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APPLICA�ION FOR COI�lSTRIi�.:T10N <br /> P�RMIT <br /> Ine Erorpieen <br /> CITY OF [wc•!ett <br /> ev�erett � <br /> BUILDING DEPARTMENT <br /> 259•8810 Tp BE COMPLETED IN INK—PLEASE PRINT <br /> OWMER 1MIL�ODHE55 OTY ZiP PHONE ` <br /> /7i'. ( � �P� 7 .',��. .33�?7 �'a/�� f�. -ri�.2oi <br /> ��N* M.aeooness . cm z�c vwone — <br /> •HCMREQORDESqNER MUL�ODFE55 GrtY 2!P PnONE <br /> � F,��� � ya - <br /> � e�s ,a- /7� %.S�C Cu 5�J6 ?s-s�llh' �(A s�-C�. , <br /> � �CTOA 1.WL��DRESS LRV 21P MONE L�CENSE.�• <br /> MEUI�NI(;ALCONTq��TON WiLADDRE55 C1TV 21G RION[ L�GEHSE� <br /> RUM&NOGONTq�TOR IMIL�Of1qE83 GTY ZIP PHpNE LICEN6E♦ <br /> CLI55 Of NpRK �� <br /> ❑ NEW ❑ ADDITION [l�l AITERATION ❑ fiEPAIR ❑ DEMOLITION ❑ WOOOSiOVE/FRPL INSERT ❑ 6UILDING REIOCRTION <br /> TEN�NT IMPROJEMENT OR IIRERqR REMODEL OHLY CqNTACf PEpgpN rN0 PNONE NO <br /> CONiRI�GT('R�GE OF WpRK <br /> UE9CRIBE WORk AND SOU�HE FOOTAOE INVpLVED <br /> W�OPJSED USE Of BW 10�N6 <br /> I HEREBY CERTff Y THAT I HAVE REAO AND E%AMINED THIS APPLICATION AND <br /> �� . KNOWTHESAMETOBETAUEANDCORAECT.ALLPROVISIONSOFLAWSAND <br /> L[(i1iL OE9CRIVfpN U'Pi10PEHfY BMOWN BELON OI1 RTACN fpUP COPIE91 ORDINANCES GOVERNING THIS TVPE Of WORK WILL BE COMPLETED WITH <br /> WHETH[R SPECIFIED HEREIN OR NOT.THE Gi74NTING OF A PERMIT DGES NOT <br /> LOT B�OCK OF FASSUME TO GNE AUTHOFIiV TO VIOLhTE OF,CANCEL THE PhOVISIONS OF <br /> ANV OTHEF STATE OR LOCAL lAW REGULATING CON579UCTION OR THE PER� <br /> FORMANCE OF CONSTRUCTION.THAT I AM AUTMORIZED BY iHE OVJNER OF <br /> THIS PROPERTY TO PERFORM iHE WONK FpR WHICH APPUCATION IS MqDE <br /> -� AND 1 COIdPLY WI7� 7HE SLttE CONTRACTORS LAW 1827 R�yy AND <br /> 296200 WAC. <br /> SIGNATUREOICONiq�CiORlIFnUir10n12[OAGENi D4if. <br /> X <br /> rno�ea�ooness � - J(� ��'j <br /> 3 �� /�, / AP ��NT9CITYBUS� SU�ENS p U9iN SNAME <br /> / �_ ` <br /> L.0 <br /> rLUMSIXO MECHANIC�L <br /> MO. T'P£OF Fl%TLRE OII ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WAiERCLOSET�TOILE� i A/C—A/HNDLGUNITS—H.P. <br /> BATHTUB FORCED AIR SYSTEMS—B.1.U. M EA <br /> _ UVATORryW/SHBASIN) UNITNEATERS-9T.U. M <br /> SHOWER CLOTHES ORYERS <br /> KITCHEN SINKB DISP. VEN7ILATION FAN <br />� DISHWASHER RANGE HOOD <br />� UUNDRV TRAV � <br /> WATER H!_qTER <br /> CLOTHES WASHER WOOD ST�VE <br /> URINAL METAL fIFEPLAGE 8 CHIMNEV <br /> DRINKING FOUNTAIN FIREPLACE INGER7 <br /> FIOOq DRAIN HEAT PUMP <br /> BACKFLOW PREVENT'cRS GAS PIPING <br /> ROOF DRAINS—RAINLEADERS EXHAUST FAN <br /> SINK�SEFVICE—BAR,ETQ) — <br /> _ SUBTOTAL S SUBTJTAL S <br /> PERMIT a PERMIT g <br /> TOTALfEE S 707�LFEE S <br /> ��ONTBETB�CK REARSETB�CN Si�ESETB�GN Pt�NCNECKMUMlE11 FEE pECE�r'/M0� <br /> usczor�E iot�nF� v.c�H*srte FEES YALUIITION FEE <br /> ❑YE9 ❑ NO <br /> TVPEO�CANST. OCCUP�HCYpRCUP NOOFOW(��INpUNlT9 BUILDING <br /> �llOw�BLE/�CfU�L — <br /> PLUMBING <br /> ea¢or e�oc. No ov s*oaies esur. xc io.o " - — <br /> �Y MECHANICAL <br /> ❑N <br /> MEi01!tIIMR�TbN OTHER <br /> FIPESPf11NKlER9NEWIREC r�yES ❑ NO <br /> — STATE BUILDING SURGHFRCaE <br /> S7ATEENERGVSURCHARGE <br /> ♦PPLIC�TION�CG BV PU1N3�PPR.PV — — <br /> PUBLIC WORNS <br /> TOTAL <br />