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APPLh ATION FOR CONSTNUCTION <br />PERMIT <br />the E.TNT R <br />CITY OF <br />PYPIPII <br />everett <br />e <br />BUILDING DEPARTMENT <br />259•8810 <br />TO BE COMPLETED IN INK- PLEASE PRINT <br />UNERALCONTRACTON M.OL ADDRESS CITY ZIP PHONE LICENSE <br />❑ NEW ❑ ADDITION W ALTEMTION ❑ REPAIR ❑ DEMOLITION ❑ WDODSTOVE/FRPLINSCRT ❑ BUILDING RELOCATION <br />ICIMFIMP MEMENFgi.TERORR1E OELONLY /yy <br />fDHINACI WI.SEDF NpIR VI4 c- / /// <br />IPER.S.O/NJ/J�Ip�/{P.N�lOME NO <br />+-/.My� {,Jh'E�LJw 7b3 7,6� <br />DEVCMOE WORM AND NUMF FOOTAGE WVOLPED1�n ' <br />Jy G85F.D��Y,s�1A4GY<c7A'ic l�cc.FA�A.r�i L✓L <br />im0 Ep USEW eu V MIND <br />,p <br />—l-I[Fa <br />I HEREBY CERTIfYTHAT I HAVE READ/ND EXAMINED THIS APPLICATION AND <br />KNOW THE SAME TO BETRUE AND CORRECT, ALL PROVISIONS OF LAWSAND <br />ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLETED WITH <br />WHETHERSPECIFIEO HEREINOR NOT. THEGMNTINGOFAPERMITDOESNOT <br />PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANYOTHER STATE ORLOCAL LAWREGULATINGCONSTRUCTION OR THEPER- <br />FORMANCE OF CONSIRUCTION. THAT JAM AUTHORIZED BY THE OWNER OF <br />THIS PROPERTYTO PERFORM THE WORK FOR WHICH APPLICATION IS MADE <br />AND I COMPLY WITH THE STATE CONTRACTORS LAW 1827 RCW AND <br />j296.2�D�D WAAE C NiWL1DRONAU1NG10CDAGENT DATE A, <br />LEGAL DESCPIYIION OF PROP[AnlsflpVN BHfM'OR AHAGN PWflCORESI <br />LOT_ DLOCK_ Of <br />6308 <br />1 GIYBOSINfS I. EMU AND BYSIME%NAME <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET(TOILET) <br />A/C— A/HNDLG UNITS — H P <br />MTHTUB <br />FORCED AIR SYSTEMS — ELT .U. MEA <br />_ <br />_ <br />LAVATORYDYASH BASINI <br />UNIT HEATERS —BT.U. M <br />SHOWER <br />CLOTHES DRYERS <br />_ <br />_ <br />KITCHEN SINK& OISP. <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHESWASHER <br />WOOD STOVE <br />_ <br />URINAL <br />METAL FIREPLACE CHIMNEY <br />_ <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLGOR DRAIN <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />ROOF DRAINS— RAINLEADERS <br />EXHAUST FAN <br />SINK(SERVICE— MR ETC) <br />SUBTOTAL <br />S. <br />SUBTOTAL & <br />PERMIT <br />S <br />PERMIT S <br />_ <br />TOTAL FEE <br />SI <br />I <br />TOTAL <br />FEE $ <br />h <br />FRONT5ETIOCK <br />REARS[1BACK <br />&DE50eELK <br />FMNCHECKNUWEB <br />TIRE <br />RECEIPT NO. <br />Uu[OZONE <br />LOTMEA <br />VAANTHIIE <br />O YES D NO <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />"PEOICONSI <br />µIOWABIOAGIUAL <br />OCCW UPANCYORP <br />NOOIDWYELUNOUNIIB <br />PLUMBING <br />SN[OE BLpO <br />NO OF SYORIE5 <br />65MI. <br />D r <br />ON <br />OCC LMO <br />MECHANICAL <br />`�. <br />OTHER <br />I IRE SPRINKLERS REOUIRED OYES ONO <br />HEKiMTLIW1AIKlN <br />STATEBUILDINGSURCHARGE <br />Mll.C.IIONMC BY RNISAPPRBI <br />��. <br />STATE ENERGY SURCHARGE <br />PUBLIC WORKS <br />TOTAL11 <br />_ <br />— <br />