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AWPLICATIi�'r! F0�3 C:�i��ISTFtIJCTe��I PE�iMIT <br />the Evm�r�an <br />CITV Of <br />everet� <br />13UlI_DING DEPARTMENT TO BE COMPLETED IN INK—PLEASE PRINT <br />259-8810 � I SUILDING �.MFCHANICA <br />I DEMOLITION I I COMBIN4TION <br />MM � PE55 CIIV ZI <br />°l"t'�- � c, � , ,, , � 1�-,i����� _ ln� ��� � � �l� �� � <br />L CI PLUMBING <br />P11 !E <br />)-� � �- � <br />rno��e <br />IEN�Ni MAILADOFi[55 "••• —/(�� <br />�O—� ZIP PHONE <br />�OGIIII ECT OR OESIGNER <br />MpR �D�RESd CITY <br />everett <br />� <br />❑ SIGN <br />f,LA550FWORK \ <br />- I NEW I I ADDITION , <br />fENAN7IMPPOPEM[NTORINiEflIOfl <br />f.ollTRACT PRII:E OF WONN: <br />OF <br />ioT <br />oF anorer+rv is+owri oeww on ni <br />BLOCK OF _ <br />IOJECT�DDPE55� `D�� /1 <br />J "' <br />, <br />PLUMBING <br />NO. TYPE OF FIXTURE OH <br />WATER CLOSET ITOILET) <br />BATHTUB <br />LAVATORY(WASH BASIN) <br />SHOWER <br />KITC' IEN SINK & DISP <br />DISHWA�F�ER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFL(1W PREVENTERS <br />ROOf DfiAINS—HAINLEADEF <br />. SINK (SERVICE—BAR, ETC.)_ <br />ff10N7 SETOAGK <br />USE ZONE <br />-�� vre or cor+sr. nuo�vnme <br />SI2L OF BLDG. <br />nccurniicv ionu <br />IILASOH FO(i SPRINKLERS <br />nPPLICntIONACC AV <br />I I REPAIR I I DEMOLITION I I!NOODSTOVE/FRPL INSERT U GUILDING REIOCATION <br />Foun coaiesi <br />FEE <br />SU0 TOTAL $ � <br />PERMIT $ r <br />TOTAL FEE $ � <br />PE�FSETO�CN SIDESLTB�CN <br />LOT �RE� VAC�NT SI7G <br />I 1 YES I� NO <br />7YPEOICUIISi,ACTUAL nCCUPurtv n�olow[luNci <br />enocr <br />NO.OFS7001ES O�SEIAERi <br />I I YGS I I NO <br />FI(IESFBNKIEPSIlEO'D HEIGNTLRAIT�TION <br />I I YES IJ NO <br />PLA1:5,1PPfiOVE�BY I CITY OF EVERETT <br />iocn� sa�es <br />TAX CODE IS 3105 <br />GONiACT PERSON ANO FlHONE 1lO. <br />i HEREBY CERTIFY THAT I HAVE READ AND FxAtdINED TI+IS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WIIL BE COMPLETED WITH WHEiHER SPECIFIED HEP.EIN OR <br />NOT. THE GRANTING OF A PER^AIT DOES NOT PRESUM[ TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING COTISTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITFI TNE STATE <br />CONTRACTORS LAW 1827 RCW AND 296.200 WAC. <br />SIGNAIUREOFCONBiACTORORAUTHOBREOAGENT �ATE <br />X _�!' `�� <br />f� 1, qNiSGTY 5 LSSLICENSENO.ANDOUSIN�SSNAME <br />Mtli�lPfVII.HL <br />NO. TYPE OF EQUIPMENT _ <br />N�NHNDLG UNITS—H.P. <br />FORCED AIR SYSTEMS—B.T.U. M <br />UNIT HEATERS—B.T.U. M <br />CLOTH[S DRYERS <br />VENTILATION FAN <br />RAUGEHOOD <br />WATER HEATER <br />WOOD STOVE <br />METAL FIREPLA�E 8 CHIM�EY <br />FIREPLACE INSERT <br />HEAT PUMP <br />_ GAS PIPING _ <br />P�AN CHECN NUlAOER <br />BUILDING <br />PLUMBING <br />MECHANICAL <br />OTHER <br />ST; TE BUILDWG SURCHAfiGE <br />STATE ENEFGV SURCHAfiGE <br />PU�LIC WORKS <br />TO7AL <br />rcc <br />SUBTO�AL S <br />PEFMIT $ <br />TOT�LFEE 5 <br />FEE RECEIPT NO. <br />VAL <br />C <br />� <br />n <br />� <br />