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_ �. <br /> ,,� <br /> I ; ''';�. <br /> � ' APPLICATION FOR CONSTRUCTION RERMIT `'�f <br /> m.E�� everett '� <br /> CITV OF <br /> everett � <br /> BUILDING DEPARTM NT �� <br /> 259-8810 „� TO BE COMPLETED IN INK—PLE�A E PRINT �+;$� <br /> ❑ DEIIAOLITION ❑ COMBINATION ❑ BUILDING Wi'MECHANICAL ❑PLUMBINO ❑ SI2iN, ��� <br /> ow��N ��r.ua/�ppppgg _�1.+�' ' "�^ '`� cin z�r r . 3�J J . .:;)? <br /> / l.l. � �2 • �+q� PL51r1�� 4'�ZU3 ��q�o , <br /> IJS____�' <br /> WUL//pq*E85 CITV ZIP PHONE <br /> �KN�/Y�-�Ci <br /> MCNITECTORDE810HEN WLADONES9 CITV 21P PNONE . � <br /> i� <br /> � OEHEMLCONIMC70R 1A�R.ADDflE55 CIT' ZIP PIIpNE LICEN'r.'E� +i <br /> , Jl A1 Dr71�R 11 Iv30s SLR'T�2 f�1?�,�YF_ �C12YJA�ND �l��.1 $SZ.a u4���� . . �. �'�, '�� <br /> PL�MIBINf!CpNTMCTOq MAR�DDRESS GTV ZIP PHONE LICEN&E� ' � <br /> CU1680F WdM( � <br /> ❑ NEW IJ ADDITION �ALTERATION ❑ REPAIR IJ DEMOLITION f 1 WOODSTOVE/FRPL INSERT ❑ BUILDIN(3 iiELOCATION <br /> 7EW W7 MPFOVEMENT 011 Wf R����L �YU CONTACT PERSON ANO PHONE NO. ' . <br /> CONiMCT PRICE OF YMDIIK: <br /> DEBCRIBE M/OIr( BOUME iME INVOLVEC <br /> �L10 1�r� Ii1rlY1� <br /> pqopoeeo�oFquwora /� I HEHEBY CERTIFV THAT I HAVE READ AND EXAMINED THI9 <br /> d '� APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> LE011LOESCRIP710NOFP n Israv+NeEiawoa�rr OURCAPIES� FROVISlON30FLAW3AN60RDMlAWCE300VERNINOTHI8TYPEOF � <br /> WORK WILL BE COMPLETED WITH WHETHEfI SPECIFIED HEREIN OR � <br /> ►oi e�oa� oF NOT. THE 6RANTINO OF A PERMIT DOES NOT PRESUME TO OIVE �� <br /> AUTHORITY TO VIOLATE OH CANCEL THE PROVISION8 OF ANY , ��,, <br /> � 5� � ' I OTHER STATE OH IOCAL UW RE6ULATINO CONSTqUCTK1N OR THE �.� � <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIIEO BV 7HE �- <br /> OWNER OF THIS PROPERTY TO PERFORM THE WOfiK FOR WHICl1 ' <br /> � APPLICATIOM IS MADE AND I COMPLV WITH THE BTATE ��,,;� �� <br /> � CONTRACTOR3 LAW 1827 RCW AN0296.200 WA0. ��;;� , <br /> . 61ON�TU OFCONTMpTOR�U[IIOR�ED�ENi�TE � ���� .. <br /> � �M 1 T I Mn 1/\ <br /> . X V�11 Vl,v� V � �I ��� �� �� � . <br /> MqJEci AODIIEBD <br /> �� ' ! APPLIGINTSCITYBUSMESSL EN .ANDBUSINE68N�ME ';�r � <br /> .� <br /> �. PLUMBIN(i MECHANICAL '� <br /> Np, TYPE OF FlXTURE OR ITEM FEE NO. TYPE OF E�UIPMENT FEE �� <br /> WATER CLOSET{TOILET) � AIC—AIHNDLO UNIT�FI.P. � , •� <br /> BATHTUB ' FOHCED AIR SYSTEMS—B.T.U. M E.A. � ; � <br /> ' LAVATORY(1NASH BASIN) � UNIT HEATERS—B.T.U. M i .. 1 <br /> gHpyyEq � CLOTHES DRYERS � <br /> KITCHEN SINK 8 DISP - � VENTILATION FAM ' �i�•� <br /> DISHWASHER <br /> � RAN(3EHOOD � '�' �� <br /> UIUNORY TRAY ; WATER HEATER ' '�}� <br /> CLOTHES WASHER � WOOD STOVE � "�! <br /> URINAL ' METAL FIREPLACE 8 CHIMNEY � ' <br /> ,� <br /> DRINKINO FOUNTAIN � FIREPLACE INSERT � 7� <br /> FLOOR DRAIN � HEAT PUMP � , �; <br /> BACKFLOW PREVENTERS ; (3AS PIPINO ' • <br /> •, .: <br /> ROOf DRAINS—MINLEADERS � EXHAUST FAN � • '; <br /> � SINK(SERVICE—BAR,ETC.) � � � <br /> i <br /> , � i.l <br /> � � <br /> i � 4i <br /> , <br /> , , �l <br /> , , �„� , <br /> � . � , <br /> SUB TOTAL S ; SUB TOtAL S ' � <br /> ti <br /> PERMIT � S � PERMIT S � `; <br /> TOTALFEE S ' TOTALFEE S ' � <br /> i�cEwiNo. i• � <br /> FppNf 6E7UiC1( REAR SETMCN SIOE SETBACN PLAN CHECK NUMBER FEE , <br /> ! <br /> �� �or�a� v�cu�r site FEES VALUATION FEE �, `�'. <br /> ❑ YES Cl NO BUILDINa . � <br /> 1Y1E0iC0113T.�LLOWMIE na�aca�sr.�cTuu o0.lwNtr Mo.ofUwElldpUMls i <br /> GRWP PLUMB�NO 1 <br /> 1 <br /> 5¢E pF BLDO. NO.OF STORIES BASEIAEN7 MECHANICAL � ' <br /> ❑ YES ❑ No � �� �'' <br /> � <br /> pCWYMIGYLWD FIRESPWA(IERSflEdD HENiHTLIMITATION OTHER i <br /> C� YES ❑ NO STATE BUIIDINQ SURCHAROE � <br /> � 9 <br /> pEA80NfOi16vR ER.. ' STA�EENEHCYSUHCHAROE i <br /> � <br /> �vr��taw�cc.ev r�ws�rrr+oveo er CITY OF EVERETT PUBIIC N/OFiKS � <br /> LOCAL SALES , <br /> � TAX CODE IS 3105 *��� <br />