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� <br /> �t,',�, �,:r.,:;: <br /> APPLIGATI��i�l FAR CONS'fRUCTe�N PER9Vill"P <br /> everett <br /> Iha Ever9reon � . <br /> CITV OF <br /> everett <br /> BUILDING DEPARTMENT <br /> 259-8810 TO BE COMPLETED IN INK—FLEASE PRINT <br /> i i �EMOLITION I] COMBINA�ION I I BUILDING � MECHANICAL ❑ PLUMBING ❑ SIGN <br /> y�r�en ;IAAIL�DDRESS ��� _ �� �� — ziv a�+o,l{e �� <br /> 1� � 5�1_ I <br /> LE�! � Ml11L RESS CITY � , PNONE <br /> AlILt11TEC70P�ESIGNER 1ANLA�DRE55 CIiV ZIP PH'vNE <br /> (f11ER��CTOR UIIF$; CII 21 P 10 IICENSEC <br /> ��N �YNLE�Y—NAqTURAL GAS, INC. ���� CS?� � `� <br /> ldECINNICMCONiAACTOR —�TS1ICA�OfiESSS��Q�42'1�4��GI7Y ZIP ONE UCENSEp <br /> C }2�6�05 McDougell <br /> PW!ABINGCONiRACTOR MRRpIN�ltes�e�h�ngtoil"�8�4 CIIY 21P PHONE LICENSE� <br /> CL4550F WOt1N <br /> I i NEW I I ADDITION ' AL k1ATION I I REPAIR �.I DEMOLITION I I WOODSTOVE/FNPL IPI.SEFT ❑ BUILDING RELOCATION <br /> TBlANT P!anOVEMENt OR INTERIOR I E�ONLV� CONiAGT PERSON AND PHONE N0. <br /> CONT{iA;T PRICE OF WORK: <br /> OESCFIEE W RK�ND SO RE FOOTn(GJE INVOLVED /) , .� <br /> �� 1 UG � n �r�i� -- <br /> �. <br /> PROPOSEOUSEOFBUILDING I HEREBY CFRTIFY THAT I HAVE READ :\ND EXAMINED THIS <br /> APPLICATION AND KNOW THE SAME TO BE TRUE AND CORPECT.ALL <br /> LEG^.i0[SCRIPTIONOFPpOPERT�51WWN0ELOWORATTACNPOURCOPIES) PROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTYPEOF . <br /> WORK WILL 8E COMPLETED WITH WHETHER SPECIFIED HEREIN OR i <br /> �oT o�ocK oF NUT. TFIE GRANTING OF A PERMIT DOES NOT P!iESUME TO GiVE <br /> �UTHORITY TO VIOLATE Qfi CANCEL THE PROVISIONS OF .4NV i <br /> OTHER STATE OR LOCAL LAW REGUUQING CONSTHUCTION OR THE �, <br /> PERFORMANCE OF CONSTRUCTION. THAT I AM AU7HORIZED BY THE I <br /> OWNER OF THIS PROPERTY TO PERFOHM THE WORK FOR WHiCH I <br /> APPLICATION �S MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br /> SIGNA7UREOFCONTRACTGRORAUTNORIZEDAGENT DATE <br /> rno�EcrnoonFss % L � �'^" �"- "-' <br /> � y.� �� APPUCnNiSCIiV�t151NE5 ICENSEHO.AN�BUSINESSNA6IE <br /> PWMBING MECHAN!C:�L <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF E�UIPMENT FEF <br /> WATER CLOSET(TOILET) A/C—NHN�LG UNITS--H.P. � ' � <br /> BATHTUB FORCED AIR SYSTEMS—B.T.U. M E.A. ' . <br /> LAVATORY�WASH BASIN) --i— UNIT HEATERS—B.T.U. M � �I , <br /> SHOWER ' CLOTHES DRYERS ' � <br /> KITCHEN SINK 8 DISP ; VENTILAT!ON FAN ; 'i <br /> DISHWASHER � RANGE HOOD —�— �. ��� <br /> LAUNDRY TRAY ; WATER HEATER ' � ' <br /> CLO7HE5 WASHER � WOOD STOVE � , <br /> URINAL ; METAL FIREPLACE 8 CHIHINEY ; <br /> ORINKING FOUNTAIN i FIREPLACE INSERT i <br /> FLOOR DRAIN <br /> —~ HEATPUMP � <br /> BACKFLOW PREVENTERS ; GAS PIPING � <br /> ROOF DRAINS—RAINLEADERS �- EXHAUST FAN � <br /> SINK(SERVICE—BAR,ETC.) ; � � <br /> � <br /> � <br /> ,-- <br /> — ' � <br /> � <br /> ---� <br /> , � <br /> SUB TOTAL $ ' SU�TOTAL $ ' <br /> PERMIT $ PERMIT $ i <br /> TOTAL FEE $ ' TOTAL FEE $ ' <br /> � <br /> Ff70NT5ET0ACK REAPSETOACK SIOESETBACK PI�NCHECHNUMBER FEE flECEIPTNO. <br /> usezoNe LOiAPEA ��CANTSITE FEES VALUATION FEE <br /> IJ YES IJ NO BUILOwG . � <br /> IVPEOfCON51RLLOWABLE TYPEOFCONSi.ACIOAI aturnx[Y uoatowEumGUxirS � <br /> cnouv p�UMBING i <br /> SIZEOFBLOG. NO.OFSTOf11E5 B�SEMENT h1ECHANICAL � �/(/���7**�,v!�r/ <br /> I] YES f 1 NO �"'�` <br /> OCCUPANGVLORD FIRESPRNNLERSBEO-D NEIGHiLIMITAiION OTHC-R i <br /> � <br /> C-1 YES I_7 NO STATE BUILDING SURCHARGE � <br /> f1EA50N FOR SPNNNLERS <br /> STATEENERGYSURCHnflGE i <br /> —' <br /> nrricnnor+ncc.nv r�nNsarenoveonv CITYOFEVERETT PUBLICWORKS � <br /> LOCALSALES <br /> TdX CODE IS 3105 TOTAL �(1� <br />