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APPLIC,�`��tON �OR CONSTRUa:T10N <br /> � PERMIT <br /> fhs Erorpreen <br /> GTV OF everetl <br /> everett � <br /> BUILDING DEPARTMENT ' ° <br /> 259•8810 TO BE COMPLETED IN INK— PLEASE PRINT <br /> pWnNEH MAILADURESS GIIY ZIP ('HONE <br /> l�.fSf.�oC.SAVIN65 ,�oe.v.AsSoo�Ana�J d7f�?F �if/�Avc Ev.w�. 9r.zo� 339-SSoO EXTa6/ <br /> iENaHT MML�DOOESS Gli Z�P PNONE <br /> MGHREGTONDES�6NEN MML�DDOE55 GiY 2�P PHONE <br /> OENENeIGONfR�C10P M�i��DOnE59 Ci1Y Z�P PHONE LIGENSE• <br /> Cne�srorN���yNS��ucnuN /�so8 �/b�y da.Nc /�Isvl. 9f27� Gs3•aavy CNchSG�qUG7 <br /> ME�:M�MGLCONiR�1CTOR MAILMORE59 CI1V I�P R10NE LICENSE• <br /> RUM�NOCONTiULtOR MMi�D0�E4S CI1V i�� PNONE L�CEN9E• <br /> SeRt.�-�Lv�nBiNEi i5�i? �ES7W/L/L !_'d .$n.t.�Nnm.yy �t/?. 9�2�0 S�6B•��7Py �� <br /> QA9D Of NORK CG�USC/G.0 f�/'��Q( <br /> ❑ NEW ❑ ADDITION � ALTEMTION ❑ REPAIR ❑ DEMOL1710N ❑ WOODSTOVFJFRPLINSERT ❑ BUIlDIN6RELOCRTION <br /> TEN�11T IMPPpVEMEMT OR INTERIOR REMOOEL OHLY GONTM1CT PERSON�Np pNONE NO. <br /> CONTpACT PRICE OF WORK <br /> DElGpIBE NORN�Np 90U�RE fOOT�pE tNVOlVEO <br /> morosEo u5E or ewimHa 1 MEREDV CERTIFV THAT 1 HAVE REAO AND EXRMINED iHIS APPLICATION AND <br /> KNOW THE SAtJE TO BE TRUE AND CORRECT.ALL PROVISIONS OF UWS AND <br /> IEO�LDESGPIPTIONUFPROFE117Y14MOWNBELOWOR�TTACHI0URC01'IES� ORDINANCESGOVERNINGTHISlVPEOFWORKWILLOECOMPLEJEDWI7H <br /> WHETHER SPECIf!ED HEREIN OR NOT.THE GRANTING OF A PER�IITDOES NOT <br /> PqESUME TO GIVE AU71tORITV TO VIO;ATE OR CANCEL THE PROVISIONS OF <br /> LOT B�oGK oF ANYO7HERSTATEORIOCALLAWREGULATINGCONSTRUCTIONORTHEPER� <br /> FORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZE�BV THE OWNER OF <br /> THIS PHOPERTY TO PERfORM TME WORK FOR WNICH ANFLICATION IS MADE <br /> AND I COMPLY WITH THE STATE CONTRACTORS LAW 78.27 RCW AND <br /> 288200 WAC. <br /> woneruneoveoxraecronrn�nun�onizeoecer+i oac <br /> RqJECT ADDPEeS � ��/�— %��p�+ �O✓. 3U�/J f v <br /> �PPLIG�NTS CItY BUSINE59 LICEN9E NO.eN0 BUSINF59 NeA1E <br /> a0 Q ve. Ev. Cv.�. <br /> PLUMBINO MECHANICAI <br /> NO. TYPE OF fl1lTUIIE ON ITEM FEE HO. TYPE OF EOUIPMENT FEE <br /> 1 WATERCLOSET(TOILEI) A/C-A(HNDLGUNITS-N,P. <br /> � BATHNB FORCED AIR SYSTEMS-9T.U. M EA <br /> UVATORY(WASMBASIM UNITHEAT[RS-B.T.U. M <br /> SHOWER CLOTHES DRYEfiS <br /> � KITCHENSINK6015P. VENTILATIONFAN <br /> DISHWASHEF PANGE HOOD <br /> � / LAUNDRYTRAV WATER HEATER � <br /> � CLOTHE3WA�HER WOODSTOVE <br /> URINAL METAL FIREPLACEB CNIMNEV <br /> DRINKINQ FOUNTAIN fIREPLACEINSERT <br /> FLUGH DRAIN HEAT PUMP <br /> BACKFLOW PREVENTERS GAS PIPING <br /> � ROOFORAIN9-RAINLEADERS E%HAUSTFAN <br /> SINK(SERVICE-BAR,ETC.) <br /> i <br /> SUBiOTAL E _a SUBTOiAL S <br /> PCRMIT E PERMI7 S Q� <br /> TOTAL FEE S TOTAL FE[ S <br /> FRONT6ETBHCK REARFEtB�CN SIOEbETBhGN VUNCHEGKNOMBER fEE AECEIPTNO. <br /> WezoNe �otea� V�GtNTBI1F FEES VALUATION FEE <br /> O YEB O NO <br /> BUILDINO <br /> IYPEOFCONST. OGCVP�NCYpROUP NO.OFDWELLINOUN179 <br /> ALLOWABLE/ACTUAL <br /> PLUM6IN� as _� <br /> AILEOFBLDO, ND.OFBIOHIEB BSMi. OCGIO�D <br /> ❑r MECHANICAL Cn <br /> � ❑N Ld"' <br /> NEWNTIIMifAIION OTNER <br /> flPE9PPINItLERSREOUIRED ❑r¢s o wo STATE BUILDING SURCHARGE <br /> � � STATE ENERGV SIIP.CHARGE <br /> APPIIC�TION ACG BY MH9 APPR.BY <br /> PUBLIC WORKS <br /> TOTAL l <br />