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�� -- <br /> �;s{ <br /> APPLICk` ION FOR CONSTR4�TION <br /> PERMIT <br /> Ihs Evsryreen <br /> CIN OF <br /> everett evere1 <br /> BUILDING DEPARTMENT � <br /> 259•88 .TO BE COMPLEy�D IN INK— PLE SE PRINT <br /> T - � cS ,S��E�ow:c/i L �dJ:� J3rt'��nr/w,oK �JF,e'FfY �19�03 �33:3- 7a85' <br /> OWNEP M�IL�DORE59 CI ZI� PNONE <br /> TEHANi MWLADDNE59 GTY ZIP PMONE <br /> ARLMITEGTOHDE81pN[p M�IL�DDHESS [IiY ZIP PHONE <br /> CV�K't=7�{ ,�r.�� l�/r-,c's aGoG E��<<h'�,t� -��/l.J-� E��'f J53- 7/6/ Ev,�REd"� <br /> OEHENI�LCONiR�CTOR M�ILAOORE99 G IIP %IpNE LIGENSE�C1/� <br /> MECN�HIGKfANiRhCTpR MMLAODNESS ' GTY ZIP R10NE UCENSE• <br /> RUMBiNOCqNTfUGiOR MAIL�DOHE99 GItY ZIP PMONE LIGENSE+ <br /> CUSSOFXORK —�— - <br /> ❑ NEW ❑ AODITION �I ALTERATION ❑ FEPAIR ❑ DEMOLITION ❑ WOODSTOYE/F�iP�INStRT C DUIIDINGRELOCATION <br /> TENIINT IMVROVEMENT OR INTERIOR REMOD[L ONLY <br /> CONT�CT pER50N AND VHONE NO <br /> � CONTfUCTPi11LE0iWORK � � �� <br /> DEBCRIBEWORK�NDSOU�RE(OOIROEINVOIVED — <br /> El�'OO� �/1C[ /��RIJO[dti .dCr . S 6 <br /> moro5eous oreui oiNo ��3t�XOL IHEREBYCERTIFVTHATIHAVEREAOAN�EXAMINEDTHISAPPLICATIONAND <br /> � KNOWTIIESAMETOBETRUEANDCORRECT.ALLPROVISIONSOFUIWSAND <br /> LEO�L DE9GHIP710N OF PROPERtt�SMOWN BELOW OR�TT�CM FOUiI CqPIES1 OROINANCES GOVERNING THIS iVPE OF WOFK W;LL BE COMPLETED WITH <br /> WHETHEF SPECIFIED H EFEIN OR NOT.THE GRANTING OFA PERMIT DOES NOT <br /> �m S Bip�K�_ pp PFiESUMETOGIVEAUTHORINTOVIOLA7EOHCANCELTHEPROVI510N50F <br /> ANY OTl1ER STATE OP LOCAL lAW REGULAiING CONSTRUCTION OH THE PER• <br /> FORMANCE OF CONSiRUCTION.THAT I AM AUIHOAIZED BV THE OWNEF OF �� <br /> THIS PROFER7V TO PERFORM 7HE WORK FOR WHICH APPLICATION IS MADE <br /> AND I COMPIY WITH ?HE STATE COIQTRACTOR:i LAW 18.27 RCW AND <br /> L ^1/ /� o 296.2001VAC. //_/y �f <br /> /NGlII.LQS� �✓1lI /� /�F�/fY� 91GNATURFOFGONiPRGtOROf1AUiHORIiEDGOENT O�TE <br /> � 2�a �RDA�u��1�r EJceF>f[�N• 99 X '�`�D` . <br /> PIqJECTADDRE58 � �P IG�NT9CIiY8U$ME`SLIG[NSENOANDBUSINC59NAM��r <br /> PLUMlINO MHCHANICAL <br /> NO. TYPE OF FUfTUpE Oq ITEM FEE NO. �YPE OF EOUIPMEN7 FEE <br /> WATER CLOSET(TOILEn q/C—!VH NOLG UNITS—H.;. <br /> BATHTUB FORCEDAIRSI'STEMS—B.T.U. MEA <br /> UVATORY(WASH BASIN) UNIT HEATERS—B.T.U. M <br /> SHOWER CIOTNESDRYERS <br /> - KITCHEN SINK 6 DISP. ' VENTILATION FAN <br /> � DI9HWASHER qANGEHOOD <br /> LAUNDRVTRAY � WATER HEATER <br /> CLOTHES WASHER WOOD STOVE <br /> URINAL METAL FIpEPLAC[8 CHIMNEY <br /> DRINKINO FOUNT4IN FIREPLACEINSFR7 <br /> FLOOR DPAIN � HEAT PUMP <br /> BACKFLOW PREVENTERS GAS PIPING <br /> ROOF DRAINS—RAINLEADERS EXHAUST FAN <br /> SINK�SERVICE—BAR ETC) <br /> SUBTOiAL S SUBTOTAL E <br /> PERMIT S PERMIT S <br /> TOTALfEE E TOTALFEE S <br /> FBONTSCTB/�CN BEAqSEfB�CK bIDE5ElBRGK PtANCNECNNUMBEq FEE RECEIPfNO. <br /> USEZOrie �otu��n veGeNtsire FEES VAlU11TION FEE <br /> n res ❑No <br /> 1YPEOFCqNST. OCGUP�NGYOROUP NO.OFOWELLIHOUN�TB BUILDING � �� 9�• <br /> �uoweeivecTuei <br /> PLUMBINO <br /> SREOF3LOQ NO.OFBTONIEB BSMi. p�Q�p�p — <br /> o r MECHANICAI <br /> _ ON <br /> IIEIONiLIMIT�T10N OTHER <br /> FIRE SPRINKlEF911E0UIHED O YE9 O NO STATE BUILDING SURCHARGE C�'' <br /> _ � <br /> SiATE ENERGY SURCHARGE <br /> �fPLIG1T10N�CGBY PUNS�PPfLBY — <br /> � „�^ PUBLIC WORKS <br /> ►r; <br /> TOTAL U G <br /> ✓ <br />