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� <br /> �. <br /> APPLICATIOr! FOR CONSTRUCT.JN PERMIT everett <br /> ,�E,�,�,�„ TO BE COMPLETED IN INK—PLEASE PRINT � <br /> an oF <br /> everett HEATING SYSTEM: ❑GAS ❑ELECTRIC ❑ <br /> BUILDING DEPARTMENT <br /> 259-8810 <br /> i-; DEMOLITION L-� COMBINATION I"_� BUILDING f:]MECHANICAL ❑PLUMBING i SIGN <br /> ONRIEP /��ILIIDDRESS CIiY 21P PHOIIE <br /> /L/Ou,t,�.vv �70/�� ��0. �6ox 78a3 �ve�eY� �q,�o/ .✓?,f�-a�iy <br /> NT �ILADORESS CITY 21P PMONE <br /> ARCNITEGTORDESIGNER MAILADORESS CITY ZIP PHONE <br /> GENEfULCONTFACTOR M IIADDflESS CIT�V/ 21P PMONE LICENSEI <br /> 'c - � .-?�� .S7'aNw�.•� ��.�29a2 aS8=3S7b Qas,'c RI'l3o Po <br /> ` CHANIGILCONTR�GTOR MAILMDRE55 aP�y ��IIA/ CITV ZIP PMONE LICENSEI <br /> PLUMBING CONTflACTOR MAIL�DDNE55 CITV ZIP PHONE LICENSE� <br /> CLASS OF WORN �� <br /> � :� NEW ❑ ADDITION i' ALTERATION i ; REPAIR .�1 DEMOUTION i:i WOODSTOVE/FRPL INSERT ;� BUILDING RELOCATION <br /> i, CONTACT PERSON AND PHONE NO. <br /> , CONTRACT PRILE OF WORK <br /> ,' �SCRIBE M/ORK AND SOUARE F T� E I VOIVED <br /> p '�' �i 0 � DOJ �f oa� <br /> `P roseouseoFauaon+c 1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> �or APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> L DESCRIPTION OF PROPERTV�SHOWN BELOW OR ATTACN FOUfl COPIES) 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 PRESUME TO GIVE <br /> AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY � <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTAUCTION OR THE <br /> - PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> , OWNER OF Th115 PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> � CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br /> SIGNATUREOFCONTRACTOROR�UTHOflREDAGENT OATE <br /> � ��Q� �Or�ani V2. c� X ,Q rs -Z".✓c <br /> � PRO.IECTIIDORE55 LJO.S%G R(W <br /> � �PPLICANTS CITY BUSINESS LICENSE NO.AND BUSINESS NMIE <br /> PLUM81N6 MECHANICAL <br /> N0. TYPE OF FlXTUNE OR REM FEE N0. TYPE OF EWIIPMENT FEE <br /> WATER CLOSET(TOILET) � AJ�lVMNDLG UNITS—H.P. � <br /> BA7HTUB ; FORCEDAIRSYSTEMS--B.T.U. M E.A. � <br /> � UVATORY(WASH BASIN)� � UNIT HEATERS—B.T.U. M ; <br /> ; SHOWER ' CLOTHES DRYERS � <br /> ' KITCHEN SINK&DISP � VENTILATION FAN ; <br /> '� DISHWASHEH � RANGE HOOD � <br /> � LAUNDRY TRAY ; WATER HEATER ' <br /> CLOTHES WASHER � WOODSTOVE � <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 /> i i <br /> � i <br /> _ 1 <br /> � <br /> SUB TOTAL S ; SUB TOTAL S ' <br /> PERMIT $ � PERMIT S � <br /> TOTALFEE $ TOTALFEE S <br /> FOR OFFlCE USE ONLY: <br /> FNONT SET&1CK REAR SETBACK SIDE SETB�CK PIAN CNECK NUIIBER FEE RECEIPT NO. <br /> USE2dJE LOTARE� VAC�NTSITE FEES VALUATION FEE <br /> BUILC'NG � <br /> 7VPEOffANTS.ALlOW,1BlE 1VPEOfCONSi.qLTWL atuP�N[r rroarowFwMGUxrts � <br /> �aW" PLUMBING � <br /> SIZEOFBIOG. NO.OFSTORIES BASEMENT MECHANICAL � <br /> i <br /> OCCUPANCY LOAD FIRE SPRNKLERS REO'D HEIGHT LIMITATION ADDITIONAL PLAN CHECK i <br /> OTHER <br /> � <br /> REASON FOR SPPINKLERS <br /> STATE BUILDING SURCHARGE i <br /> INTAKEBY PUNSAPPROVEDBV CITYOFEYENE7T PUBLICWORKS � <br /> LOCALSALES � <br /> TAX CODE IS 3105 TOTAL �� �' �d <br />