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� 1 <br /> APPLlCAT11�N FOR C�.INSTRUCI �ON PERMIT everett <br /> �,�E�,���� TO BE COMPLETED IN INK—PLEASE PRINT � <br /> CITV OF }} <br /> �Ve�C�LI HEATINGSVSTEM: GAS ❑ELECTHIC ❑ <br /> BUILDING DEPARTMENT <br /> 269-8810 / <br /> �:l DEMOLITION i7 COMBINA;ION i 1 BUILDING `!'MECHANICAL PLUMBING SIGN <br /> ONMER MRILADDRESS Q� �7 Q��n' Z�P PHOn� <br /> TENAN��A� M�I�R ORESS P� IJLJY 1 OC�IS � ZIP�I� PH���_��� <br /> I��-Sre�.ir-ru ��� 3zzs s►a+rnk k.� �.rr� �8�2OI 3�t-2r„32 <br /> ARCNITEGT OR DESIGNER MRIL�pORESS CITY ZIP P1pNE <br /> GENEMLGONTRALTOF MAILAD�RESS CITY 21P PMONE LICENSE� <br /> M�E+CNANICALCdITRRC�TOP M�ILAODNE55 .--1� CITV 21P PNONE LICENSE• <br /> I�oRT1':�1 TL�FY'�"� — f�t I � K_ . <br /> PIUMBMGCONTRACTOR M�ILAOOPESS CITY ZIP P110NE LICENSEI <br /> CLASS OF WORK <br /> ;� NEW CJ ADDITION .✓ALTERATION i_I REPAIR . 1 DEMOUTION �. i WOODSTOVE/FRPL INSERT Ci BUILDING RELOCATION <br /> 3pe N CON.T��CT•P�ER.S�ONANUVNONENO. <br /> CONTMGT PRICE OF WOi1K ✓�- � � <br /> DESCRIBE V/OflN�NO SIX1�RE FOOTAGE INVOLVEO <br /> =+Isv►11 * - � �a.l !J�— '�{�-Si�tcls�v"Tk. �OI.T <br /> rr�wosEouseocew�on� $.VEqtTKU RaeFiN�MRW--�EVW ,HEREBY CERTIFY THAT I HAVE READ AN'J EXAMINED THIS <br /> APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> LEGAL DESCRIPTION OF PROPERTV�SMOWN BELOW OR�TTACH FIXIN COPIES) PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> WORK WILL DE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> ior e�ocK oF NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AUTHORITV TO VIOLATE OR CANCEL THE PROVISIONS OF ANV <br /> OTHER STATE OR LOCAL UW REGULATING CONSTRUCTION OR THE <br /> PERFOHMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM 7HE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br /> SIGNAIDREOFCONTMGTORORAUTHOPIZED�GENT D�TE <br /> X '���a-i.•u,4,� /�IA oZ6d NQ <br /> P�ZZSSSnn c�. <br /> APPLICANTS CITY BUSMESS LICENSE N0.AND BUSINE55 N�ME <br /> PLUMBING MECNANICAL <br /> Np. TYPE OF flXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET iTOILEn /V�-AMNDLG UNITS-H.P. � <br /> � BATHTUB FORCED AIR SYSTEMS-B.T.U. M E.A. <br /> LAVATORV(WASH BASIN) � UNIT H[:ATERS-B.T.U. M <br /> SHOWER � CLOTHESDRYERS ' � <br /> KITCHEN SINK 8 DISP VENTILATION FAN <br /> DISHWASHER RANGE HOOD <br /> LAUNDRYTRAV ' WATER HEATER _ ' <br /> CLOTHES WASHER � WOOD STOVE � _ <br /> � URINAL METAL FIREPLACE 8 CHIMNEV <br /> DRINKING FOUNTAIN � FIREPLACE INSEflT � <br /> FLOOR DRAIN HEAT PUMP � <br /> BACKFLOW PREVENTEflS ; GAS PIPING ' <br /> ROOF DRAINS-RAINLEADERS � EXHAUST FAN � <br /> SINK(SERVICE-F?AR,ETC.) _ <br /> � <br /> � <br /> � <br /> � <br /> SUB TOTAL S ; !` SUB TOTAL S ' <br /> PERMIT $ PERMIT $ / <br /> TOTAI FEE S ' TOTAL FEE $ O ' . <br /> FOR OFFICE USE ONLY: <br /> FRONiSETBACK REAflSEfBl�GK SIDESETBACK PLANCHECKNUMBER FEE RECEIPTNO. <br /> U�EZONE IOTAREA VAC�Nisite FEES VALUATION FEE <br /> , BUILDING 1 <br /> TYPE Of LON15.ULOWABIE 1YPE OF CONSi.ACIDAL o[tuo�xtv ro a owEwMGUNrtS <br /> cuwv - p�UMBING � <br /> --�— <br /> — � <br /> SIZE OF BLDG. NO.OF STOPIES BASEMENT MECH1INICAL �Q i_ <br /> OCCUP�NGV LORD FIRE SPRNNLERS RF.OL HEIGHT LIMITATION ADDITIONAL PUN CHECN i <br /> OTHER � <br /> REASON FOR SPR�NNIERS �— <br /> STA7E BUILDING SURCHARGE � <br /> INTAKEBV PlANSAVPROVEDBV CITYOFEVEHETT PUBL�CWORKS i <br /> LOCAL SALES —� <br /> �� TAX COUE IS 3105 T�T�� ,30 � � <br />