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;�:.� ,-- <br /> APPLICATION FOR CONSTRUCTiON <br /> PERMIT <br /> GTY OF reon C C�.��„en,Q`� ��vcrell <br /> everett ��N� ��°�� e <br /> BUILDING DEPARTMENT G2z"� �7 <br /> 259•8870 TO BE COMPLETED IN INK— PLEASE PRINT <br /> ownen rnai�nooacss arv xm rnor�e <br /> �Er� Q-��i✓on� G�Ur° L,c, C(a�,or�/vi/ m�3sz,c- � 35G C��tir� Ce.,kf <br /> IENANT RIPILAOD�E55 GIIY 21P �� �fQHONp���� ��_�/,� <br /> 4 <br /> ♦RCHR[GiO�DES�GNLR IA��LAOOPE55 CIIY 21P PNObE <br /> f.fNERµCONiPr1GiOP M�ILAUURESS GILY ZIP PHOHE UCENSE• <br /> No%�� �,✓,uG �l-.�'. /`lzo� B�li,�.�t.c cus/ J'Ed;�_YP���'.T 3�1=�5�•� .vo2r,�/Ru3�7r� <br /> MEGIIAVIC�ICONIRACTOA MAILROOfiE55 CITV Z�P PI�ONE LICENSEo <br /> �LUMOINCCUNIi.eGiOR M�IL��ORESS CITY ZIP PHONE UGENSE� <br /> CL�SS OP\YOfiN <br /> ❑ NEW ❑ ADDITION �I hLTERATION ❑ REPAIR ❑ OEMOLIiION ❑ WOODSTOVUFRPLINS[RT ❑ BUILOINGRELOCAiION _ <br /> IEN�NT IMPROVEMENT OR R1iER10R REMO�EL ONLY GONtAGi PEfl50N AN�PIIONE 110 <br /> CONiitACTP1iICEOFWOfiN: MV�r-��7�-v0� ���—Ir�� _ <br /> DESGfVIpE WOfiN RNO SOUAlI[FOpiqpE INVOLVED <br /> PROPoSED USF OF OUtIOMG I HLRE6Y CER7IFY THA71 HAVC-READ AN D E%AM W ED THIS APPLICATION AN� <br /> � KNO W THE SAME TO BE'i RUE AND CORRECT.ALL PROVISIONS OF LAWS AN D <br /> lEOAL Dt9l'AUPfION OF PROVERtt�SHCWN BELOW OB ATTqCH FOUR GOPIE51 ORDINANCES GOVERNING THIS TYPE OF WORK WILI BE COMPLE7E�W�TH <br /> WHETHER SPEGFIED HEREIN UR NOT.7HE GFiANTING OF A PERMIT DOES NOT <br /> PRESUME TO GIVE A�JTHORITV TO VIOLATE OR CANCEL TfIE PROVISIONS OF <br /> �p� B�ocK or — ANYOTHERSTATEORLOCALLAWREGULATINGCONSTRUGTIONORTHEPER� <br /> FORMANCE OF CONSTf7UCTION.TI1A71�M AU7HOF.IZED BY THE OWNER OF <br /> THIS PROPERNTO PEf7FORM THE WORK FOR WHICH APPLICATION IS MADE <br /> - AND I COMPLV WI7ti THE ST�7E CONIRACTORS LAW 10.27 RCW AND <br /> 296.200 WAC. <br /> sir,Nnruneorcor+rencionor�nuniomzeoacer+r oare <br /> �ROJEGTADDRE55 ��� ���/�_ ✓/�/�— <br /> APPLICRNTS CIIv pU5R1E551 ICCNSC NO RND OUSW E55 NAlAE <br /> .� l _ <br /> PLUMBING MECHANICAI <br /> NO. 1YPEOFFIXTUfiEC[i1TEM FEE NO. TVPEOFEOUIPMENT FEE <br /> WATERCLOSET�TOILE7) A/C—A/HNDLG UNITS—H.P. _ <br /> 6ATHTUB FORCED AIR SVSTEMS—&T.0 Q M EA _ <br /> LAVATORYIWASHBASIN) UNITHEATERS—dT.U. M _ <br /> SHOWER CLOTHESDRYERS _ <br /> KITCHEN SINKB DISP. VENTILATION FPN <br /> DISHWASHER RANGE HOOD <br /> LAUNDRYTRAY WATERHEATER _ <br /> CLOTHES WASHER WOOD STOVE <br /> URINAL METAL FIRE?LACE 8 CIiIMNEY <br /> DFINKING FOUNTAIN FIREPLACEINSERT <br /> FLOOR DRAIM HEAT PUMP <br /> BACKFLOW PREVENTERS _�_ GAS PIPING __ _ <br /> ROOF DRAINS—RAINLEADERS EXHAUST FAN <br /> SINK(SERVICE—BAR,ETC.) _ — <br /> uUBTOTAL 5 SUBTOTAL 5 <br /> P[RMIT S PERMI7 S <br /> TOTAL FEE 5 TOTAL FEE S <br /> fRONiS[iBRGR AEPR9ETBACI( Slp[SEIOACN PIANCNECRNUMBEN FEE IIECEIPTNO. <br /> usezor+[ �Oi:.REA VALANTSIiE FEES VALUATION FEE <br /> ❑ves ❑ r+r <br /> BUILDING <br /> 1YPEOFGONST. OCCUPNNCYGROOP NO.OFOV.ELLINOUNITS — -- <br /> A�LOWABLE/ACTURL PLUMBING <br /> 512EOFBLDG. — M1�OFSTOI11E5 BSR?� OGGLOPO — <br /> ❑r MECHANICAL <br /> ❑N <br /> Neic�rtuninnnar+ OTHER <br /> fINESPRINKlEPS REOUIRED ❑YES ❑ NO STATE BUILDING SURCHARGE <br /> STATE EM1ERGY SUPCHARGE <br /> �PPLILAiIONRGC.pY PlANSAPPp.pY <br /> PUBLIC WORKS <br /> ����� TOTA�. _ <br />