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1 <br /> APPLICATION FOR CONSTR4�:TION <br /> � PERMIT <br /> Ihs Ewrpreen <br /> GTV OF rvrrcll <br /> everett e <br /> BUILDINO DEPARTMENT <br /> 259-BBtO TO BE COAIPLETED IN INK— PLEASE PRINT <br /> qVNER M��L�pUfll53 LIIY J�i' �IID4E <br /> � _____ ._. .. _-- <br /> TEN�NI M�IL1DDfIFSS l]IV � !��' � VIIONF <br /> E�L"`�� LCIn„/� C �. I 3Gr� �CaSi �•!v �v��c't-� � � <br /> -- - - ----- -------- —---- --- — <br /> •ne�arceronoesinnen M.aeonncss cnr nr rvar+e <br /> - ---- -- -- -- -,r'�EFt�cl�Lo�. <br /> OENE1111LGONiP�CfOB MMl�b0111:95 �- r lllv '{7� )�I' - � 1`11011[ I�CENSE• <br /> M N�NIC�ICOHIR�CTON��� t1U�pllC9���r� �—�_' ��U� � ' w�. . . ��L �� LICENBF�"-'- <br /> - -- - -- - --Y�v3z_ --- --------- <br /> RUMMNOCONiR11GIOR M�II�DDOC4S I:i�Y )II' IYIONI IICEN9f� <br /> --_____-_______ . ..__ ._... . _..- . _... . _ . . . -____ <br /> Q11S�Oi WJ11N . ..- -.._...-_____ _._ <br /> ❑ NEW ��DDITION ❑ ALTERATION ❑ t1EP�IR � DEMOI.ITION ❑ WOODSIOVUfRPL INSEfiT_�_ OUILDIN6RELOCR710N <br /> TEN�NIIMPHOVEMENIORINfEI110R0E DE`ONLY CONII�G�f'E�SON�NOPBON N.rOr1 ` !L <br /> GpNfRACT PRICE O�W011K ��� CQ � O� Q � _ ��� �V J/`9� fl ^4 �O <br /> OEECRIBEV/OHN�NpeOU�PEfOD1/iOE NVOIVE ` <br /> I��fC-Tc.�Jd.� � GCi<i,.rJ N R;l1�r ------ ------------ — <br /> rrroroaEouscwemio�r�p � J�` ^ IHEiiEBYCEt7TIFVTMATIH�VEREADANDE%AMINEDTH19APPUCATIONAND <br /> E''TO� 'T'EC�-���c_v,� �iJ "�J�-�., KNOW i11E SAME TO DE TRUE AND CO�RECT ALL PROVIStON90F LAW9 qND <br /> iEqN.,oyyryWlp�q rnoncnrvis��avr�nc�owon auc��rouncones�-� -- ORDM4NCE5 GOO[RNIN(3 TIIIS tYPE OP WORK WIIL BE COMPLETEO WITH <br /> �'�/ )��.��L WHETHERSPECIIlEDHEREINORNOt.THEORANTIN00PAPERMITDOE9NOi <br /> CRESUME 70 OIVE AUl HOf1ITV TO VIOLAIE OR CAHCEI THE PROVISION9 OF <br /> lot Bioc�_— or __ ANVOifIERSTATF.ORLOCAILAWRE4ULAi1NOCONSiHUC710NORTHEPEP� <br /> L FORMANCEOFCONSTtiUCTION TIIATIAMAUTHORIIEOBV711EOWNEROF <br /> A�O,C'}t6� A '1 Lea-s � � ����a ��J �c��� ��co-ra 1�119PROP[RTVT07EfiPORM1NEWORKFORWNICHAPPLICAT10N19M11DE <br /> 1 � — ANU I COMPLY WITH THE STATE CONiRACTOqS LAW 1827 RCW AND <br /> 6 1 1 "'-' Y�QT O� T�SLdJ� ��, N[KQ.��C s�aN�u�Wor or��n�cr��irin�utr�onirco�arNT o��e <br /> �,,,,��S�k�C-e�'�410(� <br /> �w`rS' - -- X ��,��v��' " ' - cr,��'91d;n� <br /> P1qJEGI�00RE8S �PMI 19CIIYBU4i C ��NIlPU9�NE55NAME <br /> �., G C <br /> VLUMSINO MECMIINICAL <br /> N0. TYPE OF FII(NRE OR ITEM FEE N0. T'PE OF EOUIPMENT FEE <br /> WRiER CL09ET ITOIIEI) NC—A/IINDLG UNITS�-H P. <br /> _ __ .---_—__ __._ __ __ _.____ .________ . . . .___'_____' ________ ___ <br /> BAiNTUB FORCEDAIfI5Y51EMS--HT.U. MEA <br /> L�VATORVIWASHBASIN) UNITHEATERS--OTIl M ___ _ _ <br /> BNOWER CLOTHESORVFf15� � <br /> KITCNEN 91NK6 DISP. _ _ _� _VENTILAtION f�N _ _ _ _ _ I _�j� <br /> 019HWASHER RANOE NOOD <br /> IAUNDRY TRAV ---- —_ �_— WA7ER IIBAlEf1-��_- _� ' -- — <br /> CLOTHESWASHER WOODSTOVE � <br /> —_ —_.._— __._ _...__. .._.__ —'_. _ _ __...__._.__"_._ —__ —._ --_ ._ <br /> URINRL METAL fIREPLACE 8 CHIMNEY <br /> DRINKIN�FOUNTAIN FIREPLACE IN9ERT <br /> FLOOR DRAIN --- -- HEA1 PUMP�'�_ �_�------ -- — <br /> B�CKFLOW PREVENTER3 dA5 PIPINO <br /> ROOFOR�INS—RA�NLEADERS E%HAUS FpLN � <br /> SINK�SERVICE—BAR,ETC) _ �1��(�Ju{IG _—_ . � � — 5[L <br /> __ —_ .____ .—._._--__.-.. __._ ..___. _ ---- -- <br /> SUB TOiAL S __ _ SUB TOTAL _ 4 �f� <br /> PERMIT — f —_ - —— __— ____—______ _�PERM1IIT __ S --JS_ W <br /> IOTAL FEE S TOtAL FEE S � <br /> iRONIBFiB�CK RE��SEI9�CK 9�UE9EIp�f.''. RANCHFCNNUMB[R i[E AFCEIPTNO. <br /> usEtON[ �o��nEe v�tuacnr �-� FEEB VALUIITION FEE <br /> IttF9 iiNO <br /> TYPEOfCON9t OCCUI`ANCv0f10UP HOOfpWEILINOpNi1S BUILDINO . _ _ _ _ _ _ <br /> •IIOWABLE/�CN�I P�UMBINO <br /> __ -_--_-- _—_ ___— _ _—_ <br /> 6RE O�BlOO NO OI9�ORiCtl B9MI OCL LOM� <br /> _ __ <br /> n r MECH�NICAL <br /> ❑ N __-_._"__. __.._ ____. __.—__—. ____ '__— <br /> IICiOtl�LIMtlA�ION OTHER <br /> "_ _______ __._ .___"____ . <br /> fNE9PBINNlE115REWI1IED ores uNo , __. _ ___ _ STAIE�UILDINGSURCIIARGE <br /> STATE ENERGV SURCHARGE <br /> ervucenoe�cc a. ciews.ri�n er � --- -------. ___ _ --. -.-_-_—._--- ----- -- <br /> f'l1BLIC WORNS <br /> TOTAL <br />