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AIPRdICatlONpFERRUC'T NSTR1�a:TION <br /> evere�t <br /> Ihe EveNreen � <br /> GTY OF <br /> everett <br /> BUILDING DEPARTMENT TO BE COMPLETED IN INK- PLEASE PRINT <br /> 259•8810 <br /> GITY 21P PIVON[ G� / <br /> ER AMIL�DOPESS ,/ 1�1�D I � S ( i/ �` / . — <br /> L '• ���� � � <br /> V A/rr � `cTr "iiv � PIIONE <br /> mAa�ooaess <br /> NANT <br /> M�IL�DURE55 <br /> GITY 21P PHONE <br /> /,p�NITECT OR OESIGNER <br /> Z�p PMONE LICENSE• <br /> dENEFALGONTR�CiON <br /> M�IL�ODNE55 ��N <br /> M�II�OOHE55 GITY <br /> z�p PHONE LICFNSE• <br /> MECHANIC�LGONTF�CTON <br /> M�IL AODRE55 ��TY <br /> =�p PIIONE LICEHSE t <br /> PLUMBIN�GO R�.CTOR <br /> �1A54OF WORK �p' <br /> ❑ NEW ❑ ADDITION ❑ AITEMTION ❑ REPAIR ❑ DEMOLITION �W CW�q50NONOPHONE pSERT BUIIDINGREI.OGATlO <br /> TENANT IMPROVEMENT OP INTERION NEMODEL ONLY <br /> rqNTR�CT PPIGE OF WORK <br /> pESGPIBE WOflR I1N0 SOU�AE FODI�GE INVOIVE� <br /> �e�ouseore i a lHEREOVCERTIFYTHATIHPVEREADANDEXAMINEDTHISAPPLICATIONAND <br /> KNOW THE SAMETO BETriUE AND CORREGT.ALL PROVISIONSOF UWBAND <br /> ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLETED WITH <br /> �Eo�� EScnivrioN FPNOPERttISHOW�lBELOWOHAT1�CNi0URCOFlE51 WHETHERSPECIFIE�HEREINOViNOT.THEGRANTINGOFAPEHMITDOESNOT <br /> PRESUME TO GIVE AUIHORIN TO VIOLATE OR CANCEI TFIE PROVISIONS OF <br /> B�oCK ANY OTHER STATE OR LOC�L LAW REGULATING CONS7RUCTION OR THE PER- <br /> �or �F FOAMANCE OF CONSTRUGTION.THAT I AM AUTHOPIZED BV TH[OWNER OF <br /> I pN1D IRCOMP YTWITHRTHEMSTAT WCONTRACTORSHLAWL1B2T7�RCW AND <br /> 296200 WAC. <br /> SIGN�IUREOFCONIF�CTO��RAUIHOPI'.EDAOENT OAlE <br /> X ��.��'t- �, �-is B� <br /> � <br /> PHOlECTADURESS �PPLILANTSCIIYBUSME59lICENSENO.�NOBU51NE5SNAME L <br /> 1 y/ s �-�y`'� �,�a yg�� <br /> �1 MECNANICAL <br /> PLUMBINO �� FEE <br /> FEE NO. TVPEOFEOUIPMENT <br /> NO. TYPEOFI"IIITUNEORITEM p��_q�HNDLGUNITS—H.P. <br /> WATERCLOSET(TOILE7) — FORCEDAIRSVSTEMS—B.T.U. MEA <br /> BATHTUB — UNITNEATERS—B.T.U. M <br /> LAVATORY(WASH BASIN) CLOTHESDRYERS <br /> SHOWER VENTILATION FAN <br /> KITCHEN SINKB DISP. -- RANGE HOOD —' <br /> UISHWASHER yyq7ER HEAiER -- <br /> LAUNDRYTRAY -- WOODSTOVE — <br /> CLOTHESWASHER _� METALFlfiEPLACEBCHIMNEY <br /> ' URINAL FIREPLACEINSERT — <br /> j DRINKINGFOUNTAIN HEA7PUMP -- <br /> FLOOR ORAIN ---' --_/ GAS PIPING <br /> ' BACKFLOW PREVENTERS — -- �— — <br /> , E%HAUSTFAN <br /> ROOFDRAINS—RAINLEAOERS — -- <br /> SINK(SERVICE—BAN.ETC 1 ---- <br /> SUBYOTAL S <br /> SUBTOTAL $ pEFMIT E <br /> PERMIT $ TpTAL FEE s <br /> TOTALFEE S FEE RECEIPTNO. <br /> qE�RSETB�LN SIDESElBl1LN VIwNGNEGNNUMBEN <br /> fP011T SETBALN . <br /> VALUATION FEE � <br /> —�-- IOT�BE VACRNTSITE FEES . <br /> 1�5E ZONE ❑YE9 ❑NO <br /> BUILDING <br /> OCGUP�NCY0110UP NO.OFOWE <br /> n�v e or wnst. pLUMBING — <br /> p��pW�BIE/ACIUAL `j <br /> YiEOFBLIXi NOOFSIOPIES u4YT� aCLOAD MECHANICAL -- <br /> ON <br /> 11EiGNTLIMITRION OTHER <br /> FINElop�NKLEN9REWINED O YES O NO <br /> STATE BUILDING SURCHARGE <br /> STATE ENERGY SURCHARGE -- <br /> APGLIC�T�NA7G9Y PLANSFPPP.BY PUBUCWORKS <br /> p,�i� TOTAL <br />