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fr. <br /> pppLlCi�rT10N FOR CONSTRf�T10N <br /> PERMIT <br /> everett <br /> tM Ewrpnan � <br /> CITY OF <br /> everett <br /> BUILDING DEPARTMENT Tp BE COMPLETED IN INK— PLEASE PRINT <br /> 259-8810 <br /> I �,UILADDPE59 GIiY ZIP PMONE � <br /> i OWNER . � c> � r��f39J� 9',P,ao,P. d4�J-aS`d'9 ��P�s`r9-d�9/ <br /> � A � fJ ��7I � I'r/) J C3 I 21P PNO E <br /> J .�F M/JLADDNE55 ��TM <br /> TENI�NT <br /> � AUIL�DORE55 GTY IIP PNONE <br /> � µG111TECTONDESIONER <br /> jGITY ZIP PMONE tICENSE• <br /> � OENEMLCANTfl�CTOF MAILADORE53 /C �%�/Og �6� <br /> � h�;/ � Son�.s i o Pq.I 41'c� �� � '' � <br /> 3 ' �f MAIL�UDRESS GITY 21P VNOHE LIGENSE• <br /> � MEGM�MI CONTNACTOfl <br /> .1 GTY 21P PHONE 4CEHSE• <br /> � PIUM&NOGOhTRPCiOR MAIL�ODRESS <br /> 1 <br /> :� <br /> C1A880F WOHv, <br /> ❑ NEy/ ❑ ADDITION ❑ ALTERA710N ❑ REP:IR DEMOLITION ❑ WOODSTOVEIFPPL INSERT BUILDING RELOCATION <br /> TENIJiT IMPROVEMENT OR INTEPIOP REMODEI ONLY <br /> CONIACTPEPSONAH�PHONENO. <br /> �OIITFACTPR�CEOf WOPM <br /> pE9��WOPKAN�SOUMEFOOTWEINVOLVEO <br /> (/Q JLI$ � 1\ <br /> pROPOBEO U9E OF BUIlDINO 1 HEREBY CERTIFY THAT I NAVE REA�AND EXAMINED THIS APPLICATION AND <br /> ;� �� � KNOWTHESAMETOBETRUEANDCORRECT.ALLPROVISIONSOFI.AWSAND <br /> � ORDINANCES GOVERNING THIS NPE OF WORK WILL BE COMPLETED WITH <br /> LealoE IPTIONOFPPOFERTYISMOWNBELONOflAT1�CNFOUNCOMES� yyHETHERSPECIFIEDHEREINORNOT.THEGRANTINQOFAPERMITDOESNOT <br /> ,J�-�/p� •�.�.''�1�5 SI .AD'� PRESUMETOGIVEAUTHORITYTOVIOLATEORCANCELTHEPROVISIONSOF <br /> LOT�����K ��"— oF ANVOTHERS7ATEORLOCALLAWF7EGULATINOCONSTRUCTIONORTHEPER- <br /> FORMANCE OF CONSTRUCTION.THAT 1 AM AUTHORIZED BV THE OWNER OF <br /> THIS PROPERN TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE <br /> �j ' AND I COMPLY WITH THE STATE CONTRACTORS LAW iB.27 RCW AND <br /> 296.200 WAC. <br /> 90H�TUREOFC NiRACiORORRUTH NREO�OENi O�TE <br /> X �L�' l '7 / - O <br /> PpOJECTADUPESS APPLIC�NTSGI BUSINESSIIC SENO.�NDBU91NES9N�ME <br /> / <br /> �p�/� �/ � �iYPtt(��[«r c, . <br /> MECHANICAL <br /> PLUMlING FEE <br /> NO. TYPE OF FU(TURE OR ITEM FEE N0. TYPE OF EOUIPMENT <br /> WATER CLOSET(TOILEn A/C—A/HNDLG UNITS—H.P. <br /> FORCEDAIRSYSTEMS—&T.U. MEA <br /> BIITHNB <br /> LAVATORY�WASHBASIN) UNITHEATERS-6T.U. M <br /> CLOTHESDRYERS <br /> 9HOWER <br /> KITCHEN 81NK 6 DISP. VENTILATION FAN <br /> DI9HWA3HER RANOE HOOD <br /> UUNDRY TRAY WATEF HEATER <br /> CLOTHES WA3HER WOOD STOVE <br /> METAL FItiEPLACE 6 CHIMNEY <br /> URINAL <br /> FIREPLACEINSERT <br /> DRINKINO FOUNTAIN NEAT PUMP <br /> FLOOFi DRAIN <br /> &1CKFLOW PREVENTERS GAS PIPING <br /> AOOF DRAINS—kAINLEADERS E%HAUST FAN <br /> � SINK�BERVICE—BAR,ETC.) <br /> i <br /> SUBTOTAL S SUBTOTAL E <br /> PERMIT S <br /> PERMIT s TOTAL FEE 3 <br /> TOTALFEE S FEE RECEIRNO. <br /> FPONTBETBAG1t PFARSETOACK <br /> SIOESEIB�CII PIANCNECKNUMBEP <br /> t <br /> V�CANi:ITE FEES VALUATION FEE <br /> U9E20NE IOT�PEA O YE9 �NO <br /> w BUILDING <br /> `.�� iYPEOFCANST. OCGUP�NCYOROUP NO.OFUWElLINOUNITS <br /> ?,��3 ALLOW�BLFJACTUAL PLUMBINO <br /> ��� 9KEOFBL00. NQOFB70PIE9 OSMT. OCGLO�� MECHANICAL <br /> � OY <br /> � � ❑N <br /> �� �. NEIGHTIIMITRION OTHER <br /> •}� FIRESPRINNlERSPEWINEO OYE9 ONO S?ATEBUILDINGSURCHARGE <br /> i�^" STATE ENERGY SURCHARGE <br /> �� �PPLICAtIONALGBY PUNSAPPRBY PUBLICWORNS <br /> Fy: <br /> 4 TOTAL <br /> %r��. <br /> �M <br /> '�J• . . ��.....�...���..rv�i.Yu.r�fR���n.t\L-09\�CIMM49rv'al��vlslA�n.�w�w <br />