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APPLICATION ►- dR CONSTRUCTI4� PERMIT everett <br /> meevergreen TO BE COMPLETED IN INK—PLEASE PRINT � <br /> CITV OF <br /> everett HEATING SYSTEM: (�,GAS ❑ ELECTRIC ❑ <br /> BUILDING DEPARTMENT <br /> 259-8810 <br /> DEMOLITION COMBINATION BUILDING �MECHANICAL PLUMBING ' SIGN <br /> OW ER MqILAOq�ESS GITY 21P PNONE <br /> Q�mo�'�M/.�fi��1u/-f'h �D�ax24's�0 �vrl'� �ff7-� � ZS8' �JfraZ <br /> TE��nT MAILA�ORE55 CIiY ZIP PHONE <br /> ARGHITEGTORDESIGNER MAILAD�RE55 CITV ZIP PHONE <br /> GENERALCONTRACTOR MAllAODFESS CITY ZIP PHONE UCENSE/ <br /> M�EC/HANILAL/CIONTRFCTOR IAAILAD�RE55 GTY ZIP PHONE LI E SEr <br /> /"Ol��/�G/�n Gng���lTT9 JJJV � SE �Ylf��/�1l��1�/'/y �� ars- 3s3s� �)nl�tl�T i33/Y17 <br /> PLUIdBiNGCONTRACTOR �my�ILAD�RE55 QTY ZIP PMONE UCENSEr <br /> / <br /> CLASS OF WORN <br /> �NEW f... ADDITION . .. ALTERATION '. � REPAIR DEMOLITION . WOODSTOVEJFRPL IN RT ... BUILDING RELOCATION <br /> r2 CONTACT PERSON FND PHONE NO. G� / �/ <br /> NTR/C'PiiICEO�WORK � � O J t . S C f �SO G�i <br /> �ESCRIBE WOflK AND SOUARE FOOT�GE INVOLVED f . <br /> — ' 4 � c< J' 3 rrG L <br /> aaoaoseouseor m�oiuc I HEREBY CERTIFY THAT I HAVE READ AND EXAMWED THIS <br /> f � o�fe I� f �'C APPIICATION AND KNOW THE SAME TO BE THUE AND CORRECT.ALL <br /> L AL DESCRIPTION OF P OPERN ISHOWN BELOW OR�TTACH FOUR COPIES� PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> WORK WILL BE COMPLETED WITH WHE-THER SPECIFIED HEREIN OR <br /> �oT BLOCK oF NOT. THE GR.4NTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTFIiCTION.TH�T I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPECiTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMP!.Y WITH THE STATE <br /> CONTAACTORS LAV✓18.27 RCW AND 296.200 WAC. <br /> SIGNATUREOPCONTRACWRORAUTHORIZEDAGENT GATE <br /> ���i <br /> PPOJEgCT�DDRE55 G��en OVJC �i/'04� o/pC � � `� " � <br /> Z �JS IO*� ✓ I6 O �°P��CAN CITYBUSINE55LICENSEN AN BIISMESSNAME �,/ a I, <br /> PLUMBING MECHANICAL �� <br /> N0. TYPE OF FIXTURE OR ITEM FEE NO. TYPE CF EQUIPMENT FEE <br /> WATER CLOSET(TOILET) � A/�A/HNDLG UNITS—H.P. � <br /> BATHTUB ; FORCED AIR SYSTEMS—B.T.U. M E.A. <br /> LAVATORY(WASH BASIN) � UNIT HEATEAS—B.T.U. M <br /> SHOWER CLOTHES DRYERS <br /> KITCHCN SINK 8 DISP � VENTILATION FAN <br /> DISHWASHER � RANGEHOOD � <br /> LAUNDRY TRAY WATER HEATER <br /> CLOTHES WASHER � W000 STOVE <br /> URINAL ' METAL FIREPLACE 8 CHIMNEY <br /> DRINKING FOUNTAIN � FIREPLACE INSERT � <br /> FLOOR DRAIN HEAT PUMP � <br /> BACKFLOW PREVENTERS ; GAS PIPING <br /> ROOF DRAINS—RAINLEADERS � EXHAUST FAN <br /> _ SINK(SERVICE—BAR,ETC.) <br /> � � <br /> , � <br /> ' <br /> SUB TOTAL $ SUB TOTAL 5 �;G <br /> PEAMIT S PERMIT 5 ����G'"D <br /> TOTAL FEE 3 TOTAL FEE 5 !Ir <br /> FOR OFFICE USE ONLY: <br /> FRONTSEiBACK REARSETBAGK SI�ESETBACN PLANGHEGKNU!ABER FFE RECEIPTNO. <br /> �� � <br /> us=_zor+e LOiAREA vncnNtsire FEES VALUATION FEE <br /> BUILDING <br /> IVPE Of COIIIS.AI IOWABIE TYPE OF CONST ACiUAL oC[uvnxcr no C:W;Ew•.;uv:ls <br /> cnoua PLUMBING i <br /> SREOFBLDG M1O.OFSTORIES BASEMGNT MECHANICAL `� <br /> �/ �_ <br /> � <br /> OGCUPANCVLOFD FIRESPRNKLERSREG'D MEIGHTLIlAITATION ADDITIONALPLANCHECK i <br /> i <br /> OTHER ' <br /> REASON FOH SPRINK�ERS —T— <br /> STATE BUILOING SURCH,IRGE <br /> INiAKE�Y PLANSAPPRUVEDBV CITYOFEVERETT PUBLICV�ORKS i <br /> LOCAL SALES --� <br /> �� TAX CODE IS 3105 TOTAL ��; � <br />