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:�iSI��A <br /> , � APPLICATI " FOR CONSTRUC `' N PERMIT <br /> everett <br /> ' tM Ewryrwn <br /> CITV OF � <br /> ; everett <br /> , BUILDING DEPARTMENT <br /> 259-BB10 TO BE COMPLETED IN INK—PLEASE PRINT <br /> � C] DEMOLITION ❑ COMBINATION ,G�UILDING ❑MECHANICAL fl PLUMBING ❑ SIQN <br /> ON?!Efl MAILADDRE55 i CITY 21P PNJNE <br /> Lur�+- � h��C .� ����c3�e ����r�-ti- 9��� 2.59-Z�,87 �' <br /> 7ENM1T • N.�IUDDRE55 CITV ZIP � � P.qNE <br /> L�•�J , �� ,�R{1� �' Z'�0�, _ <br /> ANClIITECTOROESiONER MMLADDRE55 CIN 21P PHONE � <br /> � <br /> OENERALCONTMCTOR MNLADDRE55 � G1Y 2iP PHONE UCENSE� <br /> ' .►�'01Ln,�� s�' CTJ ,I I lC^?p2 o LIC.�'.fl� � 'rf 0 .%o�l v.�r o�� `�82d l 295b'l�ISZ BrZDK#t�T�l <br /> MECIUN�C+LLCONTR�CTOR � MnIL�DDFE55 CITY 21P PHONE 4CENSE� <br /> PLUMRIN6CONPUCTOR MAIIADDRE55 GITY 217 PMONE LICENSE/ <br /> �u$y pF YppK <br /> i ❑ NEW ❑ ADDITION IJ ALTERATION Cl REPAIR I� D'cMOUT10N C WOODSTOVE/FRPLINSERT ❑ BUILDINORELOCATION <br /> 7EN'•VT IMPIqVEMENT J9INTERq11 REMpDEL ONLY CONTACT PERSJN ANO PHONE N0. <br /> COt��AAGT PRN:E OF WIXiK: <br /> � pESCRI�EMVNNANDSOU�HEF00U0EINVOLVED <br /> � $� yC� x-FF � <br /> � PIqPOBEDUSEOFBU0.01N� I HEREBY CERTIFV THAT I HAVE READ AND EXAMINED THIS <br /> � �'rC� APPLICATION AND KNOW THE SAME TO BE TRU[ANO CORRECT.ALl <br /> i �yKpESGR�PT�ONOFiROPE1ITY�SNOWNBELOWCRAR�GMFWBCAPIES� PROVISIONSOFLAWSANDORDINANCESOOVERNINOTHISTYPEOF <br /> � WORK WILL BE COMPIETED W(TH WHETHER SPECIFIED HEREIN OR <br /> -aT �� �'� NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO 41VE <br /> A'JTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHEFi STATE OR LOCAL UW REGULATING CONSTRUCTION OR THE <br /> 7 PERFORMANCE OF CONSTRUCTION.THAT I AM AU7HORIZED BY THE <br /> + OWNER OF THIS PROPERTY TO PERFORM ThIE WORK FOR WHICH <br /> % APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> 7 CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br /> 513N�IDREOFCONTR�CTOROR�U7HORiffD�G'NT D�TE <br /> � �: <br /> , � . �c� <br /> � - . <br /> '�PAOJ'EC^T�DORE6�5{��� �/�7��� .^�. �!��� <br /> Y�� ��y �UL1�X!1 �,�I'I��C �;J�(.��J,J �U�.JUW /a(J'(�• APPI NTSCiTYBV51NE654CEN5EN0. JDBUSWE55NM1E <br /> � <br /> �:"a'- KIMNIfi M CMANICAL � 1 <br /> 4i�`N0. TYPE OF FlI(TURE OR ITEM FEE N0. TYPE OF EOUIPMENT FEE <br /> � ;��A�>' WATERCLOSET TOIIET) � A/C—Mi!�DLGUNITS—H.P. � <br /> BATHTUB ; FORCED AIR SYSTEMS—B.T.U. M E.A. � <br /> � UVATORV(WASH BASIN) � UNIT HEATERS—B.LU. M ; <br /> � ' -� SHOWER ' CLOTHES DRYEHS � <br /> KITCHEN SINK 8 DISP � VENT�UTI04 FAN ' <br /> - DISHWASHER � HANGE HOOD � <br /> LAUNDRYTfiAY ; WATEFHEATER ' <br /> � � CLOTHES WASHER � WOOD STOVE �— <br /> URINAL ' METAL FIREPLACE 8 CHIMNEV � <br /> DRINKINO FOUNTAIN � FIREPLACE iNSERT ; <br /> FLOOR DRAIN � HEAT PUMP � <br /> � � BACKROW PREVENTERS � GAS PIPING ' <br /> ROOF DRAINS—RAINLEADERS � EXHAUST FAN � <br /> �-��� ' SINN(SERVICE—BAR,ETC.) ; ' � <br /> � � <br /> ' � � <br /> — � <br /> � � <br /> � � <br /> SUB TOTAL S � SUB TOTAL $ ' <br /> PERMIT E � PERMIT S � <br /> TOTAL FcE $ <br /> � TOTAL FEE S ' <br /> FIIONTSETBACK flE�R5ET8/�CN SIDESETB�CN PIAf(f�C �MBER FEE •O�3G PECEIP — <br /> Y � <br /> useza+¢ LOTAREA v�c�v+Tsrte FEES VALUATION FEE <br /> O YES 0 BLULDING �s�pp � <br /> 7YPEOfCONSi./iIIOWABIE IYPEUfCONSi.�L7UAL OCNMNn rR�. Ow[I:�MGu4i�5 / � <br /> cnr�v �, <br /> �"� '� �_Z PLUMBING � <br /> -_�_�_ <br /> SQE OF BLD(3. NO.Of STORIE5 BnSEraENr MECHANICAL � <br /> g�{qp T.1• 3 r'-� . YES U NO � <br /> pCp:PNlCYLO�D FIRESPRNItlER5RE09 HEIONTLIMITA710N OTHER i <br /> � u i <br /> I"t �„ YES ❑ NO — STATE BUILOM(15UFiCHARGE Ll � <br /> REASON FOR SPqINNlERS <br /> STA7EENERGYSURCHARGE i <br /> APPLIC/�fqNACC.BV PlANSAPPqOVEDBY CITYOFEVERETT PUBLICWORKS � <br /> �� LOCAL SALES � <br /> TAX CODEIS 3105 TOTAC � <br /> . ._. . . �.. ,.. . . ._.. . ...:.::� � ,•.• �•.:. •�t:.�,.. . . . . . � .. . . ,. .��•: .. ...!�?,t,n.n''y;i�I <br /> wras� a. ....„ . . . _. .. . , <br />