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APPLICATIC�'� FOR CONSTRUC't�DN PERMIT �'�''"'" <br /> Hm F�r�gre!en TO BE COMPLETED IN INK—PLEASE PRINT � <br /> everett �111/ I HEIITING SYSTEM: U GAS U ELECTRIC 0 <br /> BUILDING DEPARTMENY <br /> 259-8810 <br /> I I DEMOLITION I I COMBINATION I I BUILDING I �MECHANICAL PLUMBING I I SIGN <br /> OMMEN M�ILA�O{IE55 CI1Y ZIP P1qNE <br /> fbR7 oF' Eu�-a�r!' P 0, B�x ,s�x . �iiFiP��t- 9F'�a6 2s9-3[6� <br /> TEN�NT MAl�ODRE55 CIT ZIP P/IONE <br /> S��t <br /> �qCHITECTOfl0E51GNER WUlADp1E55 � �Itv ZtP pNONE <br /> MaaRF fr�eE- AaaTe�nont i86z� s� Mav ✓�y ,Pn rss��� � q az7 <br /> 6ENER1ILCONiRACTOR M�0.�ODRESS CITY ZIP � VIIONE LICENSEI <br /> �(!e�lc CzulaLeo�rtO�U 2�4s .s'U� �¢6�"^ Lnr � SF�tTF�E� 96/66 824-4Laa <br /> 1.1ECN/u/1C�1LCpITqACTOf1 MAIL�UpRE55 piV ZIP Np1E LILENSEI <br /> PLU�MMOCONTMCTdi WILADORESS CIiY =IP PIKKIE LIGENSE/ <br /> �iclaoR� Fi,�E ���rro�cl Sk�t� s3f- 7� -�/ <br /> C1A550F N'ORK <br /> I l NEW �ADDITION I_1 AUrFRt!ON I I REPAIR I I DEMOLITION I.1 WOODSTOVE/FRPL INSERT ❑ BUILDIN(3 RELOCATION <br /> CONiMGII`RICE01W0{IK � �� g�QI� CONTACTPERSO(�NNlDPyp�ENO. � <br /> . DESGP9EWJ11KM/OSOU�PEFOOT�GEINVOLVEO �I_ '(Fl��LY��� <br /> Aa s iK s , ` 0 6 �s9— 6 <br /> r�aroseousea`eutioMo I HEREBV CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> _M�SCi /-CYUIPMFi� E APPLICATION AND KNOW THE SAME TO BE TRUE AND CORflECL ALL <br /> IEO�LDESGRIPTIONOFPROPEPTY(SIIOWN9ELOWp1�TT�CHFWRCOPIE51 PROVISIONSOFLAWSANDORDINANCESGOVEHNINGTHISTVPEOF <br /> WORK WIIL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> �or etocK ov IJOT. THE GRANTING OF A PERMIT �OES NOT PRESUME TO GIVE <br /> /� � _ r,��^ AUTHORITV TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> SE� �I-IAZ1�iUG�1.![ OTHER STATE OR IOCAL LAW REGULATING CONSTRUC710N OR THE <br /> `�� n ! n PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORI2ED BY THE <br /> � OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WNICH <br /> f APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS lAW 18.27 RCW AND 296200 WAC. <br /> SIGNATVREOFCONTR�CTOflOfl�UTHONIZEO�GENi O�IE <br /> _ ` <br /> X <br /> PiIO.IECT��(Dq1E55 �r <br /> 3S�JO ' L � APPIIC�N C BUS E IC SENOANOBUS�NESSN�ME <br /> PWMBINO MECNANICAL <br /> NO. TYPE OF FIXTURE OH ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) � AIC—A/HNDLG UNITS—H.P. <br /> BATHTUB ; FORCED AIR SYSTEMS—B.T.U. M E.A. <br /> LAVATORY�WASH BASIN) � UNIT HEATERS—B.T.U. M <br /> SHOWEH � CLOTHESDRYERS � <br /> KITCHEN SINK 8 DISP ; VENTILATION FAN ; <br /> DISHWASHER � RANGE HOOD �— <br /> LAUNDRVTRAV � WATER HEATER <br /> CLOTHES WASHER � WOpD S70VE ; <br /> URINAL ' METAL FIREPLACE d CHIMNEV —T <br /> DRINKING FOUNTAIN � FIREPLACE INSERT ; <br /> FLOOR DRAIN � HEAT PUMP � <br /> BACKFLOW PqEVENTERS ; GAS PIPING ' <br /> ROOF DRAINS—RAINLEADERS EXHAUST FAN � <br /> _ SINK(SERVICE—BAR,ETC.) � <br /> � <br /> � <br /> � �_ <br /> SUBTOTAL E ; SUBTOTAL S <br /> PERMIT E � PERMIT $ � <br /> TOTAL FEE E ' TOTAL FEE E —~— <br /> FOR OFfICE USE ONLY: <br /> FRONT SETB�CN REAR SETB/1G1( SIDE SETB�CK PLAtl CIIECN NUMBEfl 1 EE fIEC PT NO. <br /> • ,� .� 2� `= ,� <br /> VSE 20NE LOT�RE� VRCANT SITE FEES VALUATION FEE <br /> BUILDIN6 � <br /> iYPF Of CONI5.11LLOW�lIE fYP[pf LON57.�LIU�I ttwnNd rq q pKiiixc W16 — <br /> ��� PLUMBINQ <br /> SIZC OF BIDp. NO.pF STORIES BIISEMEN7 MECHANICAL <br /> i <br /> OCCUP�NCYLO�O FlqESPRNKLERSRE00 NE1GHiLIMITATqN �DDITIONALPLANCHECK � <br /> � <br /> OTHER �j �� <br /> RE�SON FOR SPPINNlERS <br /> S1ATE BUILDING SURCliAFiGE <br /> INT�NE BY PL�NS APPf10VED BY CITY OF EVERETT PUBLIC WORKS � <br /> LdCRL SALES <br /> I�(G/�� �/f TIIRCOUEIS3105 TOTRL �/��('� <br />