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APPLICaf ION FOR CONSTRI.�.T10N <br /> PERMIT <br /> fhe Everyreen everett <br /> CITY OF <br /> everett e <br /> BUILDING DEPARTMENT <br /> 259•8810 TO BE COMPLETED IN INK— PLEASE PRINT <br /> OWNER MAIL�UDRE55 G11Y ZIP PMONE <br /> � <br /> � T M�ILAO�PESS CITY 21P PNONE <br /> �oc��tr- ��c'un�rs a9a� �ont� ST �����fi �5a a�1ay <br /> �RGNITECTORUESIONER M�IL�ODRESS CITY 21P PHONE <br /> GFNEfl�LCANTflAGTOR MAILADDPE55 piY ZIP PMONE LILENSE• <br /> MECN�NIC�LCANTR�CTOR M�IL�ODflE55 CITY 21P PNONE IICENSE• <br /> �.a��d �'VI���R, �',�. P�• 6a�6�'8.�3 S�a.• (i�u. �IFlbb' $'�Sbib7 Ll#-N6--5M-'f-6�ns <br /> PLU�ONT ACTOR M�ILFO�PE55 GITY ZIP PHONE LIf:ENSE• <br /> CLASSOF WOHK <br /> ❑ NEW ADOITION ❑ ALTERATION ❑ PEPAIR ❑ OEMOLITION ❑ WOODSTOVE/FRPLINSEFT ❑ BUILDINGRE�OCATION <br /> TEN�HTIMPROVEMENTONINTERIORREMODE.L1ON,I/V� GONT�CTPEFSON�NDPMONENO. <br /> GONTMGTPRICEOFWOHk � 1�V•D� <br /> UESCNIBE WOPK AND SOl1ANE i00TAGE INVOLVEO q� � <br /> �rgt�ll � .�y (��tcr {�(akri dhd �n,i a �� UniTS�7fc>. Ido <br /> rnoroseo use oF euuowa I HEREBY CERTIPY THAT 1 HAVE READ AND E7(AMINED THIS APPLICATION AND <br /> KNOW THE SAME TO BE TRUE AND CORRECT.ALL PROVISIONS OF LAWS AND <br /> LE(NLOESCRIPTIONOFPRGPENtt�SNON'N BELO'NOR�TTACNFOURCOPIES� ORDINANCES GOVERNING THIS NPE OF WORK WILL BE COMPLETED WITH <br /> W;IETHER SPECIFIED HEREIN OR NOT.THE GRANTING OFA PERMIT DOES NOT <br /> PRESUME TO GIVE AUTHORIN TO VIOLATE OR CANCEL THE PROVISIONS OF <br /> �oi s�ocK or ANYOTHERSTATEORLOCALLAWREGULATINGCONSTRUCTIONORiHE?ER� <br /> FORMANCE OF CONSTRULTION.THAT I AM AUTHORRED BY THE OWNER OF <br /> THIS PROPERN TO PERFORM THE WORK FOR W H�CH APPLICATION IS MADE <br /> AND I COMPLY WITH THE STATE CONTRACTORS LAW 18.27 RCW AND <br /> 296200 WAC. <br /> SIGN�IUREOFCONiRACi000B4U7NOP2ED�0ENT D�iE <br /> � X �I� .�- P� �����9 <br /> PpOJEGTADDNE55 ^,T/ /,pp��CANiSCITY 51 SIICEN5EN0.�NDBU51NE55N�ME <br /> { v ' <br /> PLUMBINO MECHANICAL <br /> NO. TYPE OF FI%TURE OH ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILEp A/C—A/HNDLG UNITS—H.P. <br /> BATHTUB FORCEDAIRSYSTEMS—BT.U. MEA <br /> LAVATORYIWASH BASIN) UNIT HEATEFS—9T.U. M <br /> SHOWER CLOTHESDRYERS <br /> KITCHEN SINKB OISP. VENTILATION FAN 1 <br /> DISHWASHER RANGE HOOD <br /> LAUNDRYTRAY WATER HEATER <br /> CLOTHES WASHER WOOD STOVE <br /> URINAL METAL FIREPLACEB CHIMNEV <br /> DRINKING FOUNTAIN P�REPIACE INSERT � <br /> FLOOR ORAIN HEAT PUMP <br /> _ BACKFLOW PHEVENTERS _�/— GAS PIPING � <br /> ROOF�RAINS—RA�NLEADEflS � E%HAUSTFAN <br /> SINK(SERVICE—BAR,ETC I <br /> SUBTOTAL S SUBTOTAL 5 ! <br /> PERMIT 5 PERMIT S � <br /> TOTAI FEE 5 TOTAL FEE E <br /> FBONTSETB4CK RE�RSETBACN SIOESETBACR PUNCNECIINUMBER FEE RECEIPfNO. <br /> � <br /> u5E2oNE LOT�REA VOA EgTbIOiENO FEEC. VALUATION FEE i <br /> BUILDING <br /> 1YPEOFCAN9T. OGCUPANGYOROUP NO.OFOWELlIN0UN1ffi <br /> •LLOWABIUALTUAL PLUMBING � <br /> i <br /> SREOFBLW NOAFSTOFIES BSAIL OCGLO�O <br /> ❑r MECHANICAL <br /> ❑N <br /> NEIGMTLIMITATION OTHER <br /> I <br /> FlNESPRINKLEP9PEOUIFED OYE9 ONO STATEBUILDINGSURCHARGE <br /> STATEENEFGYSURCHARGE <br /> APPIICATIONACCBV PUNSAPPRBY <br /> ' PUBL�C WORHS <br /> TOTA� a y4,o.ov <br />