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a�, .�- <br /> APPLICATIOFI FOR CONSTRUCTION <br /> PERMIT <br /> Ihe Eveiprean <br /> CITYOF �r..�-.{.�'J �•verr.l� <br /> everett `J°� e <br /> ,o,.� ����� <br /> BUILDING DEPARTMENT (�,2Z- ��� <br /> 259-8870 TO BE COMPLETED IN INK— PLEASE PRINT <br /> OWNER IAAILRODt1E55 CiIT ZiP PHONE <br /> oEr�/C /,�-cL i,/pn� G.cou� L,C, C(q,,ar�ra�/ d m�3scr � 3 S G C�[r��6r a C H.,fee <br /> iEN�NT IA�ILPOORE55 CItY Z�p �� �IQp�4�rDY ��S/, <br /> / <br /> ARCIIITECLOPOES�GNER MRILnD�iiE55 CII\' Zlv pHONE <br /> OENEAnIGONiPA�inOR MaILPDD�E55 CIiV ZIP PIIONE �ICE�lSF• <br /> .1�oai� f%ruC �J-,�,'. /9Zo�� B.4tt_.,�,�t.c LuS/ ./'F�AJPc.��i,l',r 3�t-�s���/ .<-�aL�t/Aus�71F <br /> MECNRNIGFLGONiPRGTOR MRILR��PES9 pIV ZIP PMONE L6ENSE• <br /> `� <br /> IRUMOINOCONIMGIOfl M�Il�00RE55 GITY ZIP PMONE LIGENSE• <br /> C1h55 0F VA�RN <br /> ❑ NEW ❑ ADDITION � ALTERATION ❑ R,iPAIR ❑ DEMOLITION ❑ WOODSTOVUFRPL INSE�iI' ❑ BUILDING RELOCATION <br /> TENRNT IIAPRpVEMENT OR iMEPIOR PEMODEL ONLY CONTACi PERSON AND PIIONE NO. � <br /> coNrn�crnniceorwonK _ �V���c.2/p,</ 3(P,�—/�{/� <br /> DESCRIBE WORK RND SQU�BE F W UpE INVOLVED <br /> rnorroseo use or ew�owc I H ER[BY CERTIFV THA71 HAVE READ AND E%AMINED 7H IS APPLICATION AND <br /> � � KNOWTl1ESAMETOBETRUEANOCOFRECT.ALLPROV:SIONSOFIAWSAND <br /> � ORDINANCES GOVERNING THIS 7YPE OF IYORK WILL BE COMPLETED WITH <br /> ieon� es PIPIIONOFPfiOPEBTY(SHOWNBEIOWORATTACHFOU�COP1E51 WHETHERSPECIFIEDHEREINORNOT.THEGRANTINGOFAPERMIiDOESNOT <br /> PRESUME TO GIVE AUTHORIN TO VIOLATE OR CANCEI THE PROVISIONS OF <br /> �or___ e�ocK or ANVOTHERSTATEORLOCALLAWREGULATINGCONSTRUCTIONORTHEPER� <br /> FORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE OWNER OF <br /> THIS PROPERN TO PERFORM TH[WORK FOR WHICH APPLIGATION IS MADE <br /> — AND I COMPLY WITH THE STA1E COIJTRACTCI75 LAW 18.27 fiC6V AND <br /> 296.200 WAC. <br /> SIG11fdME0FCONTBACiOf�011Aptl�OR12E0AGENT OAIE <br /> PPOJEG�rl00R�. -- ��' --`� �/�/ <br /> �� APVLIGAl1i5 CIiY BUSINESS IJCEflS[NO.AND OU3W[55 NRb1E <br /> �� L <br /> PLUMBINCa MECHANICAL <br /> NO. TYPE OF FIXTURE 091TEM FEE NO. TYPE OF EOUIPMENT FEE <br /> _ WATERCLOSET�f01LET) --j A/C—A/HNDLGUNITS—H.P. <br /> BATHTUB _ !_ FORCEDAIFSYSTEMS—B.T.UfJQMEA ___ <br /> LAVATORYIWASHBASIN) � UNITHEATERS—O.T.U. M <br /> SHOWEfi CLOTHES�RYERS <br /> KITCHEN SINKB DISP. VENTILATION FAN <br /> DISHWASHER RANGE HOOD <br /> LAUNDi7Y TRAY !NATER HEATC-R <br /> CLOTHES WASHER WOOD STOVE <br /> URINAI METAI FIREPLAC[8 CHIMNEV <br /> DRINKING FOUNTAIN FIREPLACEINS[RT <br /> FLOOR DRAIN HEAT PUMP <br /> BACKFLOW PREVENTERS � GAS PIPING <br /> FOOF DRAINS—RAIN�EADERS EXHAUST FAN <br /> SINK(SERVICE—BAR,ETC.) <br /> SUBTOTAL S SUOTOTAL 5 <br /> PERMIT $ PERMIT 3 <br /> TOTAL FEE $ TOTALFEE S <br /> FRONiSEiBnCN REFRSEiBRCN SiUES[IOnCH PIANCNECNNOM0E11 FEE PECEIPTNO. <br /> usezoNe LOIAPER VAGANTSIiE FEES VALUIITION FEE <br /> O YES ❑ NO <br /> ttPECFCONST. OLLU�ANGYGBOUP NO.OFOWELL�NGUNIiS BUILDING _ <br /> ALIOWABLVFGTURL <br /> PLUMBING <br /> S�ZE OF BLDG. NOAF SiOfLES &SMT. OCG LJRO <br /> ❑v MECHANICAL <br /> ❑ N <br /> NEIGIITLVd17Aii0N OTHER <br /> FRESPflINKLER51iE0UIRE0 ❑ves ❑ r�o STATE BUII�W�SURCHARGE <br /> STATE ENERGY SURCHAfiGE <br /> pPPLIC\TION�CC OY PLANSAPPR BY <br /> PUBLIC WORI<S <br /> ----d� TOTAL <br />