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APPLICATIO�N FOR CONSTRUCT�ON PERMIT <br /> Ilrc E�vrgreen everett ; <br /> CITY OF � <br /> everett <br /> BUILDING DEPARTMENT <br /> 259•8810 TO BE COMPLETED IN INK—PLEASE PRINT <br /> !-, DEMOLITION : COMBINATION _; BUILDING ] MECHANICAL ' . PLUMBING ❑ SIGN <br /> OWNER M�IL�ODFEcS /� CITV ZIP PNONE <br /> LttM� / 'r� ASSO�II�-lL3 JOZO �Y�.(CKWQ t4t/La' SNI/Gs' ��(�', Gl�L�E�T� �.S�I'�tfd� <br /> iENANT MRII AD ESS CITY � 21P �� PNONE <br /> SoLdt,�e�. Rcs-c��,�eY c���� . S'..,�� zog — s�a..,�- — <br /> APCHITECTORDESIGNER MRILADDRE55 �r CITV 21P PHONE <br /> GENERqILONTRACTOR MAIL�D�RESS CIiV ZIP PMONE LICENSE� <br /> MECH�HICALCONTR�CTOR MAILAOCRESS CITV ZIP PHONE UCENSE� <br /> /�AJL-�S7 1�' �-twt6�..(,- `�f{[�7�-.G-, f3KU6 Ft3�S(, Sl2; S�.uHo.�rrSr-1 .4n• riSr2/�G <br /> �PLUMBINGCONTP�CTOR MAILADDRE55 � CITY ZIP �� UCENSEII <br /> 57,8- �5'7] <br /> CLASSOF WORK <br /> [_' NEW ❑ ADDITION L: ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOV6FRPL�NSERT ❑ BUILDING RELOCATION <br /> TEN�NTIMPROYEMENTORINTEHIOPflEMODELONLY GONTACTPERSONANOPHONENO. <br /> CONTRFCi PRICE OF WORK: <br /> 1/DESCRIBE WORK AND SOWRE FODTAGE INVOLVED <br /> X ll,t S de LC. � .S( <br /> �POPOSEDUSEOFBUILDING I HEREBY CERTIFY THAT I HAVE READ AND EXPMINED THIS <br /> ACFiLtf A?PLICATION AND KNOW THE SAME TO BE TRUE AND(:ORRECT.ALL <br /> LEGALDES.^.RIPTIONOFPROPERTV�SHOWNBELOWORATfACHFOURCOPIES� PROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTYPEOF <br /> WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> �oT BLOCK oF NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AUTHORITY TO VIOLATE OR CA�JCEL 7HE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> — PERFORMANCE OF CONSTRUCTION.THAT 1 AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> A^PLICATION IS MADE AND I COMPLV WITH THE STATE <br /> CONTRACTORS LAW 1827 RCW AND 296.200 WAC. <br /> SIGNAiUREOFCONiRRCiORORAUTNORIZEDAGENT OFTE <br /> /^/ o2fss� A <br /> PRQIECTADORE55 �-b\ �1 �C/�HSI r""�'M���'�' � C9� �� � <br /> �OZU �QU�-�C � � 7�s � C7y � APP��CRNTSCIiVBU51NE55LICE SENO.ANDBUSINESSNAME <br /> PLUMBIN6 MECHANICAL <br /> N0. TYPE OF FU(TURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) � A/C—A/HNDLG UNITS—H.P. � <br /> BATHTUB ; FORCEDAIRSYSTEMS—B.T.U. M E.A. � <br /> LAVATORY(WASH BASIN) UNIT HEATERS—B.LU. M � <br /> SHOWER � CLOTHES DRYERS � <br /> KITCHEN SINK 8 DISP VENTIUITION FAN ; <br /> DISfiWASHER � RANGE HOOD � <br /> LAUNDRY TRAY ; WATER HEATER ' <br /> C'_OTHES WASHER i WOOD STOVB I <br /> URINAL ' METAL FIREPtACE&CHIMNEY � <br /> DRINKING FOUNTAIN � FIREPLACE INSERT � <br /> FLOOR DRAIN � iEAT PUMP � <br /> BACKFLOW PREVENTERS ; GAS PIPING <br /> ROOF DRAINS—RAINLEADERS � EXHAUST FAN <br /> SINK(SERVICE—BAR,ETC.) ; <br /> � <br /> � <br /> � <br /> � <br /> � <br /> � <br /> SUBTOTAL $ ; SUBTOTAL $ ' <br /> PERMIT $ PERMIT $ <br /> TOTALFEE $ ' TOTALFEE $ � <br /> FFONTSETB�CK REARSETBRCK SIOESETB�CK PLANCHECNNUM62R FEE RECEIPTNO. <br /> USE20NE LOTAREA VRCANTSITE FEES VALUATION FEE <br /> T <br /> ❑ YES ❑ NU BUiLDiNG � <br /> 7VPEOfCONSTALLOWABIE TYPEOfCONST.ACiUAL OCLIIPANLY xoaowFuix6uxrt5 — � ' <br /> 4P0�P p�UMBING ; <br /> SRE OF BLOG. NO.OF STORIES BASEMENT MECHANICAL � <br /> J YE3 ❑ NO � <br /> OCGUPRNCVLOFO FIRESPFNKLERSREO'D MEIGNTIIMITATION OTHER i <br /> ❑ YES ❑ NO STATEBJILC'VGSURCHARGE � <br /> REASON FOR SPFINK�ERS <br /> STATEENERGVSURCHARGE i <br /> i <br /> RPPLICATIONRCC.BY PLANSAPPROVEDBV CITYOFEVEREIT PUBLICWORKS i <br /> LOCALSALES <br /> TAX CODEIS 3105 ror�� � <br />