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1� ,'�� �zi>:� <br /> A�PLICATION FOR CONSTRUCTION PERMIT <br /> • . , <br /> everett 4 <br /> Ine Evorgioon � <br /> CITY OF <br /> evereit <br /> BUILDING DEPARTMENT <br /> 259-8810 TO BE COMPLETED IN !NI<—PLEASE PRINT <br /> I DEMOLITION Il COMBINATION �'BUILDING I I MECHANICAL I I PLUMBING I.I SIGN <br /> OWNEfl MAL�DDflESS CITV ZIP PMONE <br /> Crosh . I-�� .. I„,, . � I�000 vYi,i� C.w�-�. 6�,.8 CY1��1 cw.QPa.. �.,n '�ys_ 0�92 <br /> TENANl IAAILADORESS CITY ZIP PHONE <br /> AqGMI1ECTOROESIGNER MAILADDFESS CITY ZIP Pk10NE <br /> � <br /> GENERALCONTRACTOR I.UILAOURE55 GITY 21P PIIONE LICENSEI <br /> SGyy.x,. �-�'�S(3G�-11 I �ll L� <br /> lAECMrWICALCONTflACTOfl MAILA�ORESS + CIiY 21P PIIONE LICENSEI <br /> PWMBWGCONTPACTOR MAllA00HESS qTY ZIP PIIONE LICEHSE� <br /> CLASS OF WORN <br /> � NEW LI ADDITION ❑ ALTEflhTION f.J REPAIR I I DEMQLITION I I WOO�STOVEIFRPL INSERT I.I BUILDING RELOCATION <br /> TENANT IMPflOVEMENT OR INTEfi100 REAIODEL ONLY CONTACi PEfl510�N AN/O�PHONE NO. <br /> GONTflACTPRICEOFWORN: ���k.Y ` �/J56�! � � S-O� �1 <br /> OESGRIBE WOPN ANO SOUAflE FW TAGE INVOIVED <br /> PFlOPOSEDUSEGFBl11LDING I NEREBY CERTIFY THAT I HAVE PEAD AND EXAMINEQ THIS <br /> APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECL ALL <br /> IEG�LDESCRIPTIONOFPROPEflTV�5110WNflELOWOFATTACHFOURCOPIES) PROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTYPEOF <br /> WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> �or�_ e�ocK oF NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AUTHOFITV TO VIOLATE OR CANCEL THE PROVISIONS OF AN1' <br /> OTHER STATE OR LOCHL 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 1 COMPLY WITH THE STATE <br /> � CONTRACTORS LAW 1027 RCW AND 29fi200 WAC. <br /> SIGNATi1REOFCONTRACTORORAUiNOflIZE�AGENT DATE <br /> . //' <br /> X / �� <br /> ,: `'" /��c-_-_=- <br /> PROJECTAODRE55 ' ` L � ' ��' � �� <br /> aoa- is+h r�„�.,µ�. ��3 APP�ICnNTSCITY0U5MESSLIC[NSENO AHODUSUJESSNAME . <br /> PLUMBING MECNANICAL <br /> NO. TYPE OF FI)CTURE OR ITEM FEE NO. TYPE OF E�UIPMENT FEE <br /> WATER CLOSET(TOILET) � NC—A/HNDLG UNITS—H.P. � <br /> BATHTUB ; FORCED AIR SYSTEMS—B.T.U. M E.A. <br /> LAVATORY(WASH BA61N) � UNIT HEATERS—B,7.U. M � <br /> SHOWER ' CLOTHES ORYEfiS �— <br /> KITCHEN SINK 8 DISP � VENTILATION FAN � ; <br /> pISHWASIIER RANGE HOOD � <br /> LAUNDRYTRAY ; WATER HEATER ' <br /> CLOTHES WASHER � WOOD STOVE � <br /> URINAL - ' METAL FIREPLACE 8 CHIMNEY <br /> DflINKING FOUNTAIN � FIREPLACE INSERT � <br /> FIOOR DFiAIN HEAT PUMP � <br /> BACKFLOW PREVENTERS � GAS PIPING ; <br /> ROOF DRAINS—RAINLEADERS EXHAUST FAN --r— <br /> --�— <br /> SiNK(SERVICE—BAR, ETC.) � <br /> � <br /> � <br /> _ �_ <br /> � � <br /> � — � <br /> � � <br /> — i � <br /> SUBTOTAI $ ; SUBTOTAL $ ' <br /> PERMIT S � PERMIT $ i <br /> TOTALFEE $ ' TOTAIFEE $ ' <br /> FflONT SETDACN flEAfl TB CK SIDE SETI3ACH � PLAN CII CK NIIMBER FEE ' flECEIPT NO. <br /> ' 3 'L `-�^ :7;�r� 3 � -� '.F'� - <br /> usezav LOTAHEA VACANTSITE FEES VAIUATION FEE <br /> �-� ❑ YES fiYNO BUIL�ING � — � <br /> 7YPfOFLONST.�LLOWABtE TYPEOFLONSTACIOAL ���PINtx naamvfuixcuxns <br /> 4P P � <br /> ' ' a PLUMBING � <br /> SREOFBLDG. NO.OFSTOflIES OASEMENT ' MECI'IANICAL � <br /> � 5� I�I YES � NO � <br /> OCCIIPANCY LOAD FIRE SPRNKLEFS FlE�'D IIEIGHT LIMITATION OTHER i <br /> CI YES }(I NO _ STATE dUILDING SURCHARGE ' <br /> i <br /> REASON FOR SPflINNLERS T— <br /> STATE ENERGY SURCIiARGE i <br /> PPP4CATIONACC.BY PUNSAPPqOVEOBY CITY OF EVERETT PU�LIC WORKS i <br /> /Lt1 LOCAL SALES <br /> `� N TAX CO�E IS 3105 TOTAL � <br />