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ARPLICA�10�� FOR CONSTRUCT��JN PERMIT � <br /> everett <br /> fhe Erergreen � <br /> CITV OF <br /> everett <br /> BUILDING DEPARTMENT TO BE COMPLETED IN INK—PLEASE PRINT <br /> 259-8810 <br /> C 1 DEMOUTION I I COMBINATION i I BUIL.UING � �MECHANICAL I I PLUMBING I l SIGN <br /> O!W1NER �'.IAILAD�RE55 CIIY 2�P P110NE <br /> ,57 / 6'C�`�/ �� ' �1� ���6 � �•.,�1.r+ /� % � ii'' � � '�"il% i .i ii �: j 7 J ..�, �:,� , <br /> TENANT � MAIL��ORE55 CIiV IIP �NONE <br /> ARCHITEG�OROFSIGNEA MAILRDDNESS CI1Y 21P PIIONE <br /> ��A�4�p�' IOR MAILAODRESS CIIY ZIP PIIONE LILENSEI <br /> 5/'L�'cLil7l�'yl ,5��� ,.:'i5 '1'//� �� �!) �I� � / C%�!/ /� %�J[", i �i.�� /Y��1`% 1) %-'!'�f. -'� �/(��/��) <br /> MECN�NICALLOMR�LION 'M4R�UOPE55 CIiY ZIF PHONE UCENSE� <br /> PLUMBIN6 W11111�C10R M41L ADDIIFSS CIIY 71P �IIONE UCENSE• <br /> GlA55OF WOfiN <br /> JKI NEW I I AO�ITION I I ALTERATION I I REPAIR I I DEMOLITION I I WOODSTOVE/f-fiPL INSERT I I BUILDING RELOCATION <br /> TEN�NT IMPROVEMENI OR INl EIiIOR REMOOEL ONLV CONI�CIrI PER$ION AND PIIONE NO / <br /> CONTR�CTPRICEOFWORN: �C SC��� � I'1� (�Q" ✓L� 3y7 -i�3�1 <br /> DESCRIBE WORK 6ND SOU��E FOOIAGE INVOLVEO <br /> lA`fI��.L�:''1V :')n't', ;,'�- � - <br /> PRnPO5E0USEOFGUILUINC I tiEREBY CERTIfY TI1AT I HAVE READ AND E%AMINED THIS <br /> � , � (_('���![(��{C, �PPLICAiION AND KNOW THE SAME TO BE TRUE AND CORRECL ALL <br /> LE�ALOESCAIP110NOFPIlOPE111Y�5NOWN�ELOWO ninc��rounwrir� PROVISIONSUFLAWSANDOiiDINANCESGOVERNINGTHISTYPEOF <br /> WORK WILL BE COMPLETEU WITH WHETHER SPECIFIED HEP.EIN 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 CONSTRUCTION OR THE <br /> PEFFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED 8Y THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS lAW 18.2�RCW AND 296.200 WAC. / � <br /> SIGN�TUREOFCOHTRAGTOROR�UTHORIZEDAGEN;� �ATE �IY/'Y�/�,y <br /> � + 'V(J � <br /> -;i�...,�.�,; ,r �;�I, � i <br /> I (% , , <br /> PROIECTADORE55 � I ��,) � 1 /� ( 'I� '� I I�1 �IGI�� !�/.l Ci�S I <br /> _� APPUCANISCIIV9USINESSUCENSENO.ANDBUSINESSN�ME � � <br /> / <br /> PLUMBINO MiCH4NICAL <br /> NO. TYPE OF FIXTURE Ofl ITEM FEE NO. TYPE OF EOUIPMENT FEE i <br /> WATER CLOSET(TOILET) � NC-A/HNDLG UNITS-H.P. � <br /> BATHTUB ; FORCED AIR SYSTEMS-B.T.U. M E.A. ' <br /> LAVAlUHY '!NASHBASM) --T UNITHEATERS-B.LU. M � <br /> SHOWER ' CLOTHES DRYERS ! <br /> KITCHEN SINK 8 DISP ; VENTIL�TION FAN � <br /> DISHWASHER � RANGE HOOD � <br /> LAUNDRV TRAY WATER HEATER � <br /> CLOTHES WASHER ?—� WOOD STOVE � <br /> � <br /> URINAL METAL FIREPLACE 8 CHIMNEY ' <br /> URINKING FOUNTAIN � FIREPLACE INSEHT � <br /> FLOOP DRAIN �— I1EAT PUMP ' <br /> BACKFLOW PREVENTERS ; GAS PIPING � <br /> ROOF DRAINS-RAINLEADERS � EXHAUST FAN <br /> SINK(SERVICE-BAR,ETC.) ' ` <br /> --i—— <br /> � <br /> � <br /> � — � <br /> � <br /> — � � <br /> 1 T <br /> SUB TOT�L 5 ' SUB TOTAL $ <br /> PERMIT $ --�— PERMIT $ � <br /> TOTAL FEE $ ' TOTAL FEE S ' <br /> fRONi5El0�CN nennsrtoncn $IOESfIP4CH rinncurc mnmrn rer necemrt+o. <br /> 5 _ .�v • //>``- .3oilg <br /> usezorve iornn�n V�C�IIf51IF FEES VALUATION FEE <br /> I I YES I I NO f7UIIl1MG ILp S C�O � SL� ' "�� <br /> IYP[Of CUNSI AUOWAtIII IYP[Of C�I,Af.IUN - --�xrnMm r �m ar i�ynuMGurync _._"- . -. - . . -... .. —.L--.- '—- ---- � <br /> i <br /> .-- � 'V �•_A. � "�1 PLUIdPWG i <br /> �+— <br /> 9ZE OF PL�G. NO Of StO0lE5 045f1AFNI �,�[f,11�NICAL ' <br /> �'j0 SF I � � YES a`'i NO . ... . _...._ _ . .__.' ___.____ _.. .. ._ . .___. __ � <br /> -- —" O111Ff1 � <br /> occurnNcvtonn rmrsrnr�Kii[nsnr-o�n �ic�rtur.mnuor+ __ _ ____ <br /> --------- - — <br /> �J1- I I YES � NO ��� __ SINEf7W�UWc:SUHCIIMCE ' .SU <br /> RE�SOHPOIiSPRiNNlGf15 .'"___ _—_-'_ _ ____ _____- -__-_—___ �— <br /> S1P�E ENERGY SURCHMGG i <br /> ' —' � <br /> APPUGNIONALCOY PIANS�PPf10Y[DOY CITYOFEVERETT ruiucwonKs ; <br /> 1 LOCAL SALES <br /> ,��. TAX COOE IS 3105 TOTAL � sa <br />