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� <br /> : . APPLICATION FOR CONSTRUCTION PERMIT eV�'°�t � A� � <br /> �E,�p� T4 BE COMPLETED IN INK—PLEASE PRINT � I <br /> arr or j <br /> everett ��{EATING SYSTEM: ❑GAS O ELECTRtC ❑_ _— l � <br /> ��� BUILDINu DEPARTMENT � <br /> 259-881C �. <br /> p � '• DEMOLITION •t COMBINATION BUILDING MECHANICAL PLUMBING SIGN �+�, <br /> ; i OW4EP MAIIADDR[SS Cltt 21P PHONE 4 <br /> N�� S C �I('UN hr-n M�nY EK��N l � luR��nN+Y fv�a�ri" �l'��� _ 25�- t c �) ' <br /> f]� tENMR M�IL�OORE55 ��T�' Z�P P��� <br /> 1/ Qy�[� <br /> �� .L,r � �RpHiiECT^OR0E5iGNER MAILRpDRE55 LITY 21P PHpRE <br /> �•A C�� /' - <br /> r��j= GENER�ICONtR�CIDA ���I�DDNE55 CrtV 21P PNON[ L�CENSE• <br /> "",,Qj� /✓Al6�y, (PMST 1t3t1riGc.r�eilH� C=�2`�c`>r `) tw� lst-�y.fo ,�'+v��c.f, �-3an/-� ' <br /> MECNMllC�I C(MIiPACTOF MAIL RDDHE55 GiN 21P PMONL UCENS[Y <br /> n <br /> Q� . FIUMBiMG CONTR�C*OR MML�ODRE55 CITV ZIV PMONE IIGENSE� <br /> �Cy� �_,p .- 3vir KrZ�•,Fn Eu=�rsY _ <br /> CUSS OF WORK <br /> �1-1 ;_7 NcW � � ADDITION '� � ALTERATION k REPAIR DEMOLITION - WOODSTOVFJFfiPL INSERT _� BUILDING AELOCATION , <br /> �u H — fANiAGT PERSON�Np PNO'iE ND <br /> ��� GOHlRI.LT VRIGE OF WONK I oB6b �- . = NA�3�r <br /> r DE:iC11�BE WORN�ND SOUI.RE FOO GE iNVOWE� <br /> yL9 ` LJ 1-'� 'J/'O <br /> O�A R " P(lYM��t WIrPfNl Rf�R C!9/H .✓ n1 Y <br /> vn OSEDUSEOrBUiLDING ���� I HEFEBV CEFTIFV THAT I HAVE READ AND E%AMWED THIS <br /> �� APPLICATION AND KNOW l"HE SAME TO BE TRUE AN�CORRECT.ALL <br /> iec��oescaivrror�ovraorenn�sNowr+eEiowoa�necNcouacoviesl PROVISIONSOFLAWSANDORDINANCESGQVERNINGTHISTVPEOF <br /> � g�ocK �l �S ov ��e�0 - E�h'G H'ORK WILL BE COMPLETED WITH WHETHER SPEC!FIED HEREIN OR I <br /> �or r�i' NOT. THE GRANTING OF A PEFMIT DOES NOT PRESUME TO GIVE i <br /> AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANV � <br /> OTHEF STATE OR LOCl.:LAW REGUV+TING CONSTRUCTION OR THE <br /> PERFORMAP'�E OF CONSTRUCTION.THAT I AM AUTHORRED 8Y THE � <br /> nN� � � OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> L APPLICATION IS MAOE AND 1 COMPLV WITH THE STATE I <br /> CONTRACTORS LAW 18.27 RCW AND 296200 WAC. . <br /> SIGN�TUfiEOFCONTR�GTORORAUTHORREDRGENI pRE � <br /> S-1-5� I <br /> X��� 9$3� , <br /> PRQIEGTADDRE55 <br /> pPPLILRNTSGTY USMESSUCENSENORNDBUSiNE55NAME � <br /> _.,� �t� o a a <br /> f�� PlUM81NG MECHANICAL i <br /> I � NO. TYPE OF FlI(TURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) � NC—AMMDLG UNITS—H.P. � <br /> � '} BATHTUB �_ FORCED AIR S`.'STEMS—B.T.U. M E.A. <br /> 1 � k LAVATORY(WASH BASIN) UNIT HEATERS—B.T.U. M _T � <br /> � ' I �� ;� SHOWER _ CLOTHESORVEfiS ' <br /> I 4 � KITCHEN SINK 8 DISP � �' �� /R VENTILATION FAN � <br /> ,� OISHWASHER RANGE HOOD �— , <br /> I � . ; LAUNDRY TRAV n v r I WATER HEATER <br /> `�' CLOTHES WASHER N�117 /�t`/n i.< i —' WOOD STOVE <br /> URINAL ��'�Y METAL FIREPLACE 8 CHIMNEY <br /> I �. DRINKING FOUNTAIN FIREPLAC[INSERT <br /> . FLOOR DRAIN HEAT PUMP � <br /> � � BACKFIOW PREVENTERS � GAS PIPWG � <br /> � �'� � ROOF DFAINS—RAINLEADEPS / EXHAUST FAN , <br /> � �� SINK(SFNVICE—BAR,ETC.) — <br /> � <br /> �� . i <br /> SUB TOTAL $ U ; SU6 TOTAL $ /J�; � <br /> ,_� PERMIT $ PEFlMIT S <br /> �` TOTAL FEE $ TOTAI FEE $ --� <br /> FOR OFFICE USE ONLY: <br /> FFONTSETOACK REMSETBALN SIDESETBACK PUNCH[CNNUMBER P[E FECEiPTNO ', <br /> 3GGo� <br /> use2orve �otaacn VACPNTS!TE FEES VALUATION FEE T <br /> AUILDIk3 _ //� 'DO <br /> IYI'fOiCONiS.�LIOWI�PLf tYi'FOfLONSi./iCiU�L x[wwn noPV:mli�cakc5 -- i � <br /> LPNP PWMBING ITO ` <br /> S2EOFBLDO. NOAFSTORiEs B�SEMENT MECHANICAL � <br /> " cv <br /> OGCUPANGYlO�� FlRESPRNNLEPSREO'D HEIGHTLIMITAtION ADDITIONALPLANCHECK i <br /> i <br /> OTHER � <br /> REASON FOR SPfiINKL[�5 --� <br /> STATE BJILDING SURCIiARGE y �SZI . <br /> — <br /> iN1AKEBY PUNSRPPflOYEDBV CITYOFEVERE7T PUBLICWORHS <br /> LOCALSRLES <br /> TAX CODE IS 3105 TOTAL �6 j � � <br />