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APPLICATIOl.FOR CQNSTRUCTIo N PERMIT everett <br /> tnee�eroreen TO BE COMPLETED IN INK—PLEASE PRINT � <br /> CITV OF <br /> Pverett HEATING SYSTEM: GAS U ELECTRIC ❑ <br /> BUILDING DEPARTMENT — <br /> 259-8810 <br /> : I DEMOLITION COMBINATION BUILDING �MECHANICAL �PLUMBING SIGN <br /> OWNER � MAILAD�RESS CITY ZIP PHONE <br /> ��� �r�,u�}��� ��1�- �3�- �ve�e-N- 9��i ����-y��s <br /> TENFNT MAII�DDRE55 CITY ZIP PHONE <br /> �I'l l C � <br /> ARCNITECTOFDESIGNER MFILA�OiiESS CITY 21P PHONE <br /> GENERFLCONTRACiOR MjAIL'A\OOF'yE5,5 � CITY /�, nry2�1P� h �J PHONE LICENS/E'A /�, /1 'J <br /> ��.II�V��'lWl�.�� �IpIUDRr,1,l � �r� ! ((.'V�1��T1 �d(/Ll/ C/� / -Pa331 /LIUENIY(�/I/U��C� <br /> �C;�YI� <br /> PL�UM9�IN�GCONTRACTOR lANI.�DORESS CRY 21P PHONE UCENSEa <br /> �.�,\.1 / K � <br /> CLASS OF WORK <br /> �.�NEW ! �. ADDITION .� . ALTERATION �. �. REPAIR ' '. DEMOLITION !.� WOODSTOVEIFRPL INSERT f.�. BUILDING RELOCATION <br /> � ���� �O — CONTACiPER50NANDPHONENO. <br /> CGtJI FACT PRIGE OF YlORK U L} <br /> DESCRIBE WORKAND SOUARE FOOTAGE INV LVED <br />� (�S{ I _ v - , !,v �l teC 1.� 3 I <br /> PROPOSEDU�pSEO II.OING � ( �/� I HEREBY CERTIFY THAT I HAVE REND AND EXAMINED THIS <br /> �I I `�Y� . �I�IU L(I f ��Ci(�C � � APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> �.ecn�oe c IPTION �PROPERN�S IOWNBELOWORATTFCHFOUBLOPIES� PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> �or e�ocK oF NOT. THE GRANTING OF A PERMIT DOES NOT PRESUMF TO GIVE <br /> n� AUTHORITY TO VIOLATE OR CANCEL THE PFiOVISIOtJS OF ANY <br /> �� �' S '� -W I — � � OTH[R STATE OR LOCAL LAW REGULATING CONSTRUCTION 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 WITH THE STATE <br /> I� i'� ^� Gc^�) I��� CONTRACTORS LAW 78.27 RCW AND 296200 WAC. <br /> I Cy' IJ ST- C� /��N/ SIGNATUREOFGONTRACTORORAUiHOPIZEDAGENi pATE <br /> X �.,` <br /> aAaecraooaess � �� � �`�,�(�)'�,��GY�l,lit�%�, <br /> AFPLICANTSCIiYBU5WE5SLICENSENO.�ND�USWESSNA�J�E� 1j � A � (n �L_� <br /> l lJ! /) J ! 7 r <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EDUIPMENT FEE <br /> WATER CLOSET(TOILET) � NC—NHNDLG UNITS—H.P. <br /> BATHTUB ; � FORCED AIR SYSTEMS—B.T.U. M E.A. <br /> LAVATORY(WASH BASIN) � UNIT HEATEFS—B.T.U. M ; <br /> SHOWER CLOTHESDRYERS T— <br /> KITCHEN SINK 8 DISP ; VENTILATION FAN ; <br /> DISHWASHER RANGE HOOD <br /> LAUNDRY TRAY ; WATER HEATER <br /> CLOTHES WASHER � WOOD 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 5 ; SUB TOTAL 3 ; � <br /> PEfiMIT $ PERMIT 5 �;' <br /> TOTAL FEE $ TOTAL FEE S -- <br /> FOR OFFICE USE ONLY: <br /> PRONTSETBACK REABSETBFCK SIDESETBACK PLANCNEGNNUlADER FEE RECEIPTNO. <br /> 'S <br /> usezorvE �ornaen VqCANTSITE FEES VALUATION FEE 'y� <br /> BUILDING � �� <br /> iYPEOiW�liS.ALLCWABLE IVPEO�C@lSi.pC1VAL aar„r¢r uuor�wEue:su����s ' <br /> caouv pLUMBING � <br /> i ; <br /> SIZEOF�IDG. NO.OFSTORIES P45EMENT �dECHANICAL ���� .���� <br /> OCCUPANCVLOAD FIRESPPNKLERSREO'U HEIGHTLiAITATION ADDITIONALPLANCHECK �� <br /> OTHER � ;y <br /> BEASONFORSPRINNLEFS �— ' <br /> STATE BUILDING SURCHARGE <br /> _ <br /> IIlTAHF.FIY PL�NSAPPROVEOBY CITY OF EVERETT PUBLIC WORKS � <br /> LOCAL SALES <br /> TAX CODE IS 3105 TOTAL <br /> , � <br />