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i � �. <br /> � APPLICATI�i�I FOR CONSTRUC�N PERNliT <br /> j - everett <br /> . �E�q�� e <br /> � cin oF <br /> � everett <br /> BUILDING DEPARTMENT TO BE COMPLETED IN INK—PLEASE PRINT <br /> 259-8810 p7�ON I I BUILDING ( 1 MECHANICAL 1 1 PIUMBIN(i ❑ SION <br /> � �EMOLITION I1 COMBIN <br /> pW1/ER <br /> MMl�DDRE55 CITY ZIP PNONE <br /> ' �I! <br /> �� IENN/T M�IL�DDPESS CITY ZIP <br /> P1qNE <br /> 11qCHITECTpIDESqNER M�I�ODRE55 <br /> QTY IiP VMONE <br /> � GITY 21P PIqNE LICENSE� <br /> D�pk��p�Cipq M�0.AODRES$ <br /> .,� n �i Si'�7��� /J7/JYL� /�l !39 0 i <br /> /1:�•t�f C �.w�r��.�t� t /�'1/ //�N/CS�/� /wi/ 98^A PHONE LIGENSEI <br /> �C�µ��Tq�CTpp W�IL�DDRE55 <br /> ,' p�{�IA�rypGONip��tpq MMLADDRE55 CITY IIO P1qNE IIGENSE• <br /> , <br /> l C�S��K ��� <br /> ' O NEW ❑ ADDITION I_7 ALTERATION Yf REPAIR C7 DEMOLITION I 1 WOODSTOVE/F(iPl INSERT ❑ BUILDIN6 RELOCATION <br /> � x 7EMW}YPROVEMENT dl MtEP10N RE��IV � CONI�CT PEPSON ANO PHONE H0. ^ <br /> i !•Y� J7 ' �i S.Z '/L���i <br /> �� COMTNN�LTPRiCEOFWOR1t: CJL� <br /> ; � y/p{�(µp 5W�RE F 6E INV0.V <br /> 7 � <br /> i o, seor unoR+a I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS �� <br /> S � ` �1� � �� � APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECL AlL <br /> � ��� PROVISIONS OF LAWS AND ORDINANCES(iOVEHNIN6 THIS TYPE OF <br /> �_, ��y� ��aPnor�RT.�fi�o�m e��pwon T�CHFWRCOPIE51 yyORK WILL BE COMPLETED WITH WHETHEfl SPECIFIED HEREIN Ofi <br /> 5 ,��_ �� or NO7. THE GRANTIN6 OF A PERMIT DOES NOT PRESUME TO QIVE <br /> AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> 1 OTHER STATE OR LOCAL LAW REGUUITING CONSTRUCTION OR THE <br /> � � _ e i e p:qFOflMANCE OF CONSTRUCTION.THAT I AM AUTHOiiIZED BV THE <br /> O'NNER OF THIS PROPERTV TO PERFORM THE WORK FOR WMICH <br /> A?PLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br /> � SION�NREOFCOM1A�GiORORAUTNOR�2EDMENT WTE <br /> � X ��=�� i_�_ 90 <br /> i <br /> �i �������� �PPLICNITSGTYBUSINESSLICENSENO.�JlOBUSINESSNNAE <br /> .� ��� MECMANICAL " � <br /> � FEE <br /> :1 N0. TYPE OF FlI(7URE OA ITEM FEE NO. TYPE OF EWIPMENT <br /> i i A/C—NHNUL6 UNITS—H.P. ' <br /> WATER CLOSET(TOILET) � <br /> � FORCED AIR SYSTEMS-9.T.U. M E.A. <br /> �1i BATHNB ' ; <br /> �� LAVATOR'f(WASH BASIN) � UNIT HEATERS—B.T.U. M <br /> � CLOTHES DRYERS ' <br /> SHOWER � <br /> j KITCHEN SINK 8 DISP � VENTIUITION FAN � <br /> �� DISMWASHER ; FANGEHOOD ' <br /> ��� UIUNDRV TRAY , WATER HEATER � <br /> �, , WOOD STOVE ' <br /> y CLOTHES WASHEf1 � <br /> '� URINAL ' METAL F�REPIACE 8 CHIMNEY <br /> .�� FIREPLACE INSERT � <br /> , � DRINKINO FWNTAIN _ ' , <br /> FLOOR DRAIN � HEAT PUMP <br /> � BACKFLOW PREVENTEflS ; GAS PIPING � <br /> (�� ROOF DRAINS—RAINLEADERS � EXHAUST FAN ' <br /> � <br /> ;�1 SINK(SERVICE—BAR,ETC.) � � <br /> � <br /> � <br /> � i i <br /> i <br /> i <br /> � <br /> � SUB TOTAL S � SUB TOTAL S ' <br /> � PERMIT S PERMIT S � <br /> ,� T01AL FEE S ' TOTAL FEE S ' <br /> � VUNGH[CKNUMBER FEE PECE�PTNO. <br /> pppNTgE79��K REARSETB�CK SI�ESETBACI( <br /> I v�cu+t site FEES VALUATION �E <br /> ' UBE20NE LOTAREA i <br /> ❑ YES I 1 NO BUILDING � <br /> �CN�MLY Ip p VMllIXO UNI�t � <br /> trreawxsteuowuae nnacoescecm�� c,�. ' <br /> PLUMBING � <br /> i <br /> 6�pFg�pp Np,OFSTORIES B�SEMENT MECHRNICAL � <br /> ; ❑ YES ❑ NO i <br /> OTHER ' <br /> � OCCUPANCYLO�U FIPESPRNKLEHSREO'D NEIaMTLIMIT�T10H � <br /> + L] YES ❑ NO STATE BUILO�NG SURCHARGE i <br /> � <br /> . pEA$ONFONSPRMKLERS SiA7EENERGV SURCHAHGE ' <br /> � �PPLILATION ACC.AY FUNS�P A �EO BY CITY OF EVERETT PUBLIC WORI(S � <br /> LOCAL S11LE5 �; -�j� <br /> TAX CODEIS 3105 TOTAL <br /> � � - - ,� <br /> r.i -.`1'ee�. -,:�;. - � - - <br />