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APPLICATION FOR CONSTRUCTION <br /> PERMIT � <br /> m.ewro,..� � <br /> CRY OF evere�t � <br /> everett e <br /> BUILDING DEPAHTMENT <br /> 258•8810 TO BE COMPLETED IN INK— PLEASE PRINT <br /> � <br /> p�Vf�Ff � A1�.IL e��PE55 CITY ZIP PHONE <br /> HUUyA.'TUvc� G.L�:�►�� c�'iu�, ��, . ,�?'1y;tJ��i1sl'i$F: k t;,t�icc:/ ' J'�'1L ��� ��JS � <br /> �NAHT MAII ADOPESS GRY 21P PMONE 'i <br /> �C`�Lc�¢.t�' E<J13v,;1�•��r� C�C.��+L-� t'� .`.353'[.>�i.3 ) .. <br /> � UICHITECTOROESIONER --�M�IL�DORE55 Crtv ZIP PHONE '�. <br /> SA�rt.c �.S �x.u,� r�� . /�f�/�.c/G�l-�/j9A ' <br /> GE IUL C�NTR�CTOR M�IL�ODRESS GITY ZIP PHONE LICENSE• I <br /> ����.,-� ,E,c�ti�,�, �a,r�;,�a ��,�-�;�. , ��« . ���:�- .�� �� � <br /> ME IUNICALfANTMCTOB MML�OORESS CITY ZIP PHONE LICENSEY ��. <br /> ,d '�Lc r � t �oaVi,�-�;. /-�.�,� � �,� , G� `�- ��S- �/b� � <br /> Pl pCON CTpp MRIL�00 ESS CITY ZIP PHONE LICEN9EY II <br /> S�,v:1e ►�'.�.�;ca . �, <br /> CU&t OF WORN <br /> � NEW ❑ ADD�TION ❑ ALTEMTION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FP7LINSEflT ❑ B4ILDINGRELOCATION J <br /> � TENIIHTIMPROVEMENTOi11NlERIORREMODE�ONLY WNTRCTPERSONANOPHONENO �J/ /� p( '� <br /> CONTNACTPPICEOFNORK�I.��. � � � .�C)CJ �. � _ �C6�f � �UW /,� /.J '.. <br /> pE9CP18ENOPNAND MEF TMaE1NVO�VEO � 1 <br /> �D� is- 1 ib� ,L. c�,.��7'. — i <br /> PNOPpSED USE OF BUILDIN6 I HEREBV CEHTIFY THAT I HAVE READ AND EXAMINED THtS APPLICATION AND I <br /> S/.Vy'�, ��yj�-/� Cq . KNOWTHESAMETOBETRUEANOCORRECT.ALLPROVISIONSOFLAWSAND 1 <br /> � LEMLDESCRiVIIONOFPPOPEPtt�SMOW aeLOWON�TT�CNFOURCOPIES� OROINANCESGOVERNINGTHISTVPEOFWOfiKWILLBECOMPLETEDWITH i <br /> n WHETHER SPECIFIED HEREIN Ofi NOT.THE GRANTING OFAPERMITOOES NOT <br /> .1, u(y� L���/.� PRESUME TO GIVE AUTHORITV TO VIOLATE OR CANCEL THE PROVISIONS OP <br /> �OT� e�ocK or � � ANVOTHERSTATEORLOCALLAWREGULATWGCONSTRUCTIONORTMEPER� <br /> FOFMANCE OF CONSTRUCTION.THAT I AM AUTHORRED BV THE OWNEH OF I <br /> THIS PROPERTV TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE � i <br /> � AND I -MPLY WI�H THE STAiE CONTFACTORS LAW 1827 RCW AND � <br /> 2962 C. <br /> SIGN�TU E Oi CONTMCTOR ON AUTHOfl12EQ�GENT U�TE <br /> p� i <br /> X ,...�� /" L t�0 5/�i d"' � <br /> ��E���A� � � A PLIC�NTSCRVBUSINESS ICENSENO�NOBOSINESSN�ME � <br /> t/9.�U �'Cn�.��iz-.�r�u.��z, ��i��'i� _ , � <br /> _ ; <br /> PWMBING MECHANICAL , � <br /> qp. TYPE OF FIXTURE ON ITEM FEE NO. TYPE OF EOUIVMENT FEE �, 3� <br /> WATERCLOSET�TOILEf) '�' A/C—A/HNDLGUNITS—H.P. �, .� <br /> . BATHTUB FORCED AtR SVSTEMS—dT.U. M EA <br /> � IAVATORV�WASHBASW) '� UNITHEATERS—&T.U. M �� �' <br /> gHpyyEp CLOTHESORVERS � <br /> . � KITCMENSINKBDISP. � � VENTILATIONFAN — <br /> J DISHWASHER RANGE HOOD <br /> � LAUNDRYTPAY WATER HEATER � � <br /> CLOTHES WASHER � WO00 STOVE I �� <br /> � URINAL METAL FIREPLACEB CHIMNEV j � <br /> . DRINKING FOUNTAIN FIREPLACE INSERT �I <br /> FLOOR DRAIN HEAT PUMP " a <br /> 1 <br /> , BACKFLOW PflEVENTERS GAS PIPING .� <br /> ROOF DRAINS—RAINLEADERS EXHAUST FAN ' <br /> _ SINK�SERVICE—BAR,ETC.) �'�] <br /> , I <br /> SUBiOTAL S — SUBTOTAL E � ��� <br /> PERMIT S PERMIT S � ] <br /> TOTAL FEE S � TOTAL FEE S � <br /> FpONTSEiBGGK NEARSETB/�CN SIOESETBACK VLAHC ECKNIIMlEP FEE 11ECEPfNO. <br /> Zo� 't�s•wa,►r- C' � �l 5 '`I 'Ya�' �O� � <br /> usezory�— I �men� r V �NTSRE FEES WILUATION FEE � �� <br /> K I� �!�� �.ES ❑ NO ,/ �� I � <br /> IYPEOFCOHST. OLLUP NCYABOUP NOOFDWE�LINOUNITS BUILDING Y <br /> A�LOw�e�t/�cTu�� �/ �� PLUMBING � <br /> �r <br /> 91ZE OF BL00. NO.OF STOHIES � OCG LORD � � <br /> �d � a t / ❑ N �'� MECHANICAL <br /> P <br /> 7SSO SF PT�^GC MEIOXTLIr�lr�iron� OTHER <br /> FIPEBMINKtERBREWIRED ❑YES ❑NO �0 � , <br /> STATEBUILD�NCaSURCHARGE ,/ <br /> STATE ENEROV SURCHAFGE ✓�I <br /> APPLLCATIOy I�CC BY K�NS�PP�.BY <br /> v' /� PUBLIC WORKS f <br /> " ��o TOTAL � �� <br /> q� .`�� �'.rt' t , Ck2 r I �7 U r �l�vT i <br /> �� ��.r n�� � n � rfir ` <br />