Laserfiche WebLink
�- � <br /> APPLICA�'ION FOR CONSTRIi.:T10N <br /> PERMIT <br /> me Ere�gree� ��'�� <br /> �,.�o� �e <br /> everett <br /> BUILDING DEPARTMENT <br /> �� � 259-88t0 TO BE COMPLETED IN INK— PLEASE PR�NT <br /> � y. �;H�,�q MNI�ODHE55 � CIIY ZIP ✓H'JNC <br /> C M -L�IN � �D�ivCK /.7/�J ��1�_/�L �,�;i�c �r�lf`/ �'?�c / .,7.5,-.7SC�C� . <br /> � H N TCNANi MPIl6DORE55 LILY I�P FMONE <br /> F � �.� <br /> H z H �R`GMRECTORDC9�GNER /� /� MAIL/�DDRoESS- CT' ZIP �ONE <br /> K ''3 � (� /�,O ,Y �A' /CC/ `�.�"u^��l(i�...�-�' �� d•ia F r,C1A' 94�c/ •7�aroG 1 <br /> � � � ']�I�MP I_AN OL MAiL�DDHL49 / ' . •'� e �CrtY ZIP P110NE LIGENSE• � <br /> GENEMLG�MTHAGT011 <br /> VJ H <br /> TpZ M[CM�NIGLCONIMCTOA MNI��OPC&9 GTY ZIO PHONE UCLNSE• <br /> l-1 O � <br /> OH v�UMBINGCONTH�QlOP MAII�ODNE34 G'Y 21P PNDHE 4CENSE• <br /> �� 8 <br /> �� � C,-U,�590FWORN <br /> y L7 NEW ❑ ADOiTION ❑ ALTE�TION ❑ REPAIF ❑ DEMOLITION ❑ WOODSTOVFJPRPLINSERT ❑ BUILDIN6RELOCA710N <br /> 'Z H <br /> iEN�HTIMPRWEMCHTORINT[RqRN[MODELONLY � COMi�CioFN40H�N0oHONENp. <br /> 1 G <br /> y y H ��pNTRI.GIPPIGEOFWORK � Z� P"' I��- O {� S � ��S _ <br /> �� M DEscn�ecwouK�Nospuau[r�uri.cE r�vrnv[o�� <br /> ��� � ��7COo¢ /Vr�,, •�FFirc - <br /> � oroseo e ov�¢uaowo I HEREBV CERTIFY TMAT I HAVE READ AND E%AMMED 7M15 APPLICATION AND <br /> � �(I �t . ��!`�'�,L. KNOWTHESAMETOBETpUEAN�CARRECT.AILPROV1510N50FLAW5AN0 <br /> y 0 N \ ��� ORDINANCES GOVERkINO THIS TVPE OF INORK WIL�BE COMPLETED WIil1 <br /> IEGAIOESCHIT10NOiPBOi'ENi"(SnpNNBELOWOHl1TfLGMFOURGO%ES1 WHETH[RSPECIFlEDHEREINORNOiTHEGR/�NTiNGOFAPEPMI700E5N07 <br /> / PRESUME TO GIVE AUTHORITY TO VIOLFTE OR LANCEL THE PRQVISI(�N$OF <br /> � �p7�� g�p�K��-'� OF 'T� / '-� ANYOTHERSTATEORLOCFLLAWREGULATINGWNSTRUCTIONORTHEPER� <br /> FORIAANCE OF CONSTNUCTION THAT I AM AUTHORIZED 9Y THE OWWER OF <br /> • TNI$PROPERTY TO PERFORM THE WORK FOR WHICN APPLIC/iION I$MADE <br /> � �< ' B AND I CO�dPLV WIT11 Pi[ STATE CONTRALTORS LAW 1B2i fiCW AND <br /> 296200 WAC. <br /> sicr+nr��eo•�rnoc*our�inarzeoz�un o>rt <br /> X -%-/b'- �"� <br /> r <br /> PROJEGTADDRE55 �.CPL2�NT CrtV9 SW 5 F�G SEN . US�NESSN�ME <br /> ; i�3 C' /l, � <br /> � PLUMBING MELHANICAL <br /> NO. TYPEOFFIXTUREOPITEM FEE NO. TYPEOFEOUIPMENT FEE <br /> /� � WATERCLOSET�TOILET) — '/C-A/HNDLGUNITS-H.P. _ <br /> ( � BATNTUB FORCEDAIRSYSTEMS-BT.U. MEA <br /> LAVATORV(WASMBASIM UNITH[A1E175-BTU. M <br /> 1 I SMOWER CLOTH[SORVERS __ <br /> INITCH EN SINK 8 OISP. YSNTILAiION FAN <br /> . I�� DISH WASHER RANGE HOOD _ <br /> ���' LAUNDRV iFAY WATER HEATER _ <br /> � CLOTHES WASMER WOOD STGVE <br /> URINAL METAL FIREPLACE 8 CHIMNEY _ <br /> I , DRINKING FOUNTAIN FIREPLACE INSERT <br /> �� FLOOP DfiAIN HEAT PUMP <br /> BACKi'LOW PREVENTERS GAS PIPING <br /> ROOF DRAINS-RAINLEADERS EXNAUST fAN <br /> 11�' SINK(SEPVICE-BAR.ETC) <br /> � <br /> � ' t I SUBTOTAI b Sl1BTOTnL S <br /> PERMIT 5 PEFMIi 5 _ <br /> TOTAL FEE S TOTAL FEE 5 <br /> FRONi5Ei8�CR AE�RS[iBAGM 810ESET9I�CN NNCNCIt�BEP �FE�1�/,� NECEIPfNO.�/� <br /> I �\��� -7 _ I .� �� � ..� M fl (_�( <br /> � GGJ i�t . �..1 � Nv.r ! <br /> usEroHe LOIARW v�c�r�rsne FEES VALUATION FEE <br /> yYES n No <br /> L'�—1 6000 '' BUILOING / 7 <br /> NPEOFCANST � aCUPANCYGNO�P NOAfOWELLINpUNIT9 T �� <br /> nILOwABIE/�c1u/�t�/.� � /J � PLUMBINQ _ <br /> y L <br /> s¢EDve�oa r+o.ovsroaiEs BSMT. OGGLOFD � MECHANICAL <br /> Z 2lc0 t y' 2- p�, .�✓ — <br /> �rticNr urniunoe OTHER �Q�, - 7 3 <br /> nn[S�PINNLER9REOWHE� ❑YES O �� STATEBUILOIN6SUFCHARGE <br /> S7ATE ENERGY SURCHAfiGE �� <br /> AP�IIU�tIOlI1p�CC.9Y FUNS�PPHBY PUBLIGH'ORKS <br /> .�A �� 7 8 a <br /> � Il�C� TOTAL <br />