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�— <br /> �•�• <br /> �`�.� <br /> APPLIC/�a�ION FOR CONSTRIi::T10N <br /> PERMIT <br /> ths Evarproen <br /> GTY OF cvcrelt <br /> everett e <br /> BUILDING DEPARTMENT <br /> �2 9•8�87p TO BE CO LETE� IN INK— PLEASEp RI�IT <br /> � f-��C'6�t �AE,PEO�o cJ,c �i �aia "�K'DAdu�Ay �dl"k'_F7f ,1�0�0.3 �53- 7o78S" <br /> OWNER M�IL�D�PESS GlY ZIF PNONE <br /> TEN�Ni MAILADDRE54 GITY ZIC PHONE <br /> �RGMRECTORDE910NEA M�IL�DORE59 GITY ZIP PMONE <br /> F�C,��'�f{ �k./</c�'s s�a� L-�e�c�;-,CEE.tI I.�AY Ede,�s� 3S3- 7id� E✓�oi <br /> OENEMtCOHLR�GiOR MML�DDRE59 GI1Y 21G PNONE LiGEHSE• <br /> MEGN�NILQCONTHAGIOR M�ILApOR[59 CRY ZiP PNONE UCENSE� <br /> PLUMBINOCAMq�pTOH MML�OORE59 GTY ZIP PIIONE LICCN9[� <br /> C1A59 OF WOnN �.7 <br /> ❑ NEW ❑ ADOIiION ❑ RLTEFATION ❑ REPAIR Kl DEMOLITION ❑ WOODSTOVE/FRPL INSERT ❑ BUILOiN6 RELOCATfON <br /> TEN�NT IMPRO✓EMENT OF INTER101i REMODEL ONLY CANT�Gi PERSJN�ND PHONE N0. <br />� CONTMCT PR�CE OF WORK� <br /> DELCRIBE WONI(�NO bOWRE FOpU6E INVplVEO <br /> /f'E�+ovE v/dba,i,��;vo ��e�� �' ,c-.7,:�,� _ _ <br /> PROP09EU WE OF BUILDINO I HEREBY CERTIFV THAT I HAVE READ AND EXAMINED THIS AFPUCpT10N ANO <br /> k� KNOW THE SAME TO BE TRUE AND CORRECT.ALl PROVISIONS OF UWS AND <br /> t LEO�LOESGRIPfID110FVAOPENIYISNOWNBELOWOR�i1�LHFOUFCOME57 OF7DINANCESGOVERNINGTHISNPEOFWORKWILLBECOMPLETEDWITH <br /> I: WHE7 NER SPECIFIED HEREIN OR NOi.THE GRANTING OF A PERMIT DOES NOT <br /> toi�_ BLOCK—� oF PRESUMETOGIVEAUTf{ORINTOVIOLATEORCANCELTHEPROVISIONSOF <br /> ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUC710N OR iHE PER• <br /> � /� FORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZE�BV THE OWNEP OF <br /> �\NN O���Q_��lY\���j��Q�� THIS PqOPERTV TO PERFORM TNE WORK FOR WHICH APPLICATION IS MADE <br /> �� AND I COMPLY WlTH THE STATE CONTRACTORS lAW 1627 RCW AND <br /> J '�7� /� 296200 WAG �/-�y yd <br />, k ST .// �• /1 L //� f SIGNATUf1EOfCONiRACTO�OIlAUL11DNiZE�RG[Nt D�TE <br />, L:2/.� ��('BAdicl/7� �✓Ci('� (w)/J. ���n.� X �+�v'/K/1/u^y���+.� uu�7�2'� -el%c� <br /> NqJECiAUDRE55 �PPIIC�NTSCIiYBUSMESStICC�N9ENO.MI pU5ME93N�ME � <br />� PLUMBINO MECHANICAL <br /> NO. TYPE JF FIXTURE OH ITEM FEE IiQ. 7YPE OF EOUIPMENT FEE <br /> WRiER GLOSET(TOILEn WC—A/HNOIG UNITS—H.P. <br /> BATHTUB FORCED AIR SVSTEMS—HT.U. M EA <br />� LAVATORV�WASHBASII� UNITHEATERS—B.T.U. M <br /> SHOWER CIOTHESDRVERS _ <br />� KITCHEN SINKB DISP. VENTILATION FAN <br />�� DISHWASMER RANGEHO00 <br /> I.AUNDRY TRAY WATER NEATEF <br /> CLOTHESWASHER ' VdOODSTOVE <br /> URINAI METAL FIREPLACE 8 CHIMNEY <br /> DRINNINO FOUNTAIN FIREPLACE INSfiRT <br /> FL07H ORAIN HEAT PUA1P <br /> BRCKFLOW PPEVENTER9 GAS PIPING <br />, RAOF DRAINS—RA!NLEADERS E%HAUST FAN <br />, SINK�SERVICE—BAR,ETC.) <br /> SUB TOTAL S SUB TOTAL S <br /> PERMIi S PERMIT S <br /> TOTAL FEE S 70TAL FEE S <br /> FROIIISETB�C6 RlAR6EiBRGK SIpESETB�GK PUNCMECKNIlMBEN fEE PECEIVTNO. <br /> ' <br /> u9ezonE IOTAPEA V�GANi51TE FEES VALUATION FEE <br /> ❑YE9 ❑NO <br /> ttPEOFCONST. OCCUPANCYOROUP NO.OFOWFLLINOUNITS BUILDING <br /> a�avea�v�cN�l PLUMOINa <br /> Bi2EOF910(1 NO.OFBiOHIEB BSMT. OCGlOAO <br /> o v MECHANICAL <br /> ON — — <br /> NEIONiIIMITRT10N QTH�R <br /> i1FE5PPINKLEH8RE0UIRE0 OYES pN0 <br /> STATE BUILDIN6 SURCHARGE <br /> STATE ENERGY SURCHARGE <br /> APPUC�TION�CGBY PLRN9APVRBY <br /> PUBLIC WORKS <br /> TOTAL <br />