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APPLICATIbN FOR CONSTRUC`r-�(ON PERMIT <br /> rn�Erero�� everett <br /> ���oF e <br /> everett <br /> BUILDING DEPARTMENT <br /> 259-8610 TO BE COMPLETED IN INK—PLEASE PRINT <br /> ❑ DEMOLITION ❑ COMBINATION ❑ BUILDING f 7 MECHANICAL CI PLUMBING ❑ SIGN <br /> OWN H / I /' MAILADDliE55 iA CIT! 21P PHONE <br /> �OSc�Gr !/. ( �t.^vie.•i � `� l3 '�'..3 Lvc.•c71 98/ o L ?__ S `) 2 o SS � <br /> TENANT � MAILAOOflE55 CITY ZIP PHONE <br /> AFICHITECTOR�ESIGNER MFILADDFESS CITY ZIP PHONE <br /> < <br /> GENEHALCONTPACTOR MAILAODRE55 CITY 21P PHONE LICENSEM <br /> �1v�+cr <br /> MECHANICALCONTPACTOH MAILAO�Rl55 CITV ZIP PHONE UCENSER <br /> P�UMBINQ CONTRACTON MAIL AODFESS CITY 21P PHOI�E LICENSE I <br /> n� <br /> ��i-ir�c-�-r.t���r <br /> CU5S OF WORN <br /> ❑ NEW f 1 ADDITION �O ALTERAT;ON I�1 REPAIR I I DEMOUTION I I ydOODSTOVE/FRPL INSERT f J BUILDING RELOCATION <br /> � TENANTIMPROVEMEN70RMTERIORREMODELONLYAI r ^ CONTACTPEq50NANOPHONENO//�,(/� /�/l/� <br /> CONTRACT PRICE OF WORK: '`� /� . / o '. / �• <br /> DESCRIBEWOPKANDSOUAREFOOTAGEINVOIVE� ��- (t� <br /> /"Ehuw �7Cr�N.Y � � y�y.s '�' I /" <br /> � PROPOSEDUSEOFBUILUING I HEREBY f,ERTIFY THAT I HAVE FEAD AND EXAMINED THIS <br /> 'tr� I e x APPLICATIO� AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> lE0�L0ES RIPTIONOFPROPEFTY�S110WNBELOWORAT7qGHfOUqCOPIES) PROVISIQNSOFLAWSANDOFDINANCESGOVERNINGTHISTYPEOF <br /> � �oT e�ocK S�7 6 oF E✓«� y WORK WILL BE COMPLETED WITH WHF.THER SPECIFIED HEREIN JR <br /> NOT. THE GRANTING OF A PERMIT DC:ES NOT PRESUME TO GIVE <br /> 1� � AUTHORITY TO VIOLATE Ofl CANCEL THE PROVISIONS OF ANY <br /> v1/ �2. I J — Z O OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> � PERPORMANCE OF CONSTRUCTION.THAT�AM AUTHORIZEb BY THE <br /> OWNER OF THIS PROPERTY TO PERFOFiM THE WORK F013 WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br /> SIGNATUFEOFCONTAFACTORORAU7HOR2E�AGENT DATE <br /> x ��/ <br /> ��; / Z�, S� s� <br /> PRQIECT ADDRESS <br /> / 9 /3 4 3`� -S� /�- ~C r G '� A pNTS QTY SINE55 UCENSE NO.AND BUSINESS NRME <br /> � PLUMBINQ MECHANICAL � <br /> . N0. TYPE OF FIXTURE OR ITEM FEE N0. TYPE OF E�UIFMENT FEE <br /> � Z WATER CLOSET(TOILETj � A/C—A/HNDLG UNITS—H.P. i <br /> BATHTUB ; FORCED AIR SYSTEMS—B. .U. M E.A. <br /> LAVATORY(WASH BASIN) � UNIT HEATERS—B.T.U. o ; <br /> SHOWER � � CLOTHES DRYEAS � <br /> KITCHEN SINK&�ISP 2.. VENTILATION FAN ; <br /> � DISHWASHEfl � RANGE HOOD � <br /> LAUNDRY TRAY � WATER HEATEfi � <br /> CLOTHES WASHER � WOODSTOVE � <br /> URINAL ' METAL FIREPLACE 8 CHIMNEY � <br /> DRINKING FOUNTAIN � FIREPLACE INSERT ; <br /> FLOOR DRAIN � HEAT PUMP i <br /> BACKFLOW PREVENTERS i GAS PIPING ; <br /> ROOF DRAINS—RAINLEADEFiS EXHAUST FAN <br /> SINK(SERVICE—BAR,ETC.) ' ' <br /> -- � <br /> � i <br /> � � <br /> � i <br /> � � <br /> � , <br /> � SUB TOTAL $ '� - SUB TOTAL $ ° --- <br /> PERMIT $ � PERMIT $ � � <br /> TOTAL FEE $ -•' -- TOTAL FEE $ �� <br /> FRONTSETBACK flEAR5ET8ACK SIOESETBACK PLANCHECNNUMBER FEE RECEIPTNO. <br /> IISEZONE LO7AREA VACANTSITE FEES VALUATION FEE <br /> I7 Y=S I 1 NO BUILDING /��� '� <br /> TYPEOFCONSi.ALIOWRBLE TYPFOFCONST.ACiUAI acuvpHtr NoarfrvFlilNCUN�tS � <br /> Gnour ' <br /> PLUMBING � � _- �. <br /> �T <br /> 512EOFBLDG. NO.OF510RIE5 BASEMENi MECHANICAL IC�i _- <br /> I I YES I 1 NO , <br /> OCCUPANCY LOAO FIRE SPRNNLEBS REO'D HEIGHT LIIAI7AT ON OTHER j <br /> IJ YES I 1 NO STATE BWLDING SURCHAR�E � <br /> PEASON FOR SPRINKIEFS � — <br /> STATEENERGYSURCHAR6E i <br /> APPLICATIONACC.BV PLANSr1PPflOVEDBY CITYOFEYERETT PUBLICWORKS i <br /> LOCAL SALES <br /> TAX CODE IS 31D5 TOTAL f(�)��°j <br />