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�r� <br />[7 <br />>H <br />>H[�i� <br />4 ry+ <br />C <br />I � T N <br />�H� <br />� C�A H <br />[�] O � <br />H t7 <br />��g <br />(7 Y �] <br />t'y� <br />HH <br />�� <br />C� t7 V� <br />� � � <br />zyw <br />H O (A <br />I '�� Yr <br />v� i►� <br />�� w <br />� r� <br />:`(� :�.; ). '. �. : � '!. ••: � �y� 9 � L �� 1' . •' <br />����� e�-�„n,���"� <br />a rv oF <br />everett <br />BUILDING DEPARTMENT <br />259-8810 TO BE COMPLETED IN INK—PLEASE PRINT <br />DEMQLITION COMBINATION ✓�UILDING MECHANICAL <br />OVMER I,IAI�pp�qE55 Gtt ZIV P��p��E <br />`�..e 1�ilrl�n�r ��m-is��= Yv�r�,-�- ��z��� - <br />��U �-i�X��- _. ..._.._ <br />n�.CNRELTOfl�[SIGN[R lAA��40DFE55 CILY 21P PHONE <br />everett <br />PLUMBING SIGN <br />GENEFALCONiRACTOR MAILqDOBC55 GITV IIP PHONE tIGENSEn <br />� ) l�) �l P � <br />16ECHANICFLCONTRAGTOH MAILADDRE55 CITY IIP PHONE LILENSEk <br />IAAII ADDFESS <br />c nss oF woarc <br />.. NEW . � �. ADDITION ' ' ALTERATION .1/�EPAIR <br />TENANi IMPRCVEfd[Ni OR IMERIOR REl.IODEL ONIY <br />D� Cqlp[1YOFKAN�50 AFEFOOTAGEINVOLVEI <br />C`�.t Nl� (.liV� IA,4� 1� <br />PROPUSEO USE CF pUllDll G <br />�'�f'�1dpv�c� S�-� <br />LEGAL UES{�NIPTION OF PROP RTV �SHOWN BELO' <br />Yu>Lp4o'ao/� S l��rK .3 7 oF <br />21P PNONE LICENSEa <br />DEMOLITION � WOODSTOVE/FRPL INSERT '�. BUILDING ReLOCATION <br />I CONiAGT PERSON ANO PNONE NO. <br />I HEREBY CERTIFY THAT I HAVE REAU AND EXAMINED THIS <br />APPLICATION AND KNOW TH'e SA6IE TO 8E TFUE AND CORRECL ALL <br />oRanacHFouacoaies� PROVISIONS OF LAWS AND ORDIPIANCES GOVERNING THIS TYPE OF <br />'� WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEHEIN OR <br />NOT. THE GRANTING OF A PERWIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIJLATE OR CANCEL THE PROVISIONS UF qNY <br />���,��[�� OTHER STATE OR LOCAL 1A�7 PEGULATING CONSTRUCTION OH THE <br />PERFORMANCE OF CONSTRUCTION. ThIAT I AM AUTHORIZED 8Y?HE <br />b� � OWNER OF T41S PROPERTY TG PERFORPd THE WORK FOR WHICH <br />APPI.ICATION IS MADE AND I COIdPLY WITH THE STATE <br />CONTRACTORS LAW 1827 RCW AND 296.200 WAC. <br />�l. C� SiGNATUREOFCONTqnCiORORAUTHORREOAGENi OATE <br />( — �� �`� �,� X ��1,�--t"'- 3� `� 1`�( <br />APPLiCAMSCItVpISINE55LiCEN ENO.FNpBU5ME55NAM[ <br />PLUMBING <br />0. TYPE UF FIXTURE OR ITEM FEE <br />WATER CLOS[T(TOILET� <br />BATHTUB <br />LAVATGi'Y (WASH BASIN) <br />,"iHOWER <br />KITCHEN SINK & DISP <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHEP <br />URINAL <br />DRINKING FOUNTAIN ' <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />ROOF DRAINS—RAINLEADERS <br />SINK (SEPVICE—BAR, ETC.) <br />SUB TOTAL S , <br />FRONTSETBAGK <br />USEZONE <br />iY'rE O`F C�tlSi. AILOWA6lE <br />1/— � <br />SIZE OF BLDG. <br />E K� S1, uG <br />occuNaNcviono <br />N /L� <br />flEASON FOq SPfiiNKLERS <br />qPPLICAT10NACG DY <br />FE4R $ETBAGH <br />LOTAREA <br />TYPE Oi COqSi. ACNIL <br />V' �l <br />NO. OF STORIES <br />� <br />FlFE SPRNKlERS REO'0 <br />�.' YES )( NO <br />PLANSAPPRpVEOAV <br />�� J la <br />S ; <br />SIpE SET9�CH <br />��ACnNT SITE <br />VES NO <br />OCLOv0.'Itx HOG�RNfLL'V.ul <br />4aouv <br />�-3 I <br />BAS[MENi <br />YES X NO <br />NEIGHi LIIdIiATl01! <br />CITY OF EVERETT <br />LOCALSALES <br />TAX CO�C IS 3105 <br />TYPE OF EQUIPMENT � FEE <br />lDLG UNITS—H.P. <br />FORCED �IH SYSTEMS—B.T.U. PA E.A. <br />UNITHEATERS—B.T.U. M <br />CLOTHES DRYEHS <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />WOOD STOVE <br />PAETAL FIFiEPLACE 8 CHIMI <br />HEATPUMP <br />GAS PIPING <br />EXHAUSTFAN <br />PlM! CII[CK N00.19ER <br />FEES <br />BUILDING <br />PLUMBING <br />MECHANICAL <br />orriea 'P�D�t Ch,tt% <br />STATE BWLDING SURCHARGE <br />STAiEENERGVSURCHARGE <br />PUBLIC WORNS <br />TOTAL <br />PERMIT $ <br />TOTAL FEE 5 <br />fEE RECEiPi1:0 <br />FEE <br />m <br />