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� <br /> I <br /> , <br /> • � <br /> APPLICATIt,N FOR CONSTRUCI �bN PERMIT <br /> everett <br /> �ndE�a.erea� e <br /> C�TV OF <br /> ` everett <br /> �t" BUILDING DEPARTMENT TO BE COMPLETED IN INK—PLEASE PRINT <br /> �'1' 259-8810 <br /> �;;; ❑ DEMOLITION I I COMBINATION f I BUILDING I I MECHANICAL I 1 PLUMBING f] SIGN <br /> q�� � OWNER MAIL ADDRESS GTY 21P PHONE <br /> - ��l.�y Ua2� �:-t�Fod �'�vKiv� y'nwY LVN,vw�na� 9&0�7 3,i� —?/� <br /> TENANT MMLAO�RE55 CIIV 21P PHONE <br /> yy <br /> 7 <br /> .�� ARCHITECTOHOESIGNER MNLAOURESS CITY ZIP PHONE <br /> ; T/l,l(�t/Y !oR/� /:zuo6 Mdiuc�coS/'uwy �YNNca��cY� Pd'037 l.c"3 —?/�-r� <br /> '�,�''' � GENERALCONTFACTOR MAILAOUPE55 CITY ZIP PIIOHE LICENSEM <br /> t', ' ' �40212o.v H-,—CN� — <br /> �1•.,�.'. a MECHRNICALCONTF�CTOR MAILADOfiESS CITY 21P PHONE UCENSE� <br /> �'` � .�Ulr.�'cT �DON,�IJL(/M.Q�/�u(^ <br /> e . <br /> � PLUMBIN6CONTRRCiJR MAILAODRESS CIIY 21P F��ONE LICENSE� <br /> p� � <br /> � <br /> ' CLASSOFWORK <br /> L I NEW L I ADDITION I I ALTERATION I I REPAIR I I DEMOUTION I I �p/OODSTOVEIFRPL iNSEFT I I BUILDING RELOC4TION <br /> �r, TENANT IMPROVEMENT OR INTEPIOR PEMOOEL ONLY CONTACi PERSON AND P110Nf./N1O�. , <br /> [� GONiqACT PRICE OF WORN: H�V GY G/-�y'z.(i-C✓/G%C 3 S 1 —�I �� <br /> DESCFIBE WORK AND SOU�RE FOCTAGE INVOLVEU <br /> � PROPQSEDUSEOFBUIL�ING I IIEREBY CERTIFY TI1AT I HAVE READ AND EXAMINED TH�S <br /> � S��Z APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> LEOAI�ESLRIPTIONOFPROPE0fY�5110WN�ELOWORA(T4CIIFOUf1COPIF.S) PROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTYPEOF <br /> �or I If BIOCK oF IG�IU/LW OCLTH"�y�� WO T THELGFANTOING OF A ERMITJDOES NOT PRIESUME O GIOVE <br /> AUTHORITY TO VIOLATE Ofl CANCEL THE PROVISIONS OF ANY <br /> ' S• � — � � OTHER STATE OR LOCAL LAW REGULATING CONSTFiUCTION OR THE <br /> � PERFORMANCE OF CONSTRUCTION.THAT 1 AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPEPTY TO PERFORM THE WORK FOR WHICH <br /> , _ _ APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br /> . SIGIlAIUREOFCONIRAGtOROfiAU1110RIZE�AGENi UATE <br /> ' �����'��� <br /> PRQIECT AUDR[55 <br /> ' '� ��D � r� � /y,n� � � ) � �L APPLICANiSCIiVBUSMESSUCEN5EN0.ANDBU5MF.55NAME <br /> L /fJ Y (/� �!/ <br /> � PLUMBING MECHANICAL - _ <br /> � NO. TYPE OF FIXTUflE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE _ <br /> WATER CLOSET(TOILET) � NC—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 /> " SHOWER � CLOTHES DRYERS � <br /> KITCHEN SINK&DISP ; �_ VENTIL.4TION FAN � <br /> � DISHWASHER —r— RANGE HOOD � <br /> LAUNDRfTRAY ' 2, WATER HEATER ' <br /> � CLOTHES WASHER � WOOD STOVE � <br /> URINAL METAL FIREPLACE&CHIMNEY <br /> DRINKING FOUNTAIN � FIREPLAC[INSERT � <br /> FLOOR DRAIN HEAT PUMP ' <br /> BACKFIOW PREVENTERS ; GAS PIPING � <br /> ROOF DRAINS—RAINLEADERS � E%HAUST fAN � <br /> SINK(SERVICE—BAR,ETC.) i CG (—CYr �-� —E'" � <br /> � � <br /> � <br /> i <br /> � , <br /> � � <br /> . SUB TOTAL $ ; SUB TOTAL $ ' <br /> � PERMIT $ � PERMIT $ � <br /> TOTAL FEE $ ' TOTAL FEE $ ' <br /> ' FHONT SETBACK PEAR SETB�CK SI�E SET�ACK PLAN CIIECK NUM�Efi FEE RECEIPT NO. <br /> usezorve LOTAREA VAGANi51IE FEES VALUATION FEE � , <br /> I 1 YES I I NO BUILDING � <br /> TYPEOfLONSi.ALLOWAOLE lYPEOFGONSI.AGiWL acurebtr u0urowuuHcuxnS i <br /> rnour pWM81NG i <br /> i <br /> SREOFBLDG. N�.OFSTOfilES PASF:MENt MECIIANICAL � <br /> I � YES I I NO � , <br /> OCCUPANCVLOAD FIf1ESPRNKLER5flE0'D IIEIGHiLIMIIAIIOA OTFIFR i <br /> I I YES I I NO S1ATE BWLDING SUHCHARGE � <br /> �i <br /> REASONFOflSPRINKLERS —j— :S� <br /> STA1E ENERGV SUfiCFIARGE i � _+ <br /> APPLICATIONACC.BY PLANSAPPflOVEDBY CITYOFEVERETT PUBUCWORH$ i ��� <br /> LOCALSALES , �, <br /> TAX COUE IS 3105 T�TA� ' I <br />