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APPLICSa��ION FOR CONSTRI��:T10N <br /> PERMIT <br /> � M�Erorproen <br /> CITY OF evercll <br /> everett e <br /> BUILDING DEPART AENT <br /> 259•8810 TO @E COMPLETED IN INK— PLEASE PRIN; <br /> /��,P,C.9� /112s u� �vYcu"���ti /�/�J fi�Q«d_..yr�rCt1`' tu>i. 9j:1J/ e25�b-(o//G <br /> OWHFR M�ILApDPESS L11Y ¢IP p�ION[ <br /> TENANT MAII�DOPE54 GfY IiP i'MO <br /> C�scd a/ ��i( i3i �1 u„ , ' n a 1 -- <br /> u�rtectonoeswME� MAILADORESS 1 Jt�`� 1� � �a/C�'f�_Jr�Q)p,�ONEry���� / <br /> �,�ru. <s „�..� �r��,an-�aa�}�n� <br /> OENEfl�LCANiRA(,TOR MqL�ppRE99 QfY 21P PNONE LICENSE• <br /> MECIUNICAtCONTPALTOR MAq�00RE59 G�IY ZIP pNONE LIL[HSE• <br /> 0.11MBIN0[ONTRACtOR M�iL�ODPE59 GItY ZIP PHONE �ICENS[• <br /> GA94 OF YqRR�.-�� <br /> ❑ NEW YC ADDIti'JN ❑ ALTERATIOH ❑ REPAIP ❑ DEMOLIiION ❑ WOOOSTOVFJFRPLINGERT ❑ BUILOIN6RELOCATION <br /> IENNITIMVNOVEMENtORIN1ER10RNEMOOELONLY /J fqN1�C11'E1150H�NO/P�IpNE Q <br /> COHiR�CiPfiICEOFW0111( ��' � •�� �le�lG� C� k��C.�S d./ 'J '�� / � <br /> DElCflllE WORIt�NO SOU�RE iO01�0E INVOIVED <br /> /�e�t1 «,�t�( J cv � LNc% e /�tl <br /> %qP09E0 USE OF BUit�iNO I HEREBV CERTIFV THAT I HAVE READ AND E%AMINED THIS APPLICATION AND <br /> � ��7J.p " KNOWTHESAMETOBETRUEANDCORRECT.AILPROVI510N30FELTAEW5AND <br /> LEMLDE9CNIPTIONOFPROPEFTY�SlIOWNBEIOWOR�R�GNFO0RC0%ES� WHE HERS ECREDHE FNH RNO7T�HEGRA�TNIOOFAPEFMTbOESNfOT <br /> iOt_1� e�ocrc,.LI os �L-�S.J__ PRESUMETOGIVEAl1THORITYTOVIOI.ATEORCRNCELTHEPROV1510N90F <br /> ANYOTHER STATE OR IOCAL LqW FECULATI VO CONSTRUCTION OR THE PER• <br /> ' FORMANCE OF CONSTRUCTION.THAT I C.M AUTHOFIZEO BV THE OWNER OF <br /> 1��I � 1HISPROPERNTOPERFORMTHEWORkFORWHICHAPPLICATIONIBMADE <br /> AND I COMPLY WITH THE STATE CONTRACTORS LAW iB27 RCW AND <br /> 298.2W WAG <br /> SIGNQURE CONiRApyI 11 UIIINIRGOPGENi D�IE <br /> l <br /> �Scs+-�f �!/tc�Ta 9�—g'S( <br /> i X r <br /> " rnuree�',�ooAess /�'SGro�¢ Mr��wo�C�i <br /> ��� � �PMIG�ITSCITYOUS�- ` SIICENSEH011NOBU5ME59HSME <br /> I <br /> � PLUMBINO N.ECHANIC�L <br /> NO. TYPE OF FI%NRE OR ITEM FEE NO. TYPE OP EOUIPMENT FEE <br /> ; WATERCLOSET(TOILET) A/C—A/HNDLGUNITS—H.P. <br /> � <br /> BATHTUB FORCED AIR SVSTEMS—6t.U. M EA <br /> � LAVATORY(WASHBASIM UNITH[ATERS—B.T.U. M <br /> � SHOWEH CLOTHES�RYERS <br /> ' KITCHEN SINKB DISP. VENTILATION FAN <br /> DISHWASHER RANGE HOOD <br /> ' LAUNDRYTRAY WATER HEATER <br /> � CLOTHFSWASHEH WOpDSTOVE <br /> ,� URINAL METAL FIREPLACE 8 CHIMNEY <br /> � DRINKINaFpUNTAIN FIREPlACE1N5Ei7T <br /> ; FLOOH OR�IN HEAT PUMP <br /> �� BACKFLOWPREVENTERS GASPIPING <br /> i 1700FURAINS—RAINLEADERS EXHAUSTFAN <br /> SINK�SFRVICE—BAR,ETG) <br /> { <br /> SUBTOTAL S SUBTCTAL 5 <br /> PERMIT S PERMIT E <br /> TOTAL FEE 5 TOTAL FEE 5 <br /> iFRONISETB��O / PEAR9ETB�CR SIOESE1p9LY, P�E����� FE� �� pECE1PTNO.�O� <br /> � � 13 <br /> ' VSEZONE LOI�REA WG�NI 555Ii��� <br /> � P � I-�'�_ o YES �yHo FEES VALUATION FEE <br /> �` � ^ BUILbING �'j/�/ � "� <br /> TYFEOFCAN9T. p��PANCY0�0UP NO.OFDWELLINOUNIi9 _��n� � <br /> /��pWABtE/ACTlIFLTi �./ � -� � <br /> .J! � PLUM6ING <br /> 91IEOFBItOQ, NO.OF910RIE9 BSMT. OCGLO�U - <br /> /Y�'�' � o N /�/� MECHANICAL _ <br /> :� HEI(iNTI�MIIAiION OTHE�i <br /> FIRESPRINNLER9REWmEO OYES ' NO STATEBUILDINGSUfiCHARGG /.-�/ ) <br /> eL� <br /> j STATEENERGYSURCHARGE <br /> 1 AFPLIWTIpr�n:�.or r�ws�aa� - <br /> �i O / PUBLIC WORKS <br /> / TOTAL C� <br />