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APPLIf..�►TiON FOR C�NSTAJCTION IUl3U <br /> PERNl�T <br /> the Everqraen <br /> C17Y OF cvMcll <br /> everett e <br /> BUILDING DEPARTMENT <br /> 259-88t0 TO BE COMPLETED IN INK— PLEASE PRINT <br /> OWNER MNL�0011ESS CIfY 2�V PIIONE <br /> Je�Sc ��d'�et's�r� ILY�� P�ra�t�� ��',�DI ,�� -`13_�_ <br /> fENANf N�ILRD011ESS CIIY TiP PIIpNE <br /> ApGNIIECiONUE5IGNER MNIApORE55 CI1Y DP PNONE <br /> GFH[H�LGONIRet1011 MAIL�DDf1E55 CITY 21P pHONE LtCENS[• <br /> IIANiGLCOMR�LTOR MAIL���PE55 CITY IM1' FHOqE UCENSE� <br /> ��Qlal.ta l�t�1 C � . L1S�.lCL��S���t����1.�Ch�41 ��L�! _�,ylo r�9<� 1111t� .i°7,NC�15�t <br /> CVSSUF WORK <br /> ❑ NEW ❑ A�OITION ALiERATION ❑ REPAIR ❑ OENOLITION ❑ WOODSTOVFJFRPLINSERT ❑ �UILD�NGRELOCATIUN <br /> TEN�NiIMPROVEMENIORINfEPi PEMODELONLY�p� GONUCTPERSONnNOPNONENO. <br /> CONiReCTFRiGE0iN9RK l - v '��lJ <br /> RIBEWO �NOSOl1AqEfOOU INVOW[D � <br /> �t1�3�GL-CIL� �h� . 4- <br /> rnoroseou5eoramioiNa � IHEREBYCERTIFYTHATIHAVEPEADANDEXAMINFDTHISAPPLICATIONAND <br /> KNOW THE SAME TO BE 7FUE AND CORRECT.ALL PROVISIONS OF LAWS AND <br /> LEG�L OESGfVIPIION Of PROPE111Y ISIIOWN OELOW OR�ITFGII fOUH COME51 ORDINANCES GOVEfiNING THIS TYPE OF WORK WILL BE COMPLETED WITH <br /> WfiETHER SPECIFIED I IEfiEIN Ofi NOi.Tf/E GRANIING Of APERMIT DOES NOT <br /> PRESUME 70 GIVE AUT HORIN TO VIOLATE OR CANCEL THE PROVISIONS OF <br /> Lot e�oGK oF ANYOTHERSTATEORLOCALLAWREGULATINGCONSiRUCTIONORTHEPER� <br /> FORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE OWNEP OF <br /> THIS PROPERN TO PLf7fORM THE WOFK fOR W HICH APPIICAiION IS MAOE <br /> AND I COMPLV WITH TI{E STATE CONTRACTORS LAW 18.27 RCW AND <br /> 296200 WAC. <br /> SIGNRiUNEOFCONiB�GiDROR�pI110PqE0FGENi ORfk <br /> p � �[•�.u�:?il�ce:i �'LCICG�V ��/�7/O/ <br /> � <br /> vr+aeer�ouness � pp�i5CI1Y�U5ME55UCEN5ENO.�N�0�51NE5SN�ME <br /> PLUMBINO MECHANICAL <br /> NO. TYPE OF FI%TURE Oli ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILEn q/C—A/NNOLG UNITS—H.P. <br /> BATHTUB _L FORCED AI(i SYSTEMS—B.T. . M EA <br /> I.AVA70RV(WASH BASIN) UNIT HEATERS—B.T.U. M <br /> SMOWEFi CLOTHESDRYGRS <br /> KITCHEN SINK 8 DISP. VENTILATION FAN <br /> DISHWASHER RANGE HOOD <br /> LAUNDRVTRAY � WATER HEATER <br /> CLOTHES YJASHER W OO�S70VE <br /> URINAI METAL FIREPIACE 6 CHIMNEY <br /> DRINKING FOUNTAIN fIFEPLACEINSERT <br /> FLOORDRAIN HEATPUMP <br /> BACKFLOW PPEVENTERS GAS PIPING <br /> ROOF ORAINS—PAINLEADERS E%HAUSi FAN <br /> SINK(SEFVICE—BAR,ETC) <br /> SUBTOTAI E SUBTOTAL E <br /> PERMIT E PERMIT E <br /> TOTAL FEE E TO7AL FEE S <br /> iNONi5ET0�CN NERRSElOACK S�OESEl9AGK PUNCNECNNUMOEB FEE RECEIPfNO. <br /> usezor+e iornner, VAC�NTSIiE FEES VALUATION FEE <br /> ❑res n r+o <br /> iVPEO�CONST. OCGUPRNCYG110UP NO.OfOWElLINOUNIiS BUILDING <br /> �llOw�BLE��CIUAL <br /> PLUMOING <br /> SIZEOFBLOO. NOOFSTOHIES BSMI. OGGLOAD <br /> a v MECHANICAL <br /> O N — <br /> INEI6MTUMIt4TION OTHER — <br /> fIRESPqIN1(lER9PE0UIRED O YES ❑NO <br /> STATE BUILDING SURCHARGE <br /> STATE ENERGV SURCHARGE <br /> �PRIGALIONRGGBY PL�NS�PPR.pY <br /> rueuc woaKs <br /> TOTAL <br />