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t <br /> APPLICATIGr�I FOR CONSTRUCT.JN PERMIT <br /> everett <br /> !fM Everpmen � <br /> CITV OF <br /> everett <br /> BUILDING DEPARTMENT TO BE COMPLETED IN INK—pLEASE PRINT <br /> 259-8810 <br /> I I DEMOUTION i 1 COMBINATION !gUILDING LJ MECHANICAL I 1 PLUMBING ❑ SIGN <br /> owr+en um�nooness citt nr rrwrve <br /> �/ •P, 3Zis-,SI�.� J�r ��.,rf 9� <br /> IEN/RNi /J/ MAIL��OR[SS GITY '/ 21P P110N[ <br /> I�CP /77I N ,jL/S S�a1.P /� I�V[.�.yl �G <br /> �OCHRFCiOR0E51GNER M�ILAOORESS CI1Y ZIP PIIONF <br /> � GEtlER6LCONIO GI00 MAILAUUf1C55 GITY 21P �`IION[ ULENSE� <br /> : �/'.�/��cUii4I .2KF`L �OC• - /v'�f� �`'w�i`��ao ' 96£JJ� .�53 'Z7L . 1fr'Ne�Y((�ZZSKN � <br /> MEGIIANIC�LCONiN4CIDi1 M4ILADDtiG55 CIiV ZIP PIWNE UCENSEt <br /> ' PLUMOINf.CONiR4C10R MnIL�OURESS C�TV 2��' � P�N�N6 UCENSE� <br /> C1A550F WO�K <br /> I I NEYV I I ADDITION I I ALTERATION '• �E?AIR IJ DEMOLITION I I WOODSTOVEIFRPL INSERT I_l BUILDING RELOCATION <br /> TENAN7 IMPROVEM[NT OR INIER�OQ�EIAODEI UNLV CONtACi PEPSON 4ND PNON[NO <br /> GONTRAC7 PRIGE OF WOPK: j�,p?-'� /1 i ✓i��f-���`r.},q,�z 3S3�2�G� _ <br /> � DESCRI9E WORN AND SOUAOE FOOiAGE INVOLVB//D /J <br /> � �� � �, �t,rS�J�CN. �' <br /> ' vnoroseouseoFo aoiNc I HEREBY CER7IFY THPT I HAVE READ AND EXAMINED THIS <br /> � APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECL ALL <br /> i�cni oesenmtioN or�norenrv is�own neiow a�nnncn roun eorn+:� PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> WORK WILL BE COMPLEIED WITH WHETHER SPECIFIED HEREIN OR <br /> ior e�ocrc �r _ NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME 70 GIVE <br /> � AUTHORITY TO VIOLAT[ OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTIOV OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZE:D BY THE <br /> � OWNER OF THIS PROPEFiTY TO PERFORM THE WORK FOR WHICH <br /> � APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> � — CONTRACTORS LAW 18.27 RCW AVD 296200 WAC. <br /> I SIGNAtUR CON111�C1 ROBPUi1bRRE0AGENT O�TE <br /> � , ,� x / <br /> 3zrs- .S� /�, ��� - <br /> I POOJECTADORE55 <br /> AP GANi5C11 A SINESStIGEN EN .ANDPUSMESSNRME <br /> I PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EdUIPMENT FEE <br /> WATER CLOSET(TOILET) � NC—lVHNDLG UNITS—H.P. � <br /> BATHTUB ; FORCED AIR SVSTEMS—B.T.U. M E.A. ' <br /> LAVATORY(WASH BASIN) i UNIT HEATERS—ii.T.U. M � <br /> SHOWER ' CLOTHES DRYERS � <br /> I KITCHEN SINK 8 DISP _ � VENTILATION FAN � <br /> i DISHWASHER � RANGE HOOD � <br /> LAUNORYTRAY ; WATER HEATER <br /> � CLOTHES WASHER � WOOD STOVE � <br /> URINAL ' METAL FIREPLACE 8 CHIMNEY ' <br /> i DFINKING FOUNTAIN I FIREPLACE INSERT � <br /> • FLOOR DRAIN HEAT PUMP ' <br /> � GAS PIPING � <br /> BACKFLOW PREVENTEFS � <br /> ROOF DRAINS—RAINLEADERS � EXHAUST FAN ' _ <br /> . SINK(SERVICE—BAR,ETC.) i � <br /> � <br /> __ � ' <br /> SUBTOTAL $ � SUBTOTAI S 1 <br /> . PERMIT $ � PEFMIT $ � <br /> TOTALFEE $ ' TOT�LfEE $ <br /> FItONT5Ei0ICN RE�f1SET0ACK SID[5[104CH PLANCIICCKNUMO[0 fE[ RECEIPTNO. <br /> � usemr+e iotnnen vncnNisne FEES VALUATION FEE <br /> I I YES I I NO � <br /> BUILDING (�( (n 3;On <br /> tvl`E Of LONSI.ALLOWABI[ IYPE Of LONSi.�CN�L rcturu<r rin m owRO�IMns � P i <br /> r,nnur pLUMBING � <br /> � <br /> SREOFBtOG. NOAFSTON[5 nnSEMENI MECHANICAL � <br /> I I YES I I NO ' <br /> � <br /> OCCUP�NCYLO�O FIR[SPRNKlER511[O'U H8IGIIIlI6�ItN10H 01k1ER ' <br /> C I YES I � NO STAiE BUILDING SURCIIARGG �� <br /> u�nson ron srnn+nier�s � <br /> STATE ENEIIGV SURCHA(iGE � <br /> 4PPlIG4IlONACG.OY Pl�NSAPPROVEDOY CITYOFEVERETT PUOLICWORNS � <br /> LOCALSALES ��_ <br /> ij� ,.Cs �,�-o ..� TAX CODE IS 3105 T�TA� _ <br /> �... �st <br />