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-� �.. <br /> APPLICATION FOR CONSTRUCTION <br /> !Ae Ererpreen PERMIT <br /> CIIY OF <br /> everett � . ��e,e,� <br /> BUILDING DEPARTMENT e <br /> 259-8810 TO BE COMPLETED IN INK-PLEASE PRINT <br /> UW�EA MMLA�OflE55 <br /> �`✓ � /' CRT ZIP PnONE <br /> ! /� , / <br /> tEH.Wi f/(/fo,�2�saA /� //� e7r /�'i 4✓iSrc.—CVcieG7 9Y�o ' �J 7�/OGG <br /> -7- M4L�DDRE59 p1Y 1 ` � <br /> Z�P R�ONE <br /> �NCNITECTORI`LSqNEH . MIJLApDRCSS <br /> - CITY I�P PMO4E <br /> r.eHe.�rorn.c.on ��jtev w�����v f✓+r��ir�, i a �v-�.�� 9�7 03 3 S 3��,.`I <br /> CrtY ZIP R�ONE — <br /> IiCENSE• <br /> MECHAHIC�LCOHiR�i00 M�ILADOFE34 <br /> CI1Y ZiP MONG <br /> LiLEI:SE e <br /> MVMpNOCONiMCfOR MML�pDRE59 <br /> Gl\ IIP — pqOHE�� <br /> I�CEHSE• <br /> GLV!OF WORK <br /> ❑ NEW ❑ 11pD1T10N ❑ ALTERATION ❑ REPAIq �, DEMOIITIDN ❑ WOODSTOVE/FRPLINSERi ❑ BUILDINGPELOLATION <br /> fENMIiIMPROVEMENtORINTEpqpqEM00[LONLY <br /> CONT�ICT P[RSpN AND PHONE NO <br /> GONTHACT PR1�Of Y/ORK <br /> M�lE YYORK�NU SOU�PE FOOiMiE INVOLVEO <br /> ' c-� ' �� <br /> rra useor ioiH <br /> �— _ � IHEREBVCERTIFYTHATIHAVEREADANDEXAMINEDTHISAPPLICATIONAND <br /> KNOW THE SAME TO BE TRUE ANU CORRECT.ALl PqOVISIONS OF LAN'$AND <br /> LEMIDESCHIPf10HOFPpppEpry�gqpyp�gE��,NOR�RhCHFOUHGO01E3� ORDINAtlCESGOVERNWGTHISTVPEOFWpRKWILIBECOMPLETtDW1T11 <br /> WHETHER SPECIFIED HEREIN OR NO?.THE fiRqNTING OFA PERMIT DOES NOT <br /> tor g�p�K OF _ PRESUME TO GIVE AUTHJt71TV TO VIOLATE OR CANCEL THE PROVISIONS Oi <br /> ANY OTHE9 STATE OR LOCAL LAW REGULATINO CANSTFiUCTION OF 7HE PER� <br /> FORMANLE OF CONSTAUCTION.THAT I AM AU7HOPo2ED BV TME OWNER OF <br /> TIiIS PROPEqTV TO PERFORM iHE WORK FOR W HICH APPLICATION IS MADE <br /> AND 1 COMPLY WITH THE STATE CONTHACT09S LAW 18.27 RCN AND <br /> 288200 WAC. <br /> S�ONATUREOFCONiPAGTOPOl1AUiN0AlIE�AGEHT DAt[ <br /> MqJECi�^D0AE83 //�� ', �. _ \/ � y <br /> �// I��/� r •��'� 1���� �Spi B ME6ELI�ENEN��BUSME� <br /> l 4 � <br /> MUM�INO V MECHl�NICAL <br /> �• TYPEOFFI1fTUpEtqITEM FEE NO. TYPEOFEOUIPMENT <br /> WATER CLOSET(TOILET) FEE <br /> BATHTUB - NC—NHNDLGIINITS—H.P. <br /> FORCED AIR SYSTEMS—B.T.U. M EA <br /> UVATORY(WA$HBASIM UN�THEATERS—B.T.U. A� <br /> SHOWE9 <br /> KITCHEN SINK 6 DISP. CLOTHES OFVEq� — <br /> DISHWASHER <br /> VENiILA710N FAN <br /> LAUNDRYTRAV RANGEHOOD <br /> CLOTHESIVASHER WATER HEATER — <br /> URINNL �^/OOD STOVE <br /> METAL FIREPLACE 8 CHIMNEY <br /> DRINKINO FOUNTAIN F'IREPLACEINSERT <br /> FLOOq DRAIN <br /> HEAT PUMP <br /> BACKFLOW PqEVENTERS OAS PIPIIJG <br /> ROOF ORAINS—RAINLEADERS EXHAUST FAN <br /> SINK�SERVICE—BtiR,ETCJ _ <br /> SUBTOTAL S SUBTOTAL <br /> PERMIT S <br /> s PERMIT y <br /> fRONTSETBI�CK q�RB�T�CKEE S TO7A�FEE a <br /> 81pE6lT&1GN PLANCMECNNUMBEX iEE RECEIPiMO. <br /> USEZONE ��T�R� <br /> VAGNT 61TE <br /> . ❑rEs e r+o FEES VALUAiION FEE <br /> TYVEOFCON9T. p�pppµ�YOHOUP NDOFpN'ELLINOVNiTB BUILDINO <br /> �LIOW�BLFJACTUA{, <br /> SIEE OF BIDU PIUMBING <br /> NO.OF6TOPIEB B9M7. OGGLO�O <br /> �Y MECHANICAL <br /> ON <br /> NEIONTLIM17�TION OTHER <br /> iIRE BPiiINNlER9 REOUIPEO ❑YE9 0 NO <br /> S7ATE BUILDING 8URCHARGE <br /> .�� �� <br /> APP�ILAiION AGG BY STATE ENERGY SURGMARGE <br /> PL�NB�PPR.BY <br /> PUBLIC WOFKS <br /> TOTAL <br /> .� '_" <br />