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� �_ <br /> '�`. APPLIC�fi'ION FOR CONSTR t"" TION <br /> PERMIT <br /> m.E..ror.s� � <br /> GTV OF everett �'I <br /> ; everett e � <br /> ! BUILDING DEPARTMENT � <br /> � 259-8810 TO BE COMPLETED IN INK- PLEASE PRINT <br /> , r.3^� onx � R45z' � <br />�� OWNEN MML�DORE53 � LiiY LP PNONE I ;, ~i <br /> ! f�Ri G-Af��r«R ��l l3oGK5 � NC-WS,.� CU�� `1820( �lS�!-�3t� <br /> TFry,�ryT Ml1�I,DORE59 CITY ZIP PMONE <br /> (:� <br /> - NICNITE�UPDE6iONEA M�ILADDFESS G�1Y 21V PMONE I <br /> � � OENEMLGONTR�LTOR M�IL�D�RESS CRY ZIG PMONE LiCENSE• <br /> : P�'6� Sou�nJTeNi dqlclNiNG- G20 .iNDt�siRiAL.�A� S�rt�E ��iIOB �22�2�q �uG�riTisO�� <br /> MECM�N�GKCANTReGTOR MI11lADOPE59 GItY IIV PNONE LICENBE�� <br /> � <br /> ' PLVMBINOLONTNIICTOR M�IL�OORESS G7Y ZIP PHONE UCEN6EI � <br /> � CLMBOFNVRIt <br />�'� " NEW ❑ ADDITIOV ❑ ALTEHRTION ❑ REPAIR ❑ DEMOLITION ❑ WOOOSTOVFJFqPLINSENT ❑ BUILDINGRELOCATI�N <br /> . TENM/T IMPROVEMENT OR INT RIOR R^EMOOEL ONLY G CONI�Ci PEHSON�NO PHONF NO I <br /> � CONTql1CTPRICEOiWORI( � /�SO' D�� �J II <br /> � DEpCqIlE WOPM�H080UARE FOOTApE INVOIVEU , <br /> '� ,: wN i!d C� II <br /> . neoroeeouseorem�on+a IHEREBVCERTIPI'THATIHnVEREADANDEXAMINEDTHISRVPLICATIONAND <br />°i ,,,...JJJ �1I � KNOW TNE 9AME TO BE 7RUE AND CARRECT.ALL PROVIBION9 CF LAW8 AND <br /> j ��\ scei onbFvnorERIV�BNOWHOELOWOR�TUCNiOUNCAPIE& �A�INANCESOOVERNINGTHISTVPEOFWORKWILLBECAMPLETEDWITM <br /> „ WHETNERSPEGFIEDMEREINORNOT.THEGF�NTINOOfAPERMITDOE8N0T i <br /> r PRESUME TO GIVE AUTHORITY TO VIOLATE OR C�NCEL THE PROVIS�ONS OF i <br /> � �m B�ocK or ANVOTNERSiniEORLOCALLAWREGULATINGCONSTRUCTIONORiHEPER- <br /> FORMANCE OP CONSTpUCT�ON.THAT I AM AUTMORIZED BY THE OWNER OF <br /> THIS PROPERTY TO PERfOFM THE WORK FOR W HICM APPLIC�TIDN IS MADE <br /> ,� AND I COMPLY WITH THE STATE CANTi7ACTORS LAW iB.27 RCW AND <br /> �� 286200 WAC. <br /> 510N�TUREOFCONiH�LiDRORGUiHONAED�GENT O�TE ��/�� <br /> j � � <br />'P �� �ila�i ��� '� <br />, Plq��pEss� /�, _ , ^ / GPPLIC�M9GIfYBVBME49UCENSENO�NDBUSINESSN�ME II <br /> �, i ��F�i r�y, i <br /> j: � L—�J`"-��/Y <br /> VWMBIN6 MECHwNICAL I <br /> NO. TTE OF FIKTUIIE OR�TEM FEE NO. TYPE OF EOUIPMENT FEE '' <br /> �� WATERCLOSET(TOILEn NC—NHNDLGUNITS—H.P. I i <br /> �� BATHTUB FORCED AIR SVSTEMS—B.T.U. M EA �� <br /> � UVATORV(WASMBA9IN) UNITMEATEFS—B.T.U. M � <br /> 'j $HOWEH CLOTHESDRYERS � <br /> �� KITCHEN SINK6 D�SP. VENTILATION FAN I i <br /> ! D18HWA9HER RANGE HOOD ' <br /> iLAUNDRYTRAV WATER HEATER <br /> { CLOTHE9WASHER WOODSTOVE �, � <br /> 1 URINAL METAL FIREPLACE 6 CHIMNEY <br /> � DRINKINO FOUNTAIN FIREPLACE INSEFi _ <br /> � FLOOR DRAIN HEAT PUMP �, <br /> BACKFLOW PREVENTERS OAS PIPING ' � <br /> . ROOFDRA�NS—RAINLEADERS EXHAUSTFAN <br /> . 61NK(SERVICE—BAR,ETQ) <br /> � I <br /> SUB TOTAL 5 SUB TOTAL S <br /> � PERMIT E PEFMIT S <br /> TOTAL FEE S TOTAL FEE S <br /> FIpHiBE'BACfl AFARBETB�CR 5i�E5ETB�GK PIANCNEC UMlEN FEi ID �ECEIPfMD. <br /> ueE2oNE �or�nu veceHtsrte FEES VALUATION FEE <br /> O YE8 �0 <br /> TYPEOFCONST. OCCUPANCYOROUP NOAFDWELLINOONI18 BUILDING a <br /> �LLOWeBLE� TUeL PLUMBING <br /> -n! l3 - Z — <br /> BRE O'BLDO. ,.,Z $.F NO OF BTOFIEB B9ML pCG LO�D <br /> ❑r __ MECHANICAL <br /> WM — ❑N — <br /> NEIOMiLIMI1�T10N O7NEii <br /> FlPi BPPIHRLERB REOUIREO u v¢a v No STATE BUILDWG SURCHARGE <br /> STATE ENE(i0V SURCHNRGE <br /> APPLIC���BY 1'UHS�1PPR B` <br /> PUBLIC WORKS <br /> � TOTAL 5, <br /> I <br /> C�'w`!U,Y.'.}Ta.�:',�cAY."�7i7xC'�nFi&T rx1-'ZT� .: !,.{•P�:. ti-:..!'.'.:f r..� �.w?.'v'.-!1't . v . . �'i�C� � � ^.v. ; 'ti�':1:y n^' � I <br />