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i�; . <br /> � <br /> � � � <br /> APPUCATlfiN FOR CONSTRUC'i .ON PERMIT ; -- --- � <br /> everett <br /> me Evergmen � . <br /> CITY OF <br /> everett <br /> BUILDING DEPARTMENT <br /> 259-8810 TO BE COMPLETED IN INK—PLEASE PRINT <br /> �' DEMOLITION COMBINATION BUILDING �MECHANICAL PLUMBING SIGN � ' <br /> � _ <br /> Ep MiLADDRE55 / n'�TY T ZIP PHONE _�J,� _ ���_� . <br /> Or:Gn �°- �� 57. ����!�-'�t ���� �- <br /> E Nt � <br /> RAD�P � CITY ZIP PMONE � <br /> ��J✓1r�Q �,�}J ��/ <br /> ARCMITELTORDESIGNEF MAILpDDRE55 CrtY 21P PHONE � � <br /> �(�� <br /> I., <br /> y GENEPALCOHTRAGTOR fAAILa00RE55 CIiY ZiP PHONE LiCEMSEe jr <br /> a�� 1 HA I ALLONTRAG 0 M ODRESS .l CITV ZIP tJF L�NSE +r� . '� <br /> H �� ,�Oa� hr2 � �-�(or�r�/��1�1L�:����1/( ��C)i .�?��- ��l�a ,; <br /> H H PLUMBINGGON ACT NA AD�RESS CrtY ✓ ZIF PHO.E LI ENSEa '� � <br /> � y� ����1�,�@1��� �L ��-�- ��-�;r > ;._ <br /> ' � H� CLASSOFWORK ` �;' <br /> y V)� �� 1 NEW �..�. ADDITION �ISERATIOIJ RePAIR DEMOLITION . WOODSTOVE/FRPL INSERT . . BUILDING RELOCFTION r�, <br /> � "'j' tENANT IMPPOVEMENt OR INTE R REIAODE ONLV CONT4Ci PERSOt!AND PHONE NO � <br /> O� GOHTRACT PP�CE OF WORN: \ <br /> O Fi OESCRIBEWOFNANO50 FEFOOiA F�y'CLVED . � , <br /> H �g `f- ' - Y 1,�. �. `, �!s rl `� ���(�, i <br /> H" n❑ raovoseouseorew�ortu� 1 HEREBY CERTIFV THA7 I HAVE READ AND EXAMWED 7H15 I . <br /> Z H g ����� APPLICATIOY hND KNOW THE SAME TO BE TRUE AND CORRECL ALL ' � <br /> aHti1 iecnioescaianoNOFPaoaeair�sr�ov+neE�owoan.lacNcouacoriesi PROVISIONSOFLAWSANDOHDINANCESGOVERNINGTHISTYPEOF <br /> C �„�y WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEFEIN OR , <br /> �y ioT o�ocH oF NO7. TH=_ GRANTING OF A PERMIT DOES NOT PRESUME TO GNE � <br /> U �H AUTHORITY TO VIOLATE OR CANCEL THE PROViSIONS OF ANV : � <br /> n d❑y OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> � C�7 PERFOR�AANCc OF CONSTRUCTION.THAT I AM AUTf!ORIZED BY THE <br /> y� OWNER OF THIS PROPERTY TO PERFORN THE W�JRK FOR WHICH , � . <br /> ypy _ APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 1827 RCW AND 296.200 WAC. � <br /> � SIG'lAiUREOFCO�ITRACTORO�AUiMOAIZEUAGENT �ATE <br /> �-�"-���(//,A�^� _��� <br /> VRQIECTR�CPESSrl q/�� ��. �' f// • /�� . <br /> �G� IL I � ` 1� , AIPIICAIlI�CIiVfiUSlp� SL�F�.fSENO. N BOSMESSNAIJE <br /> �' Ov � � <br /> � � + �'-� PLUMBING MECHANICAL � <br /> ,��� NO. TYPE OF fIXTURE OR ITEM FEE NO. TYPE OF E�UIPMENT FEE — � <br /> WATER CLOSET(TOILET) A�C—l�HNDLG UNITS—H.P. � <br /> BATHTUB FORC@D AIR SYSTEMS—B.T.U. M E.A. � ' <br /> � LAVATORY(WASH BASIN) — - UNIT HEATERS--B.T.U. 1d � �. i <br /> � SHOWEH CLOTHES DRYERS --T <br /> + KITCHcN SINK 6 DISP VENTILATION FAN ' ' <br /> DISHWASHER —�— RANGE HO00 �— � <br /> V� LAUNDRYTRAY ' � WATER HEATER <br /> �� CLOTHES WASHER —�— WOOD STOVE ,� <br /> URINAL METAL FIflEPLACE 8 CHIMNEV . <br /> DRINKING FOU�ITAIN FIREPLACE INSERT ' <br /> r'� hLOOR DRAIN HEAT PUMP —T <br /> � BACKFLOW PREVENTERS --'--_�-x GAS PIPIN6 �. <br /> ROOF DHAINS—RAINLEADERS E%�1A-�U75�-T FAN �, <br />� �'�' SINK(SERVICE—BAR,ETC.) _�_ %�1� r � i��' N �`��1 <br /> � — 0 � <br /> �� T <br /> M1 . ��l.L G _�_ <br /> — T <br /> �, ' SUB TOTAL S —�_ SUB TOTAI 5 36 ' <br /> . , PEFM�T 5 �— PERMIT S �T— <br /> .. _.. TOTAL FEE 5 TOTAL PEE 5 � <br /> fRONiSENACK B[4RSEt0ACK SID[S[i�ACK PlR'ICHECNIIUI,tp[R FFE PECEiPiNQ � <br /> usezor�e tornaen vncnursne FEES VALUATION FEE i. <br /> t <br /> � YES . � NO puILDING E <br /> iYPE pi LONS1 AIlCWA6lE ��PE Oi LONS1.ALIUAL occ.,vaucv xo Or Vxuux�uYas 1 <br /> caouo p����,�BING I <br /> SREOFOLDG. 1lOAFSTORI[5 BAS[AIEHT �,�ECHANICAL � <br /> �. � YES � NO — — y�' <br /> OCCIIPANCYLOAO FIRESPRNKLI:RSP[OD H[IGHTLIMITATION OTHER <br /> � VES � . NO _ S7ATE�UILDING SURCHARGE <br /> RE�SONfORSPRINHLERS - �— <br /> S�fATE[IJERGV SUFCHARv'E <br /> naPucnTioNacc.ov P�nNs nrannvco ov CITY OF EVEflETT PU�LIC WORKS <br /> LOCAL SALES y r � I <br /> TAX CODEIS 3105 rora� <br />