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i <br /> , �- , .� <br /> APPLICATION FOR CONSTRUCTI�N PERMIT <br /> ,M E,,,,p,�„ everett <br /> cm oc � <br /> everett <br /> BUILDING OEPARTMENT <br /> 259-8810 TO BE COMPLETED IN INK—PLEASE PRINT <br /> ❑ DEMOLITION i 1 COMBINATION f I BUILDING I 1 MECHANICAL I�PLUMBING ❑ SIGN <br /> � M�ILIIDDRE55 C�n' 2�P PIIpNE <br /> '�.- l!<3l- S'Po�+ur+ A✓ . vf t�'Z1S 2�l - �ZIS <br /> TENANT M�IL�ODPE55 CItY 2iP PHONE <br /> 11RCNITECTORDESqNER MMIAD�RE55 GiY 21P PNpNE <br /> GENER�LCONTR�G'OR M�RADDRESS CI7Y ZIP PNONE IICENSE� <br /> 4ECHN11G0.CONiry�CT R MMLADDRE55 CI7Y ZIP PMpNE UCENSEI <br /> /V•W. ti/c�k.�.-It�. '3110-1���� AVe �✓� S�la/ ZCri•t7s/ No.-�1iw�l /T7�t'T <br /> PIUMBINOCONTX�CTOR M�iIADORE55 CIIY 2�A PNONE LICENSEI <br /> t <br /> CU:90FNORN <br /> � NEW 1_1 ADDITION I I AUERATION I I REPAIR I 1 DEMOLITION I I WOODSTOVEiFqPL INSERT f 1 BUILDINa Rf:LOCATION <br /> TEtUNTIMPROVEMENfORIN1ERN%IREMCOELONIY CONL�CTI'ERSON�NOPMONE NO <br /> CWTRACTPRIGEOFW011N: I J�V <br /> OEBCRIlE Y/ORR�ND SCU�RE FOOL�OE INVOlVEO <br /> ' �'Mcc Gsts F't"f� � A!✓/� <br /> rnoro(s�,p vseoceuao 1 HEREBV CER7IFY THAT I HAVE READ AND EXAMINED THIS <br /> _�lI'�t L �L+�i� APPLICATION AND KNOW THE SAME TO BE TRUE AND COHRECL AlL <br /> IEWIDE�TqNOFFROOERTY� WNBEIOWORGTT�CMfWf1COP1E5� PROVISIONSOFLAWSANDORDINANCESQOVERNtNOTHISTVPEOF <br /> WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEqEIN OR <br /> ; �°T Bi°�K °F NOT. THE GRANTING OF A PEHMIT DOES NOT PRESUMF TO OIVE <br /> AUTHORITV TO VIOLATE OR CANCEL THE PROVISION:. OF ANV <br /> i OTHER STATE OR LOCAL LAW REGUUITINO CONSTRUCTIfM OR THE <br /> PERFORMANCE OF CONSTHUCTION.THAT I AM AUiHOR17E0 BV TME <br /> J OWNER OF THIS PROPERTY TO PERFORM THE WORK rOR WHICH <br /> � APPLICATION IS MADE AND I COMPIV WITH THE STATE <br /> � CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br /> � SIGN�lUf1E0iCONTRACTOROP�UTHORIZEUA6ENT D�TE <br /> ( <br /> j ►w��,�� x �•�u•hw� / q-/f�/4y <br /> ' �PPIICANiSCITVBUSINES ICENSENO.ANDBUSMESSNAME �� <br /> � PLUM�MIO MECHANICAL 1 <br /> ! NO. TYPE OF flIRURE OR ITEM FEE NO, riPE OF EOUIPMENT fEE <br /> ' WATER CLOSET(TOILET) NC—A/HNDLG UNITS—H.P. , <br /> BATHTUB ; FORCED AIR SYSTEMS—B.LU. M E.A. � <br /> LAVATORV(WASH BASIN) UNIT HEATERS--B.T.U. M ; <br /> SHOWER � CLOTHES DRYEHS � <br /> KITCHEN SINK 8 DISP ; VENTILA710N fAN ' <br /> �ISHWASHER RANGE HOOD i <br /> IAUNDflVTRAY ; WATER HEATER � <br /> CLOTHES WASHER � WOODSTOVE ; <br /> URINAL METAL FIfiEPLACE 8 CHIMNEV � <br /> � DRINKING FOUNTAI(J i FIREPLACE INSERT ' <br /> I FLOOR DRAIN � HEAT PUMP � <br /> ; BACKFLOW PFEVENTERS ; GAS PIPING � <br /> ROOF DRAINS—RAiNLEADEHS � E%HAUST FAN � <br /> ` SINK(SERVICE—BAR,ETC.) ; � <br /> � <br /> � <br /> � <br /> � , <br /> r— <br /> SUB TOTAL S ; SUB TOTAL E ' <br /> PERMIT $ � PERMIT S � <br /> TOTALFEE 5 ' TOTALFEE y � <br /> FPONiSE1HAC1( REARSETB�CN SIDESETB�CN PUNCNECKNUMBER FEE RECEIPTNO. <br /> usEia+e LOi�RE� WC�NTSIiE FEES VALUATION FEE <br /> LJ YES ❑ NO euaowc �— <br /> trr[acoxsi.µiow�ei[ irrcorcoesr.�cru�i �� �roamvru���xns <br /> Gp�r PLUMBING ' <br /> �T <br /> BIZEOFBL00. NO.OFS70NIES 9ISEMFNT MFCHANICAL � i <br /> I i 1'ES I I NO <br /> � <br /> OCCUPANCYLOAD FIRESPtiNKLER5RE0'0 NEI6NiLIMIlA710N OTHER � <br /> I I VES I 1 NO u1ATEBUIl01NG5URCHARGE � <br /> qE�60N FOR SPRINKLERS � <br /> STATEENERGVSURCHqRGE i <br /> APPLICATIOHACC.BY PlANS�PPROVEDBV CITYOFEVERETT PUBIICWORN$ � <br /> LOCAL SALES ' <br /> TAX CODEIS 3705 TOTAI ; <br /> ;:i,�. .. ._�:r. . . . , , . . , . <br />