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APPLIC. r10N FOR CONSTRI �TION <br /> PERMIT <br /> 1��Ewrprssn <br /> CI7Y OF iwrrMt <br /> everett e <br /> BUILDINQ DEPARTMENT <br /> 250•eB10 TO BE COMPLETED IN INK— PLEASE PRINT <br /> MFH M�iI�UURE99 Giv � 2iP PIIOi <br /> �.,✓�, ,�P�,�,v„��� I�.) , !/'n�.(���.t�.b V� q�Z <br /> IEN�NT MqL�pOAES " Ci v S�P PNO�E <br /> ��ICNITELTORpEB�ONER M�IL�DDNFB! C�1Y IIP PMONE <br /> OEN[R�LCON�HI�CIOA M�R�pDPE89 COY i1P PHONE LiGCNBL• <br /> s�;�TN �/c i¢sas� ,r�� �9n�t i,/�a„��<<� w� �s�� Sm�TNAc�S��� <br /> MECN�NIWIGOMI AL GR MNL��URE99 f.�tY ZiP PHOHE LICFN9E• <br /> RUMlINOCONTRACTOR MAIL�DDRElS CrtY 21P PHONE �ICENlE• <br /> �CjU�!!Of NV11R <br /> �a! NEW ❑ ADDITIO� ❑ �LTEMTION ❑ NEPAIP. ❑ OEMOLIiION ❑ WOODSTOVE/FRPL IN9ERT ❑ BUIl01N0 RELOC�TION <br /> TENM1iIMPIqVEMENIOXINTERiONPEMOOE N�LY/� fANt�CTPERSOHINDPMONE40 <br /> CONTRACT M1ICE OF WJRK ��J OUO <br /> OElLPolEM'ORk�NUlO � EIOpT�0E1NVOlVED <br /> /A/.Sria(1� I/ C DGGT S�S��ryr <br /> PROPOlkO U!F Oi MIILDINO 1 HEREBV CERTIFV THAT 1 MAVE READ�ND EXAMINED THI9 APPLIC�I"ION AND <br /> QF�/(GS ��JA�� NNOWTHE9AMETOBETRUEANDCAFRECT.ALLPROV1910N90FLAW911ND <br /> lFWLOElCNIMqNOiPBOPEPtt�6NOWNBELQVOR�RI�CNiOUPGONEW ORDINANCESOOVERNINaTH19TVPEOFWORKWILLBECOMPLETEOWITH <br /> WHETHER SPECIFIE�HEFEIN OR NOT.THE QRANTINOOf A PERMITDOI'9 NOT <br /> PRESUME TOOIVE AUTIIOHITV TO VIOLATE OR C�NCEL THE PRONBIOIVB OF <br /> Lpt e�ocu or pNVOTH[RS7A7EORLOCAILAWREOULATIN4CONSTRUGTIONORTHEPER� <br /> FORMANCE OF CANSTRUCTION.THAT 1 AM AUTIIORIZED BY TME OWNEfi OF <br /> THIS PROPEHTV TO P[RFORM THE WORK FOR WHICH APPLICATION 19 MADE <br /> — AND 1 COMPLV WITH THE 9TAiE CONTRACTOR9 LAW 1BR7 RCW AND <br /> l 288200 WAC. p G <br /> �j —� &ON�fUPEOiGONTP�CTOPORA ORREO�OENT D�TE��IJ/O(Y <br /> . �� � <br /> .� <br /> �� � �PPLIC�HTeCITYB1191NE9llICEN9ENU�N�BU8INE!lN�ME <br /> M.UM�INO MECHIINICIIL <br /> NO. TYPE OI FIXTUqE OII 1T[M FEE NO. TYPE OF EOUIPMENT FFE <br /> WATER CL09ET(fOILEI) NC-NHNDLO UNITB--H,P. <br /> &1TMTUB FORCED AIR SYSTEM9-6T.U. M EA <br /> UVATORVIWA9H BA91M UNIT MEATERS-9T.U. M <br /> BHOWEq CIOTHE9DRYERS <br /> KITCHEN 91NK 6 DISP. VENTILATION FAN <br /> D18HWASHER RANOE HOOD <br /> LAUNOFYTRAV WATERHEATER <br /> CLOTHEB WA9HER WOOD STOVE <br /> URINAL METAL FIREPLACE d CHIMNEY <br /> DRINKINQ FOUNTAIN FIHEPL�CE INSERT <br /> FLOOR DHI11N HEAT PUMP — ��0.✓ - ( <br /> B�CKFLOW PREVENTERS AA9 PIPINQ <br /> ROOF DNAIN9-RAINLEADERS E%H�UST FAN <br /> 81NK BERVICE-BAH,ETC.) <br /> BUBTOiAI i SUBTOTAL i <br /> PERMIT t PERMIT f <br /> TOTALFEE f TUTALFEE f <br /> fRONTBE*B�Ck PEARBETBACM BIOE8EId1Gn FlANCH[CItMUM![II f[[ 11[ld1AN0. <br /> useioNe ioru[e WC�NTlAE PEEB VALUIITION FEE <br /> ❑YEB ❑It0 <br /> lYPEOFCqNlT. OLCUPANCYOfIDUP NOOfON'ELLIIqUNITB BUILDINO <br /> �/lOW1BlE/ACIU�I <br /> PLUMBINQ <br /> BRE Oi BLOU NO Oi 6TONIE9 B9Mf. OCG LO�D <br /> ❑r MECHANICAL <br /> ' ❑N — <br /> NEIONTIIMIf�TION OTHER <br /> fINElPRINMlEP4REWIRE� ❑YE8 CI NO <br /> STATE BUILDIM3 SURCHARQE <br /> STATE ENERGV 9URCHAH6E <br /> ♦P%IC�TION IiCC BY R�H!�vpR 9Y <br /> PUBLI(:WORHS <br /> TOTAL <br />