_��� <br /> Mi H �U ApLMRECTORp[SIGNEF MniLA00R[SS IiV ZIP FIION[ <br /> �z� ��l� 4'�3s F. A�ArtC��Nac U�ny� ��lncG B�a4_23s3s �Cl <br /> G[NERALCONiqACTOR MAILAODRE55 R LITY IIP PIIONE LICEN Et <br /> O � $�(2`i Q�-nCSn, 7431�izs M�sc�rwc�¢zJ.r <br /> H MQ�JIII4D � )�/n,uc (�i�nnr �urv�-'r�c�n 9P�2a��5/7 <br /> MECIIANIGALLONIRAGTOR MALA�ORE55 ��/ CITY ZIP PMONE LICENSE� <br /> �� g �� <br /> H PWMBMGLONiRRGiOR MAILADDRESS Ciiv ZiP PMONE LiCENSE� <br /> z y� �%� <br /> � �„� y anssoFwoarc <br /> C7 V1 H �. NEW ADDITION X ALTERATION REPAIR DEMOLITION WOODSTOVEiFRPL INSERT BUILDING RELOCATION <br /> ('��N TENANiIMPROVEMENtORINiERIORREM1IODELONLV /�(�.�q � CONinC1P5R50NANOP110NEN0 <br /> �Lr CONiPACT PR CE OF WORN: �G!�/O <br /> � y y pESCRiBE WORH AND SOVARE FOpTAGE INVOLVED <br /> Z <br /> H O q� d�0 4v i- 'T(c�n) D 1 c 2k� C <br /> VROPOSTEjOUSEOFBWLOING 1 HEREBV CERTIFY THAT I NAVE READ AND E%AMINED THIS <br /> � G S� l'mL�EcTlo�1 V �SLOnI '� . APPLIC�TION AND KNOW THE SAME TO BE?RUE AND CORREGT.ALL <br /> iecniceseaianor+oFvaor�nttisHowHee�owoan**ncHFoueco�iesl PfiOVISIONS Of LAWS AND ORDINANCES GOVERNING THIS TVPE OF <br /> WORK V/ILL BE COMPLETED WITH WHETHER SPECIFIED HEAEIN OR <br /> �ur �cxrc oF NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AUTHOf�ITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTFUCTION OH THE <br /> PERFORIdANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BV THE <br /> OWNER OF THIS PROPER7Y TO PERFORM THE WORK FOR WHICH <br /> APPLICATIDN IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 18.27 RCW�ND 296200 WAC. <br /> S�GNAiOR[CFCONiRACiOROF�OiHORIZ[UAGENT OAiE <br /> PRN[CTADORESS � {�{��p Qjf�IN-y /ICIZY'V <br /> 3D� �� �� , �� ^ �1� p GnlllSCrvpU5ME55l�CENSENOANOpUS�NESSNnME <br /> n ` <br /> ' 1 PLUMBING MECHANICAL <br /> ' ' N0. TYPE OF FIXTURE OR ITEM FEE NO. T�PE OF EOUIPMENT FEE <br /> � WATER CLOSET(TCILEi) A:C—�VHNOLG UNITS—H.P. <br /> '�' BATHTU9 __ FORCBD AIR SVSTEMS—B.T.U. M E.A. I <br /> LAVATORY�WASHBASW) UNITF'EATERS-9.?U. M ___� <br /> SHOWER CLOTFESDRYERS <br /> '�' VENTILATION FAN <br /> KITCHEN SINK d�ISP <br /> 1 DISHWASHER __ RANGE HOOD <br /> LAUNDRY TRAY WATER HEATER <br /> fCI.OTHES\NASHER _ N100DSTOVE <br /> UR W AL METAL F IREPLACE 8 CHIMNEV <br /> � ORINKING FOUNTAIN _ FIREPL/10E INSERT __� <br /> !; _ FLOOR DRAIN _ HEAT PUMP <br /> BACKFLOW PREVENTERS GAS PIPING <br /> � ROOF DRAINS—RAINLEADERS E%HAUST FAN <br /> ' SINK(SERVICE—BAR,ETG) __ <br /> 1 <br /> 1 � <br /> ^+' SUB TOTAL 5 , SUB TOiAL 5 <br /> o PERMIT S —�— PERMIT 5 <br /> . TOTAL FEF. $ TOTALFEE 5 <br /> FRONiSEiIACN AEPRSEi�I.CK SIDESEiOACN PL/NQI[f.NNUM�ER FEF RECEIPiNO <br /> usezor+e �otnnen vacnNrsre FEES VALUATION FEE <br /> ,�,;z� YES NO OUiLDING �G•� ,__ <br /> IM[ofcoNSiwllOwa91F tYPFoi[oN9.atlU�l ocr�.r.�c+ noamv:wu.uV-�s <br /> r'' �yy� °P'L" PLUMBING <br /> yN�� �l�c <br /> 512[OFOL�G NO.OFStORIES BASEMENL MECHANICAL <br /> � �( �C VES NO -- <br /> OCCUMN VLOAO FlRESPRNKlERSRWD ��EIGHLLIMITAiiON �THEP � <br /> � xYES NO STATE�UILDING SURCNARGE .� ;��(� <br /> _ � <br /> R[ASON FOR SPRrtJkLERS <br /> STAT[ENERGYSURCHAhGE <br /> APPLICAiION�C; ;V i'LANSAPPROVED�� CITYOFEVERETT PUBLICWORKS <br /> � LOCALSALES <br /> TAX COOE IS 3105 TOTAL � ��O <br />