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APPLICi�t10N FOR CONSTRI.�.T10N <br /> PERMIT <br /> IM Erorpnsn <br /> CITY OF cvrret� <br /> everett e <br /> BUILDING DEPARTMENT <br /> �59•BBtO TO BE COMPLETE6IN INlC— PLEASE PRINT <br /> p�Ep Muuovacss cnr nr rrroa[ <br /> x ��� MeK�� 19�L_�o�e�1 AvE. evc-�-r �ezo� zs�t-z�za <br /> T[NeHT M�tL1100RE64 GtY 21P RIONE <br /> NILNREGtOAUE910H[A MML�OOHE88 Cilr 210 I'MONE <br /> OEMEP�LGONIR�CiOH M�IL�DDRE89 CRY ZIP PNONE LIGENSC� <br /> X �7 _ <br /> MECN�NiGICONTF�LTON M�ILADUAE39 GfY 21P PNONE LICENBE• <br /> N.{IMMMOGOMTR�GION MMLMORE83 CIfY 11P 1'110NE LILENSC/ <br /> CU1B60[WDRIt �q <br /> ❑ NEW ❑ ADDITION Wl AITERATION ❑ REPAIR ❑ OEMOLITION ❑ WOODSTOVFJFRPLINSERT ❑ BUILDINOPELOCATION <br /> 7EM�Nt IM�ROV4MENI OB�N1EFi0R NEMOUEL ONLY CANIIiGI PGRSpN�N��IqNf NO <br /> ya�rn.cT micE or woaK �'`3 SU <br /> o[e:niacworm•wosvu•n[roo*�o[mvavco p�T10vC- `tA'� S��ED <br /> X I A�StAI� 1 NK F12F wkly TO CT4T (h[-C Ui"C�M _ <br /> Fl1010EED W E Oi BVILDINO I HEREBV CERTIFV THAT 1 NAVE PEA�AND EXAMMED TNIS APPLIC�TION RND <br /> T SM�1E - �����E NNOW?HESAMET06ETf7UEANDCOAAECT.ALLPROV�5�ON90FLMNSAND <br /> �Epr,�oEecnmqNarnorEmrlBHo.vHBELoxonntucHroUntcwlEs� OROINANCESGOVERNINGTHISTVP[OFWORKWIILBECOMPLETEOWIM <br /> WNETHER SPEGFIED NEREIN OR NOT.THE GRANTING OF A PERMIT DOES NOT <br /> r L�� ��� .�p� � 11 'I ^�� j.��=../ �-1_I PRESUMETOGIVEAUTHORITVTOVIOLATEORCANCELTNEPROVISIONSOF <br /> _0.1 rl In Dip`— qNYOTHER57ATEORLOC�ILAWREGULRi1NGCONSTRUCTiON�]RTHEPER� <br /> FORMANCE OF CANSTFUGTION.iNAT I AM AUTHOR12ED BY THE OWNER OF <br /> ' TH�S PROPER7Y TO PERFORM THE WORK FOR WHICN APPLICRTION lu MADE <br /> -- AND I COMPIY WITH TI/E STATE CON7RACTORS LMN ifl27 RCW AND <br /> 296200 W�C. <br /> SION�iUREOfGONiBACIO�OfUU1HORIZED�OENf DGIE � —zC1�89 <br /> X �a�— � ��"s'-- <br /> FlIOJEGT 110URE58 �PPLIG�NB CIIY 9USINELS UCEN9E NO�ND PU91NE89 NAME <br />`, 14 31 C-OC_g�j AuE �v�zE-iT un �5zo I <br /> /WM/INO MECNIINICAL <br /> NO. TYrE OF FI1IN11E ON ITEM FEE NO. TYPE OF EOUiPMENT FEE <br /> W�TEP CLOSET(TOILEn A/C-NHNDLG UNI7S-H P. <br /> BATHTUB FOt�CEOAIR5V5TGMS-BT,U. MEA <br /> LAVIUOFY(WIISNBISIN) UNITHEATERS-B.TU. M <br /> 9HOWER GLOTHESORYERS <br /> KITCHEN SINK 6 DISP. VEN7ILATION FAN <br /> DISHWASHER RANGE HOOD <br /> UUNDRY TRRY N'ATER HEATER <br /> CLOTMES WASHER WO00 STOVE <br /> URINAL METAL FIREPLACE 8 CNIMNEV <br /> DRINKINO FOUNTAIN FIREPLACE INSEBi <br /> FLOOH ORAIN HEAT PUMP ' <br /> B�CKFLOW PREVENTER3 GAS PIPING �� <br /> ROOF DRAINS-FAINLEADERS E%HAUST FAN <br /> SINK(SERVICE-BAR,ETC.) — <br /> 5UBTOTAL S SUBTOTAL S <br /> PERMIT S PERMIT S <br /> TOTAIFEE E TOTALFEE S <br /> iflOMSEiB�Gk FlEAPSE�OPCM ulUES[IpnpN FUINCNECtlNOMBEq FEE OECEIVfNO. <br /> Ue[zonE �o1�nE� V�G�NiBrtE FEES VALUATION FEE <br /> ❑ves o No <br /> BUILDINO <br /> rypEpfCON6T. pCCU��VICYOROUP NOOFDWELLINOUNIt9 — <br /> alow�BLFiecTU�l PLUMBING <br /> 812E Oi BlDO. NO.Of 6fOH1EB BSMT. OCC LO�U <br /> ❑v MECNANICAI <br /> ON — <br /> i <br /> — NEIOMTlIM11�TqN OTHER <br /> iIREB�PINNL[R9P[WIRED OVEB ONO STATEBUILDINOSURCHARGE <br /> STATE ENERGV SURCMFRGF. <br /> •PVLIUiIONAGGBY PUN9�PPR9Y <br /> PUBLIC WORKS <br /> TOTAL <br />