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t� <br /> i <br /> APPLICATIOW FOR CONSTRUCTI N PERMIT <br /> everett <br /> TINTeeR <br /> Fp <br /> CITYY OOF <br /> everett <br /> BUILDING DEPARTMENT TO BE COMPLETED IN INK—PLEASE PRINT <br /> T 259.8810 `` <br /> DEMOLITION COMBINATION (iBGILDIN. LMfCHANICALUMBINQ SIGN 9 <br /> OWNER 'IMCITY ZIP I'NDNE <br /> ryei6�o 38L/ C�u7�4•L.D,e• Fi.��r -QBLoY 74s �y/S. <br /> TENANT MAAADDRESS CITY ZIP PHON <br /> ARCHITECT OR DESIGNER MAIL ADORf SS CITY ZIP PHONE <br /> t �i/,� _ 353 o S31T <br /> GENERAL CONTRACTOR MAILADORESS CITY 21P PHONE LICENSE <br /> o 45' A'3B0(/IE — <br /> •�y7� MECHANICAL CONTRACTOR MULADDRESS CITY ZIP PHONE LIGENSE0 <br /> yQ M PLUMBPIGCCNUR TOR ML.n.D0PE56 CITY ZIP PHONE LICEN9ES <br /> C y y — <br /> M CLASS OF WORK <br /> K GREW ADDITION ALTERATION REPAIR DEMOLITION WOODSTOVE/FRPL INSERT BUILDING RELOCATION <br /> PO TENANT IMPROVEMENT OR INTERIM REMODEL ONLY CC9�H+T�ACT PERSON ANI PHPNE NO <br /> QR R o (x ./ - U <br /> '� N CONTRACT PRICE OF WNORK: <br /> DESCRIBE WORK AND SO,ARE FOOTAGE PNOIVED <br /> px LE <br /> y C PROPOSED USED BUILDING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> O H APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> Ht0Y1�+ LEGAL DESCPIPTONO PROPERTYISNOMi BELOWOR ATTACH TOUR COPIESI PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> O„ n WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> H LOT — BLOCK OF -�s NOT THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> li y PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> gy OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> 0 t7 y APPLICATION IS MADE AND I COMPLY WITH HE STATE <br /> O <br /> C0NTRAClOqSJ,AW 18.77 RCW AND 296.200 WAC. <br /> Lyy�1 SIGNATU TOR OR AUTHORIZED AGENT DATE <br /> Oy <br /> N X <br /> PROJECY ADDRE68 _ <br /> jr,T .�/• APPLICANTS CITY BUSINESS LIC NSE NO.AND BUSINESS NAME <br /> /3- G - <br /> PLUMBING MECHANICAL <br /> I NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EQUIPMENT FEE <br /> WATER CLOSET(TOILET) 3C' A/C-AMNDLG UNITS-H.P. P <br /> BATHTUB FORCED AIR SYSTEMS-B.T.U. M E.A. ' <br /> LAVATORY(WASH BASIN) J O I UNIT HEATERS-B.T.U. M <br /> SHOWER CLOTHES DRYERS ' <br /> KITCHEN SINK 8 DISP /D VENTILATION FAN <br /> RANGE HOOD <br /> DISHWASHER 0 1 A <br /> 1 <br /> LAUNDRY TRAY WATER HEATER <br /> ' <br /> CLOTHES WASHER /0 ' WOOD STOVE ' <br /> URINAL ' METAL FIREPLACE 6 CHIMNEY <br /> DRINKING FOUNTAIN I FIREPLACE INSERT <br /> FLOOR DRAIN ' HEAT PUMP <br /> BACKFLOW PREVENTERS Z GAS PIPING <br /> ROOF DRAINS-RAINLEADERS EXHAUST FAN ' <br /> I ' <br /> SINK(SERVICE-BAR,ETC.) <br /> I ' <br /> I <br /> I � <br /> SUB TOTAL $ N7i0 i ZPERMIT <br /> o <br /> PERMIT f I TOTAL FEE f ltl ' FG ' <br /> FRONT SETWK+ REAR BE,M�I� SI(IE SETBJIP�( PIAN CHECK HUMBER CEIPT NO <br /> 57 �.1 44 // <br /> USE ZONE LOT ARE VACMITSITE FEES .7L bP[ FEE <br /> $Z� i VES NO BUILDING y/ Gg,'t :00 <br /> TYPE O CONST ALURIMM E TYPE Of CONST ACTUAL M4 l <br /> r3 Z PLUMBING <br /> SIZE OF BLDG. NO OF STORIES BAsrMENT MECHANICAL ire) <br /> �C <br /> 271- Ss r Y+r S+ �j YES /NO , <br /> TIRE SPRNKLERS REOD HEIGHT LIMITATgN OTHER ' <br /> occuPANcrLwO <br /> 1 YES :/FO Z7 STATE BUILDING SURCHARGE // 'SD <br /> REASON FOR SPRINKLERS ' <br /> STATE ENERGY SURCHARGE <br /> APPLICATKKNACCBY rANSAPpRoyEDBr CITY OFEVERETT PUBLIC WORKS <br /> LOCAL SALES 1 <br /> 0/ TAX CODE IS 3105 TOTAL <br />