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�: <br /> � ' �, APP!liCA41���1 FOR CANS'rRUC1 �-,r�N PE <br /> �7 RM�'T <br /> ' fheEvoryroen everett ��. <br /> CITYOF � '�. . <br /> everett <br /> BUILDING DEPARTMEN'� <br /> 259-8810 TO BE COMPLETED IN INK—PLEASE PRINT j' <br /> ❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL L�'PLUMBING ❑ SIGN <br /> OW/�yER MAILAO�iiESS CI7Y ZIP PHONE <br /> ��/,(�1�L�� �r�1F�,� �y ,� ,�.�,�� ��:,� <br /> � TENANT MAILADDBESS CITV 21P PHONE �� <br /> . AHCHITECTOR�ESIGNER MAILADDflE55 CITY 21P PHONE ./i <br /> 6 <br /> , GENERALCONTRACTOR MAILAOORESS pliV ZIP PHONE LICENSEM ' <br /> MECHANICALCONTRACTOR MAILAOORESS CITY ZIP PHONE LICENSEn ' � <br /> � PLUMBINGCONTRACTOR MAILAODRE55 CITY IIP PMONE UCENSEa � <br /> -�rs�',h,�rAns /��o.zi. .. ��// n,,�>�nv .�ir-�^rr �3Txri 2 r���i i <br /> i / 'a /.?:1 �..� <br /> ou sT"o oR'� i / � �-{�a—r- I <br /> , ❑ M1cW ❑ ADDiTION Cl ALTFRATION I%I REPAIR I�l DEMOLITION f I WOODSTOVE/FRPL INSERT ❑ BUILDING RELOCATION � <br /> TENANT IIAPROVEMENT OR INTEFqR REMODEL ONLY CONTACT PERSON AND PNON[N0. <br /> � CONTBACT PRICe OF WORH: <br /> WOFK AN�SOUARE FOOTAUE INVOLVEU — <br /> PflOPOSED 5 OFBUII.OING I HEREBY CERTIFY THAT I HAVE RFAD AND EXAIv11NED THIS <br /> �� APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> LC7AlDEECFIPTION OF PROPERTV(SHOWN BELOW OF ATTACHFOUR COPIES) PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> , �or BLOCK oF NOT. THE GRANT:NG OF A PERMIT DOES NOT PFESUME TO GIVE <br /> ' AUTHORITY TO VIOLATE OR CANCEI THE PROVISiONS OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> �. PERFORMANCE OP CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER Or THIS PROPERTY 70 PERFORM THE WORK �OR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 1827 RCW AND 296.200 WAC. <br /> SIGNATUREOFCIHTRACTORORAUTHORI2EDAGENT DATE <br /> ��� / <br /> i <br /> ' Pfl0.1ECTA��RESS �� � � � � / //�/ <br /> ' l�'7 � APP CAN SCITY ESSUCENSENO.ANO�USINESSNAlAE <br /> / / �O'. <br /> � PLUMBING MECHAtJICAL � i <br /> , NO. TYPE OF FIXTURE OR ITEM FEE N0. TYPE OF E�UIPMENT PEE <br /> . WAT�R CLOSET(TOILET) � A/C—rVHNDLG UNITS—H.P. , <br /> BA'fHTUB ; FORCED AIR SYSTF.MS—B.T.U. M E.A. � <br /> ' LAVATORY(WASH BASIN) � UNIT HEATERS—B.T.U. M � <br /> ' _ SHOWER � CLOTHES DRYERS , <br /> ' _ KITCHEN SINK 8 DISP "r-- VENTILATION FAN � <br /> �, _ DISHWASHER � RANGE HOOD , <br /> � LAUNDRYTRAY WATER HEATER i <br /> ' CLOTHES WASHER r-- WOOD STOVE ' <br /> ; � URINAL ' METAL FIREPLACE 8 CHIMNEY � <br /> , DRINKING FOUNTAIN � FIAEPLACE INSEP.T � <br /> . _ FLOOR DRAIN � HEAT PLMP �— <br /> _ BACKFLOW PREVENTERS ; GAS PIPING � <br /> ROOF ORAI�S—RAINLEAOERS � EXHAUST FAN �— <br /> � <br /> SINK(SERVICE—BAR,ETC.) ; , <br /> --�— <br /> � � <br /> i <br /> i <br /> ; � <br /> � <br /> _ ' <br /> � ' SUB TOTAL $ '— SUB TOTAL S � <br /> PERMIT $ — PERMIT $ ; <br /> � TOTAL FEE $ -- TOTAL FEE $ � <br /> FqONTSETBACK REARSETBACH SI�ESETBACK PLANGNECKNUM1I�ER FEE RECEIPTNO. <br /> USEZONE LOTAREA VACANi SIiE FEES VALUATION FEE <br /> : ❑ YES ❑ NO BUi�DiNG ' <br /> TYPEOFCOHSi.ALLOWABLE 1YPEOFC01'Si.ACiUAI a[Uvn4:r NoaronnuNCUNnS <br /> � <br /> cnoue ��^ <br /> PLU�d81NG <br /> , &IZEOFBLUG. NO.OFSfGRIES GASEMENT r— <br /> � MECHANICAL i <br /> I.i YES IJ NO <br /> OCCUPANCYLOAD FIiIESPpNNI.[h6RE0'0 NEIGNTLIMI�ATION OTHEF7 — i <br /> l 1 YES I_1 NO STATE BUILDING SURCHAFiGE i <br /> REASONI'ORSPRINKLEqS i <br /> T <br /> STATE ENERGY SUiiCHARGE � <br /> APPLICATIONACC.BV PIANSAPPROVEDOV CITYOFEVERETT PUBLICWORKS i <br /> I �oca�sa�es � <br /> TAX CODE IS 3105 TOTAL �; -� <br />