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� (�..a <br /> : APPLICATIbN FOR CONSTRUC`riON PERMIT <br /> ; <br /> everett <br /> fM Everyraen <br /> ( CIN OF � <br /> ; everett <br /> t BUILDING DEPARTMENT <br /> � 259-8810 TO BE COMPLETED IN INK—PLEASE PR!NT <br /> jI ❑ DEMOLITION ❑ COMBINATION ❑ BUILDING f7 MECHANICAL f PWMBING ❑ SIGN <br /> 1 O'NNER MAILADDRE55 CITY 21P PHONE <br /> � � c ti /�? q-�—rD ASSGGlL�7wS �UR•cc..(U.>R 309� 25�'i �4&2 <br /> i TENANT MRILAODRE55 Cltt ZI � PMONE �r— <br /> S�rdl-�ow�cs41 c�+ (-�t�Yut.7bl Cl-w. c 3u2c� 2�scK.v.2 !�(/6�2�T/ <br /> ARCHITEGTOROESIONEP M�ILADDPE55 �n' Z�P PHONE <br /> 1 <br /> � GENER0.CONTPACTOR M�ILA�ORESS CI1Y IIP PNONE LICENSEt <br /> i <br /> � MELM/JIIC�LCONTNACTOR MAILADORE55 CITY ZIP PNONE UCENSEt <br /> ' �'AeRrsPN /!K/ <br /> :i PLUf /.YCi�[S�^C70/`N.I�N/l/II��RE55 , JOOb ��5� � � Z'J^�O�fM[S�� NE /�`�� LICENS�G_�s� / <br /> O <br /> � CLASSOFWORK � <br /> O NEW ❑ ADDITION Ll ALTERATION L.I REPAIR I 1 DEMOLITION f I WOODSTOVE/FRPI INSERT C] BUILDING RELOCATION <br /> � TEIUNiMPROVEMENTORINTERIOPNEMODELONIY CONTACTPERSONANOPIIONENO. � <br /> CONTRIICT FRICE OF WORN: <br /> � DESCRIBE WORK AND SOU�RE FOOiAGE INYO�VED <br /> r PROPOSEOUSEOFBUILOING I HEREBY CERTIFY THAT I HAVE READ AND ExAMINED THIS <br /> p�C'h G(� APPLICATIOF!AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> � LEOALDESGRIPTqNOF PROPEPTV(SIIOWN OELOW OR ATiRCHFOURCOPIES� PROVISIONS OF LAWS AND ORDINANCES GOVERNINQ THIS TVPE OF <br /> j WORK WILL DE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> ior e�ocK oF _ NOL THE GRANTIKG OF A PERMIT DOES NOT PRESUME TO GIVE <br /> � AUTHORITY TO VIOIATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> � PERFORMANCE OF CONS'FI;CTION.THAT I AM AUTHORIZED BY THE <br /> i OW�'EH OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> . — APPLICATION IS MADE AND I COMPLY WITH 7HE STATE <br /> ' CONTRACTORS LAW 18.27 RCW AND 29E.200 WAC. <br /> � SIGNAIUREOFCONtMCTOROR�UfHORREU�GEPT O�TE <br /> X � �-._ oz r s3'� <br /> PRQIEGTADDRE55 /� / � ` p1 <br /> O �2„OO `.y (�, AP�IICANTSCIiY[iUSINE55lifFySE {� SMESq;R1,1E � �(._.�[N� <br /> tARf•a] N(J K 7dH( <br /> �, PLUMBIMO MECHANICAL <br /> ' NO. TYPE OF FlXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> � WATER CLOSET(TOILET) � A/C—A/HNDLG UMTS—H.P. � � <br /> { BATHTUB ; FORCED AIR SYSTEMS—B.T.U. M E.A. � <br /> LAVATORY(WASH BASIN) UNIT HEATERS—B.T.U. M ; <br /> � SHOWER CLOTHES DRYERS �— <br /> i KITCHEN SINK 8 DISP VENTILATION FAN ; <br /> '� DISHWASHER � RANGE HOOD � <br /> � LAUNDRYTRAY ; WATER HEATER � <br /> a CLOTHES WASHER � WOOD STOVE T_ <br /> ; URINAL ' METAL FIREPLACE 8 CHIMNEY � <br /> � DRINKING FOUNTAIN 1 FIREPLACE INSERT ; <br /> � FLOOR DRAIN � HEAT PUMP � <br /> BACKFLOW PREVENTERS ; GAS PIPING ; <br /> ROOF DRAINS—RAINLEADERS � EXHAUST FAN <br /> SINK(SERVICE—BAR,ETC.) ; ' <br /> � <br /> � <br /> � 1 <br /> i ; <br /> , <br /> . SUB TOTAL $ \ ; SUB TOTAL $ ' <br /> . PERMIT $ PERMIT S � <br /> �- <br /> � TOTAL FEE $ ' - TOT�L FEE $ � <br /> . FPONiSETB�CK REARSETBPCN SIOFSETBACK �S PLANCNECNNUAI�EA FEE RECEIPTNO. <br /> USEZONE LOTA(IE� VACANTSITE FEES YALUA710N FEE <br /> !] VES O NO BUIIDING i <br /> � 1YPEOftONSiAIIOWABIE iYPEOFCONSI.ACiUAL ottUClNtr Mo.pvMluvGunnS <br /> cuav ' <br /> PLUMBING � � — <br /> SIIEOFBLW. NO.OFSTORIES BRSEMENT MECHANICAL i <br /> ' I�.1 YES ❑ NO , <br /> OCCUPANCVLO�O FlRESPPNKlERSREOD MEIGMTLIMITRTION 07HER � <br /> ❑ YES CI NO SiATE0l11LDINGSURCHARGE � <br /> i <br /> REASON FOR SVRINKLERS <br /> S7ATE ENEFiGV SUfiCHAtiGE ; <br /> APPLICATIONACC.BY VUNSAPPROVEUBY CITYOfEVERETT PUBLICWORKS � <br /> LOCAL SALES � <br /> TAX COOE IS 3105 TOTAL /,j � ' <br /> „�, _.«. _ . . ... . - -- - <br />