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i�e Evarpreen <br />GITY OF <br />'I everett ENT <br />APPLI�A.'ION FOR CONSTRI,,.�:T10N <br />PERMIT <br />D IN INK -- PLEASE PRINT <br />rverel� <br />e <br />�OfF•_ <br />S�G.�°-.I.:r�/ ��' <br />--- <br />- ----- -- - — --- -- - - - - - - - - _ . _- ----- <br />TEN�NT A1411A0�P[55 CIIY -""' � 2�P 19101R <br />--- - - �ye�� n8� -- <br />---- ---- --- � ------------- ------ <br />♦pGNITELTOP0E51GNEN MMLADORESS CI7Y 21P PI�ON[ <br />� , �i- '- - a �,i,.. r.��, u11 G.,J,,,._;r.; 9Ir29n -5'6J'-/99� <br />MEGN�NIGALGi'iTp�GtOR AUIIADORESS GTY 21P PIIONE IiCENSE• <br />PLLIMBINGLONTP�GtOR MAILAOORESS GITY 21P PIIONE 11LEN5E• <br />. r� LC �'l��iiQ S/�Q�QL'�'-�I� `/� i IG J��— <br />CL/S50 KVRK <br />❑ NEW ❑ ADDITION ❑ ALTERATIDN ❑ f1EPAIR ❑ DEMOLIiION ❑\NOODSTOVFJFRPL INSERT ❑ BUILOING FELOCATION <br />�.E�.�„M.�.�M�n,��,n,��,����_���.�,... ,,,�y�.. - <br />CANTRAGTPRIGEOFWVRK 7 %���J ,�_ _ <br />�ESCHiBEWOFNAN�50l1AREFOOi�G[IN�V LVED <br />L%00. Sa �' 7� <br />�ovosao osr o - em�oi� <br />�_ / <br />�v <br />1_ e�ocrc - oF <br />Z�'ZS /!!9a <br />PLUhlBING <br />TVPE OF FIXTURE OR <br />BATHTUB <br />LAVATORV <br />I 11EREBY CERTIFY TI1AT I I IAVE REAO AND E�AMINED THIS APPLICATION AND <br />KNOW :IIE SAME TO BE TRUE NND CORRECT. ALL PROVISIONS OF LAWS AND <br />ORDINANCES GOVERNING TtIIS 1YPE OF WORK WILL BE COMPLETED WI1H <br />WI1ETlfERSPECIFIEDHEREINOR NOT.TMEGRANTINGOFAPERMI7DOESNOT <br />PRESUME TO GIVE AUTI IOFIN lO VIOLATE OR CANCEL iHE PROVISIONS OF <br />ANY OT11ER STATE OR I.OLAL I.AW REGULATING CONSIRUCTION OR TME PER� <br />FORIdANCE OF CONSTRUC110N. THAT I AM AUTNORRED BY THE OWNER OF <br />7HIS PROPERN TO PERFORM THE WORK FOR WH ICH APPLICAI i'vi: 15 MACC <br />AND I COMPLY WIT!I TIIE STATE CONTRACTORS LAW 1827 FC1Y nND <br />296200 WAC. <br />SIGN�fURLOFCONIRALIO1�liHAlIi110N1[COAG[NI DAI[ <br />API'll FN15�Y0115111�'.SIIfL1��D N UII H[SSNPI.1[ �—��� <br />MECHANICAL <br />FEE NO. <br />LAUNDRV Ti7AY <br />CLOTMES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />_—'_'_ _—__'_'_'____.. .___ .._. _ - <br />FLOOR DRAIN <br />BACKFLOW PREVENiERS � <br />ROOF ORAINS — RAINLEAOERS <br />FIRESPRINYLEPSi1E0UIflED p <br />FEE <br />w�.— Hinrvuw unua— n r. <br />FORCED AIR SYSTEMS— B.TU. M EA _ <br />UNITHEATER$—BT.U. h1 <br />CLOTHES DRYERS <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />WOOO STOVE <br />METAL FlFiEPLh�c 8 CHIMNEY <br />_.. _. . . _... ._.. . .____._ . _ _ _ _.. ... .__ <br />FlREPLACfINSLHT __ <br />IIEAT I�UMI' <br />GAS 1'll'ING � <br />6%IIAUSI hNN . <br />ETC) __._._.._ ..___ _—'_-- <br />SUBTOTAL _ <br />PERMIT <br />TOTAL FEE <br />IS[TBAGK <br />� �, <br />�REA <br />vi'7e � 7%! <br />rz- 3 <br />Si0FIE5 <br />'L <br />Y <br />� <br />� <br />S <br />S <br />SIOE SETB�CN <br />.� s <br />MC�NT SITE <br />❑ YES IT`NO <br />no or own ima un <br />' <br />occ �o.o <br />IIEIGIIT UMIiAiION <br />�' <br />SUB TOTAL 5 <br />,2 � � _ iOTAI FEE <br />PIAJNCN CItN11MrB��%E_N�I}��/n�( FEE '- <br />` / L�RGYO" " � �`�y <br />FEES VALUATIONr <br />BUILDMG _ �j�e <br />PLUMBING <br />MECHANICAL <br />OTIiER <br />STATE BUILDING SURCIIARGE <br />STATE ENEfiGY SURCHARGE <br />PUBLIC WORKS <br />TOTAL <br />� <br />