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� t <br /> APPLICATIt�N FOR CONSTRUCI rON PERMIT <br /> everett <br /> .��E,v���� e <br /> CI'Y OF <br /> everett <br /> BUILDING DEPARTMENT TO BE COMPLETED IN INK—PLEASE PRINT <br /> 259•8810 <br /> t � DEMOLITION I i COMBINATION � ' 6UILDING ! �t�AECNANICAL i I PLUMBING I I S�fiN <br /> ONTIER MAIL�D�fiL55 CIIY IiP 1'110NL <br /> � 7 EvNrcff�If�'�Dl ,15`f- i��l <br /> �vrrrH LBn.��»�'��ih� [.�ll'uc £��l IAle�i.�rdr�� _ — <br /> TEN�NT( M��l�11 SS GTY bP PIIONE <br /> rd�Cl/L�. - <br /> ARCHITELTORDESiGNER ����.����ESS CILV ZII` P110NE � -'�7 � <br /> 9 �S�tS' Jl '� 'Ic��1 �..:/�� ,�'� , lY ��Q� ����� 7�� /� <br /> ' CIIY ZIP PI�ONE IICENSE� <br /> GENER�L ONTH�GTOR MA:I ADORE55 <br /> —��_5e%e�PJ _ ---- — ------- — <br /> MEGN�NILQ CON1RAf.iOR M�II.ADDRESi LpY 21P PIION[ I IGFNS[� <br /> VII�MBMGCONTR�CLOR ��II �DOP[SS " "---�'---- f.I1V -"�---IIP--�—"— �110Nf. LIC[NSE• <br /> f,l�SSOF WORK <br /> I I NEW I 1 ADDITION �ALTEP.ATION i I REPAIR i I DEMOLITION I I WOODSTOVE�FRPL INSERT I I BUILDING RELOCATION <br /> co/NlrncT Penc-(/L/I ey7o nrr�onE r+o LA,f •�/J 7�/�w� <br /> TEN�NTIMPflOVEMENTORIN�I�O✓C�IY��� �'II/�S VQ/'/ �IL (,/C��Z� ILB_ ! `�`� • _ <br /> GONTRICT PRICE OF WOHK: - <br /> pES�pIgE WJfIK�NDs�pE FOOTpGE INVOI'[0 ���� S� <br /> i7�ti'/O)' /�ril.+6'c/rl�lLh�(� -- — <br /> rnuaosEo oFe�u.om t IIEREBV CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> O�C� ��mC, APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> IEGAlOESCRIPTION ��FROPERTYIS��OWNUElOWOO�iT�GRFOIIRCOP1E51 PROVISIONSOFLAW5ANDORDINANCESGOVERNINGTHISTYPEOF <br /> WORK WiLL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> toT a�ocK oF NOT. THE GRANI�ING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AUTHOFITY TO VIOLATL OR CANCEL THE PHOVISIONS OF ANY <br /> ��+`9�L� OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY TME <br /> OWNER OF TIIIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> —' CONTRACT095 LAW 18.27 RCW AND 296.200 WAC. <br /> SIGIlAIIIREOrGONiHACTORORAUINORREDAGENT O�TE <br /> -_'._ ___ _ � l. I(���(w� Li� 6(.A.Y"i " __'_ <br /> P{qJECTMDRESS �pPIICANTSCITY81151N[SSLICENSEN �ADDUSINESSN�ME <br /> � <br /> �� MECHANICAL <br /> Np, TYPE OF FlI(TURE OR ITEM FEE NO. TVPE OF EOUIPMENT �E <br /> WATER CLOSET(TOILET) _ A/C—AMNDLG UNITS=H.P. �_ <br /> BATHTUB �— FORCED AIR SYS?EMS—B.T.U. M E.A. 1_ <br /> �__ ' <br /> LAVATt�RY(WASH BASIN) _ I1NIT hEATERS—B.T.U. M � <br /> --r— <br /> � CLOTHES DRYERS • <br /> SHOWER — <br /> KITCHEN SINK 8 OISP ; VENTILATION FAN _�_ <br /> DISHWASHER ---� __ RANGE HOOD _ � <br /> LAUNDRV TRAY _____ i _ WATER HEATER _ � <br /> -��— — ; WOODS70VE ' <br /> CLOTHES WASHER __ — � <br /> URINAL _ METAL FIREPLACE 8 CHIMNEY - <br /> DRINKING FOUNTAIN i__ FIREPLACE INSER7 � <br /> —r <br /> — HEAT PUMP ' <br /> FLOOR ORAIN ~ — -- � <br /> BACKFLOW PREVENTERS ' GAS PIPING _ � <br /> --� EXHAUSTFAN ' <br /> pOOF DRAINS—RAINLEADERS _ " , <br /> — — � <br /> SINK(SERVICE—BPR.ETC.)__ __�. — -�-- <br /> — ' _—'_ <br /> i . <br /> _ i <br /> __ —_ _ �— <br /> �__ <br /> i <br /> SUB TOTAL $ ' SUB TOTAL 8 _ i __ <br /> ---�—' — PERMIT E �_ <br /> PEFMIT S ' _ , <br /> TOTALFFE $ ' TOTAIFEE $ <br /> I'I AN CI It.H N111AULR FE 5.`5 ,y ��ECEIPT NO <br /> FRONT SETBACN PE�R SEIOAGN Stl)L SGL��CH a3sus � <br /> O <br /> iot�nen VNLANTSIIE FEES VALUATION FEE <br /> USE 20NE %1/f�i G� <br /> i i ves N� uui�o�Na _���j� J-1 <br /> acur�ncr xoamnmm:uxus � <br /> iVft01L��.�rABl[ 1YPL0{CON3yAL111A1 � PLUMf31NG ..-- � <br /> �� � � _. <br /> y n! f�-'�i�c ---�— <br /> .i- o.' -�i----- ' <br /> SIZEOFi1DGi�r�-C ��OAFSTORIES BASEMENT MECHANICAL __ ___ <br /> 2 ,. a , � YES � � No — ; <br /> OTHER ' <br /> pLC PNlCVLO�O FIRESPRNKlER5RE0'D HEIGHTLIMITAiION — �� <br /> 'Z I.I VES �NO CX��ST �C9� S�ATE UUIL�ING SUNGNFRGE i <br /> _ � <br /> RE�SON FOR SPRINNLENS � <br /> S1ATE ENERGV Sl1RC11AFGE <br /> _ <br /> i <br /> APPIIC�TION�CC BY PUNSAPPROVEDBY CITY OF EVERETT PUBLIC WOFK$ � <br /> LOCAL SALES � ' � <br /> ��11m � TAX COUE IS 3105 ror�� ' <br />