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APPLICATIO�� FOR CONSTRUCTI �N PERMIT everett <br /> �E���� TO BE COMPLETED IN INK—PLEASE PRINT � <br /> cm oF <br /> everett HEATING SYSTEM: U GAS ❑ELECTRIC ❑ <br /> BUILDING DEPARTMENT <br /> 259-8810 <br /> DEMOUTION COMBINATION BUILDING MECHANICAL ! LUMBING SIGN <br /> OWNER M�iL�DDNE55 QTY 21P �MOYE <br /> �12�d�/3�..F� �+e..dZ"�k'y�rTit �/�'fltn- 25TI' /Gi9/ <br /> T N�NT MRIL�O�FESS CITY ZiP PHONE <br /> •qLMITELT OR DESIG4ER M�IL ADORE55 CITY 2iP PHONE <br /> GENERALCONTR�CTOR MRIL RDORESS Clrv ZIP PHONE LICENSE� <br /> MECHANIC0.CONTRAG70R M�IL�ODflESS qiY ZIP PMONE UGENGE� <br /> PLUMBINGGONiA�CTOR MNLAO�RESS GITV IIP PHONE L�CENSE• <br /> GLA$ � <br /> ' ! NEW . � ADDITION ✓ALTERATION �. �, REPAIR �. � DEMOLITION . . WOODSTOVE/FRPL INSERT ._� BUILDING RELOCATION <br /> - CONT�CT PEPSON AND PNONE N0� <br /> GONTR�CT PHICE OF WORK <br /> RIBE WORK AND SOU�NE FOOT�GE INVd.VED <br /> PROPOSEDUSEOFBUIIDING 1 HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS <br /> APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> IEWLDESGRIPTIONOFPROPERTYISNOWNBELOWOR�TTACHFOURCOPIES� PROVISIONSOFLAWSANDORDINAMCESGOVERNINGTHISTYPEOF <br /> WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEHEIN OR <br /> �oT BLOCN oc NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANV <br /> OTHER STATE OR LOCAI LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 1827 RCW AND 296.200 WAC. <br /> SIGNATUREOFCONTR�CTOHORAUTHOf112ED�GENT D�TE <br /> vaa�cr�oones _ <br /> X��� - <br /> ! r, A LI/11�T5 U INESSLICENSENO.ANDBU9NESSN�ME <br /> (O G <br /> PLUMBIN(i MECH�NICAL <br /> NO, TYPE OF FIXTURE OR ITEM FEE N0. 7YPE OF ECUIPMENT FEE <br /> WATEF CLOSET(TOIIET) �— A/�/VHNDLG UNITS—H.P. <br /> BATHTUB ; FORCED AIR S`!STEMS—B.T.U. M E.A. <br /> LAVATORY(WASH BASIN) — UNIT HEATERS—B.T.U. M <br /> SHOWER � CLOTHESDRVERS ' <br /> KITCHEN SINK 8 DISP VENTILATION FAN � <br /> DISHWASHER RANGE HOOD <br /> LAUNDRYTRAY ' WATER HEATER <br /> CLOTHES WASHER WOOD STOVE <br /> URINAL METAL FIREPLACE 8 CHIMNEY ' <br /> DRINKING FOUNTAIN FIREPUCE INSERT � <br /> FLOOR ORAIN HEAT PUMP ' <br /> BACKFLOW PREVENTERS GAS PIPING <br /> ROOF DRAINS—RAINLEADERS EXHAUST FAN ' <br /> SINK(SERVICE—BAR,ETC.) <br /> � <br /> � <br /> I <br /> SUB TOTAL $ SUB TOTAL 5 <br /> PERMIT $ � PERMIT $ <br /> TOTAL FEE $ TOTAL FEE $ <br /> FOR OFFICE USE ONLY: <br /> FRONT SEIB4CK AERP SETBRCN SIDE SETBRGN PUN CHECN NUMBER FEE RECEIPT NO <br /> USE ZONE iot naen vncaqr srtE FEES VALUATON FEE <br /> ew�oiNc <br /> TVPE 01 LONTS ALLOWABIf 1YPF Of LON57 FC70Al occuPwa xa or owtu�Nt uMrts <br /> 49a° PLUMBING <br /> SIZEOF9lDG. NO.OFSTORIES BASEMENT MECHANICAL <br /> OGCUPANCY LO�D FIRE SPRNKLERS REO'D HEiGHT UMITATIOY ADDITIONAL PLAN CHECK <br /> L_ OTHER <br /> RERSON FOR SPRiNNlERS <br /> STATF BUILDMG SURCHARGE <br /> iNT�NE 9V PLRNS RPPROVED BV CITY OF EVERETT PUBLIC WORKS <br /> LOCAL SALES <br /> TAX CODE IS 3105 ror�� 2Q ; � <br />