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APPLICATION FOR CONSTRUCTION <br /> PEI�;�iA1T <br /> !he Erorpfe+n <br /> QTY OF everett <br /> everett e <br /> BUILDING DEPARTMENT <br /> 259•8810 TO BE COMPLETED IN INK— PLEASE PRINT <br /> �hVNER IM�LADpR/[54 Glr Zlv pMONE <br /> 1l/�st�r��efr��?� � .�r�ar isA��,p� �v�.�� 9�zo� 3.7�-icc c <br /> i[N�HT M4UL�DORE59 GI1T Z�P PNONE <br /> •IKMRECIOPOESIGNEN 1MILADDNEBS QTY ZIP p11pHE <br /> �Cy7C � ��.�SOC.. ��V L✓Yn�/i'Lr� /!�4 �✓�r? 90 T03 3c 3-���y <br /> ccHEwafb�TllKfOR MAIL�WRE55--7 Giv ZIP RIpHE iLEHSC• <br /> IAECN�NiCALCONl1UGiOH MIJIAD�HESS '�fY ZIP PN�NE L�GEN6E� <br /> RUM&NOGONTF�CTOR MMI�DDRE63 G1Y Z�P MqNE {.ICEN9E• <br /> :U9!OF N9PK <br /> ❑ NEW ❑ AODITION ❑ ALTEPATION L1 REPAIP � DEMOlI110N ❑ WOOOSTOVFJFRPLINSERT ❑ BUILDINORELOGFiION <br /> �ENWI IMPIIW EMENi OF IMERqq PEMOpEL ONLY CqN11�Gi PE�SOH�ND VHONE NO <br /> GONiMGiPPiCEOf WORK <br /> DE9CRIlEWJRkAND80UME O0111UE�VEp <br /> - C'��( ` `� ! 1C�l,L"� <br /> PHOPOlEp U8E Oi BUILOINO <br /> r 1 HGREBV CERTIFY TH�T I HAVE FEAD AND EXAMINED THIS APPUCRTION AND <br /> ��I- I� KNCWJ THE SAtdE 70 BE TRUE AND CORRECT.AlL PROVIS�ONS OF l.MNS�ND <br /> �EWIDEBCHIPfqNOFPROPERiY�SNONXBELOWOF�TLICN FOURCANEB� ORD�NANCES GOVFRNING THIS NPE OF WORK WILL BE COMPIETED WITM <br /> WNEIMER SPEpFIED HEREIN OR NOT.THEGF�NTING OF A PERMIT DOE9 NOT <br /> im �aK oF PRESl1ME TO GIVE AUTHORIiV TO VIOLATE OR CANCEL THE PROVISIONS OF <br /> AfJY 07HER STA7E OP LOCRL LAW REGUUTING CONSTRUCTION Oii THE PER� <br /> FORMFNCE OF CONSTRUCTION.TNAi I AM AUTHORIZED BV THE OWNEN OF <br /> THIS PROPERtt TO PERFORM THE WORK FOR WNICH pPPUCRTION IS M�DE <br /> AND I COMPLY WITH THE STATE CONTRACTORS LAW 1827 RCW AND <br /> 286.E00\YAG <br /> 91GN�7UREOFCPNTRAGiOROHAUTHOi1RE0AOENi D�tE <br /> PRPIEGi�ppRE68 6CIi IHES UG[N�.�NOBU$—Y�' — `— <br /> �'-'-'.� �°C''��_ '����� <br /> PLUMlINO � � MECNANICAL <br /> NO. TYPEOFFII(1VREONI7EM FEE NO. TYPEOFEOUIPMENT FEE <br /> WATEH CLOSET(TOILEn A/C-A/HNDLG UNITS-H.P. <br /> BATHTUB FORCED AIR SYSTEMS-flT.U. M EA <br /> LAVl�TOpV ryJRSH BASIN) UNIT HEATI:RS-�T.U. M <br /> 9HON'ER CLOTHES D�9YERS <br /> KITCIiEN SINK6 D:SP. VEN7ILRTION FAN <br /> DISHWASHER RANGEHOOG <br /> CAUNDRYTRAV WATER HEATEk <br /> CLOTHES WASHER WOOD STOVE <br /> URINAL METAL FIREPLAGE6 CHIMNEV <br /> DRINKINp FOUNTAIN FIREPLACE INSEFT <br /> FLOOF DRAtN HEAT PUMP <br /> BACKFLOW PREVENiERS GAS PIPINO <br /> ROOF DNAINS-RAINLEADERS E%HAU57 FAN <br /> SINK(SERVICE-BAR,ETC.� <br /> SUBTOTA� S SUBTUTAL S <br /> PERMIT S PERMI7 E <br /> TOTAL FEE S TOTAI F1'E S <br /> FRONT6ETBACK RFARbEf9�CR fiIPEbETBACK PIANCNECkMUMSER FEE qECE1PfM0. <br /> USEZONE LOTAHEA V�C�NTBITE FEEH VALUATION FEE <br /> O YEB O NO <br /> lYPEOiCON4T. OCGUP�NCYONOUP NO.OFOWELLINOUNILS BUILDINO <br /> �LLOW�BIFJ�CiWI <br /> PLUMBINO <br /> SIZEOFBLDO. ND.OFBi0RIE8 &9Mi, OCGLO/.0 <br /> I o Y MECHANICAL <br /> ON _ <br /> MEIOHTLIMIT�TION OTHER <br /> fIRE9PRINKlEF9AE0UIREU OYE9 ONO 9TATEBUILDINOSURCHARGE <br /> STATE ENEROY SURCHARGE <br /> APP4CQION�CGBY PUNBAPPRBY <br /> PUBUC WORKS <br /> TOTAL <br />