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APPLICATIO�� FOR CONS7'RUCT�uN PERMIT <br /> everett <br /> •���Lv�rgreen � <br /> UiYOF <br /> everett <br /> BUILDING DEPARTMENT 70 BE COMPLETED IN INK—PLEASE PRINT <br /> 259-8810 <br /> ❑ DEMOLITION I_l COMDINATION i 1 BUILDING �MECHANICAL ! PLUMBING 1 ! SIGN <br /> OWNER IANLAOU�ESS CI1Y ZIP PNONE <br /> �o�+clj : Hlc.r.�o% Z/SO iU �7T^` �37a .S�cs-TT�a G/< •.���7 00 <br /> T�qqry{ M�ILRDOBESS CIiY L� PIIO��E <br /> AlIGNItEGTOR�E51GNE11 h�n�LA�DPE55 QTY 2iP PHONE <br /> yOH Clrv ZIP PHONE UGENSEI <br /> ���SI G[NERALG041R4ClOR �4�lADDRESS <br /> �.�� GITY ZiP PHONE LICENSE 1 <br /> C H MECHANiCAlCOt1LRAGtOR MA��ADDPh55 <br /> 9�-3 CA <br /> H �3 PLNfpINGCONiRI.CiOp MAILAD�RE55 CrtV IiP i'MONE I�CENSE� <br /> 02 S�TN S '� �3 ���R.�sT�+.i _�S2•25�2 2 �tu...�VE /�7 AL <br /> K C �F,�_J �isTS�YE -�� <br /> y�1 cinss ov r;onK <br /> � �-xj•�iy L I NEW ❑ ADDITION ❑ ALTERATION i , REPAIR �l 1 DEMOLITION I 1 WOODSTOV[/FRPL INSERT I I BUILDING REIOCATION <br /> y y[~"' <br /> 1 ENMIt IMPPOVEMENT OR IN1E��OR PEMOD[L ONL� CON�ACT PERSON AN�PlIOYE N0. <br /> � cor+innct rmc[ov wonrc: <br /> � yd �CSC^NEIENORKANDSOIIAPEF00iPGEiKVOWE� r <br /> l7 7LUn�B.�G �'�z N'y c✓�-T4/Z MF7'X25 <br /> �H [��JO rnonoswuscovouaoir+c I HERE�Y CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> H y C �T' �PPLICATION�N�KNOW THE SAIAE TO BE TRUE AND CORRECT.�LL <br /> 9H� �ma�oescnivnorvoFrnovEnrvis��o�+moe�owo�Air�u��ouncovie5l PROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISNPEOF <br /> WORK WILL BE COMPIETED 1NITH WHEiHEH SPEpFIEO HeREIN OR <br /> t+ H y i�r a��K or NOT THE GRANTING Of A PERMIT DOES NOT PRESUME TO GIVE <br /> � y /1UTHORIIY TO VIOLATE OR CANCEL THE PROVISIONS OF AIJY <br /> �..� OTHER SiATE OR LOCAL LAW REGULATING CONSTRUCTION OH THE <br /> (] Cy V1 PERFORI.��NCE OF CONSTRUCTION.THAT I AM AUTH0q�2ED BY 7HE <br /> � �'� OWN[R OF T411S PROPERTV TO PERFORId THE WORK POR WHICH <br /> APPLICATION IS MADE AND I COIdPLY WITH THE STATE <br /> Z y L/� CONTRAC70R5 LAW 1827 RCW AND 296200 WAC. <br /> HOfn .,�sr.niunrcrr.annnctor+onnunwnizeoneeNt onic <br /> ��naccrnooncss _� � ' xi�ucAn" rsc�"ouS�uEssucer�s�/er+on��o�ane <br /> � 7/3 �_.c . ., t;.;_ .G Cc- .�,,, <br /> PLUMBING MECIIANICAL <br /> o� N0. TYPE �F FI%TURE OR ITEM FEE N0. TVPE OF EOUIPMENT FEE <br /> I � _ WATERCLOSET�TOILET) _ ____ _ n'C-NHNDLGUNITS-HP. <br /> �ATHTUB ' � . __ FORCED AIR SVSTEMS-O.T.U. M EA. I— <br /> LAVATORV(WASH BASIN� _ UPIR HEATERS-B.T.U. M <br /> '�' � _ SHOWER _ � _ CLOiIiESURYERS —�� <br /> � � KITCHEN SINK R DISP I VEN7ILATION FAN _T_ <br /> DISHVJASHER ! _ _����G[HOOD <br /> LAUNDRVTRAY ' Y;AT[RH[ATEH -�— <br /> '� �— WOODSTOVE <br /> I � CLOIHESWASHER -- - �'^— <br /> -�� — ML1AL FIREPL7�CE 8 CHIMNEY ; _ <br /> URINAL — � <br /> DRINKING FOUNTAIN _ FIf1EPLAC[INSLRT �_ <br /> '�s _ FLOOR DRAIN —;— _ ��EAT PU1dP � <br /> �+� �ACHFLOW PfiEV[NTERS _�.__ GAS PIPI4G __�_ <br /> ROOF Df7NNS-RAINLEADERS __ E%HAUST FAN <br /> SINK(SERVICE-BAR,ETC.) � <br /> �`I 1 �ht��T— <br /> —/�'oy>ruc�i��r� r/- <br /> .— - — —T— <br /> I� � ; - <br /> .�. � SUOTOTAL $___ S� ___ SUBTOTAL 8 <br /> - -T- — PERMIT S <br /> — P[RMIT $ /D '�" _ <br /> — iOTALfEE 5 — TOTALFEE $ �— <br /> - Fnom suo�cK <br /> nennscioncK sioeseiuncn rim�cur.cK�+uMnen re� Fl[ceirr�+o. <br /> useioi+e iornn�e vncmrtsic FEES VALUATION FEE <br /> I I VES I I NO pui�oiNG : <br /> rvr[oreoxst.nuawne�[ rvrEo�toxs�eemu eccw.,r. xoamnu�xeav�is — � <br /> cawr �p-p <br /> PLUMUIIJG ��� <br /> SREOFOIW. NOOFStO�i[S UAS[�eENI MEGH�NICAL <br /> l 1 YES I I NO � <br /> xcurnr�criono rn[srnr+n�enseeao r�Eic�iruMnnuon <br /> omr:n <br /> ❑ VES I 1 NO _ S1A1G B111L01NG SURCHARG[ � <br /> �'T— <br /> fU:A50N FOII SPRIIIKLEIiS <br /> S7AlE[NLRGY SURCHA(iG[ <br /> i <br /> amocnnor+ncc.er rinusnrrnovcoov CITYOf'EVERETT pUnuCwonks <br /> LOCAL SALES <br /> TARCODEIS3105 TOTp� �� '�� <br />