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��H <br />S �� <br />� � <br />� � � <br />y�� <br />��e <br />OH <br />��8 <br />a. � <br />�y <br />� M <br />W <br />� <br />� � <br />HOrn <br />iilp EVP�QIPt!fl <br />CITY O� <br />everett <br />BUILDING DEPARTMENT <br />?5s edt0 <br />APPLICA�'ION FOR CONSTRI►..:TION <br />PERMIT <br />TO BE COMPLETED IN INY.— PLEASE PRIN'i <br />R'�'+MOR�rII�GS �I� IM1�AD� DqESS — S�OI"�OT� <br />I f NFNi M�IL AOD��F 55 CI1 V <br />u►1KWowtJ NoT I-E�yEp <br />qq�vrtECL090CS�GNEP MRiIPDOA[55 CIIY <br />So%'�• Po P�oX 5�ibl� t-'fNNwoov <br />GCNCRALC04iRI.LtON MAILADC�iE55 LIiV <br />�� <br />-1_Q53— -- <br />9$0� 719•7�3�{--- - <br />iIP pHONE l ICLNSC • <br />NOT &'t 'DPTCRMipEU — <br />C1A550F WONK <br />� NEW ❑ AODI710N ❑ ALTERATION ❑ REPAIR ❑ �EMOLIiION ❑ WOODuTOVE/iRPLINSERT ❑ BUILDINGRELOCATION <br />C ONiRALi FR!CE O� V URK <br />GESCP19E WOAN �Np �O W pE FOOiRGE INVOW ED <br />l0000 �'Q-� SXBLL ON <br />Gnoros[ouSEOFouio c <br />RGTAIL- s�lGB�J DO °Q= <br />LE6AL 0f SCPIPiION (if PPOPENTY /�N�1YN BELOW OH Ai <br />�or e�ocr or <br />5W �6R bRo�tDWAY � l� <br />�0��0�5 W �L���°C��D� <br />S'w p�_N� R 5 E w.� <br />ro�o�ect nooaess <br />PLUMBING <br />NO. TYPEOFFIXNflEORITEM <br />WATER CLOSET �TOILET) <br />BATNTUB <br />LAVATORY (VJASH BFSIN) <br />SHOWER <br />KITCMEN SINKB DISP. <br />OISHWASHER <br />LAUNDFVTRAY <br />CLOTHES WASMER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLI�W PREVENTERS <br />ROOF OR.1WS— RAINLEADERS <br />VNHiSF[]�/If.F—RdR FTf.I — <br />SUB TO7AL <br />PERMIT <br />Pl:1WFBLE/ACTUA%/^� �' <br />r <br />SIZEOFBLD4 HOAPSLORI <br />�AOfJO S � �� <br />fiRESFNINNL[PSPEOUIPED ❑YES SNO <br />5 <br />FEE <br />I H EREBY CERTIFV'HAT I HAVE READ ANO E%AMINED TNIS APPLICATION AND <br />KNO�N THE SAME TO BF TRUE AND CORRECT. ALL PROVISIONS OF LFWS ANO <br />ORDINANCES GOVERNING THIS TVPE OF'vVORK WILL 6E COMPICTED WITH <br />WHETHERSPECIFIEDHEFEINOF NOT.THEGRANTINGOFAPEFMITDOESNOT <br />PRESU1dE TO GIVE AUTHORITY TO VIOLATE OR CANLEL TH[ PFOVISIONS OF <br />ANV OTNER STATE OR LOCAL lAW REGULATING CONSTRUCTION OR THE PER� <br />FORMANCE OF CONSTRUC7ION. iHAT I i.M AUTHORIZED BY THE OWN[R OF <br />iHIS PROPERTV TO FEFFORtd THE WORK FOH WNILH APPLICATION IS WADE <br />AND 1 COMPLY WIT!1 1H[ STATE CONTPACTORS LAW 1827 RCW AND <br />796200 WAC <br />SIG4atUREO( ONin4C1(:'.��nr.n.U1HORl1[OnGENi ��.lC <br />�uc ns��veus � ssucu+ticr�o R�macsw[ss�e ����� <br />Go,gR,o eo�sr_ co . <br />MECHANICAL NV/ (N WNT/�/`�G� <br />NO. T'PE OF EOUIPMENT FEE <br />A/C— P/HNDLG UNITS— M P. <br />FORLEDAIRSYSTEIAS—B.T.U. M <br />IINITHEATEfiS—ATLI. M <br />VENTILATION FAN <br />RANG[HOOD <br />WOOD STOVE <br />METAL FIREPI <br />MEAT PUMP <br />GAS PIPING <br />YES ❑ NO <br />' euaoiNc <br />� OF DWELLINO UNITS <br />.a� PLUM0ING <br />G IOaO <br />� MECHANICAL <br />�GIITLIMITA^iION OTHER <br />N? STATE BUILDING Sl1RCNARGE <br />STATE ENERGV SURCHARGE <br />PUBLIC WORKS <br />TOTAL <br />TOTAL 5 <br />FEE <br />