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� ry� <br /> 1 APPLI�ATION FOR CONSTI��C�'ION <br /> i PERMIT <br /> � CITYOF roen <br /> everett everett <br /> � BUILDING DEPARTMENT � <br /> � 259-eet0 TO BE COMPLETED iN INK— PLEASE PRINT <br /> ; <br /> � OWNER /'+ /� MAIL�DORE55 CIiY ZIP PHONe <br /> .{ �� ' '—y�—l! / �M�I D S� �Z�� J 4� / �L!Y/ir ��0 ZIP O�Y�6"// O /!J ZD� ,. <br /> I <br /> ' � MCHRECiORDESIpNEN M�IL�ODflESS pTY ZIP PHONE <br /> � — <br /> I1 . <br /> '��� 4ENEMLCANTR�CTOR �AAIL�pDPESS pITY 21F' PHONE �ICEN9E• <br /> ' QdKAr✓ vCo 3UZo <br /> ,� R..�.c.K� Ar/a�; u,7a� 3dSc�- ,��..,�.Qrr-T -2 L <br /> _ � MECX�NICALCANTMCTOR . MAIL�ODCiP9 � CIT1 21P PHONE ��CI��CENSE• <br /> ��� PLUM&NOCANTR�CiLP M�!L�OORESS CIiY LIP PHONE /y�ry S b' <br /> � �8�? PL�,�..M6�...a �N6,A7 �3stoG r�trs7 s� o ..,�.sy ��jS2g?� z1P� "ii L:R <br /> , 7F�1uNiMPnovEMEATDOPIINOTERIOOEMooE oN�ON ❑ REPAIR ❑ DEMOLITION CON❑TACTVPOERSONONDPNONE oSERi ❑ BUILDINGRELOCATION <br /> I.� <br /> � CONiPACTPRICEOFWOqK <br /> �� OElCPolEWOPNANOBOU�FEFOOT�pEINVOWED <br /> 1 ��y� ,( <br /> •S � ��'� !1F'►IG(/� /J4f5[I�-f(� <br /> ,� �nnOr�leoweocem� N --� IHEREBVCERTIFYTHATIHAVEREADANDEXAMINEDTHISAPPLICATIONAND <br /> .� KNOW THE SAME TO BE TRUE qND CORRECL ALL PROVISION30F UW$AND <br /> IEMLDEBCpIPfIONOFPR'JPEPTY(SHOWNEELOWORATT�CHFO'�P��r1E5� OfiDINANCES60VERNINGINIS7VPEOFWORKWILLBECOMPLETEDWI7H <br /> � WHETHER SPECIFIED HEREIN OP NOT.THE GRANTINGOFA PERMRDOES NOT <br /> �m B�xK oF PRESUME TOOIVE AUTHORITV TO VICLATE OR CANCEL THE PROV1810NS OF <br /> � ANY OTHER STATE OR LOCAL LAW RE�ULATINQ CONSTRUCTION OR THE PER- <br /> FORMANCE OF CONSTRUCTION.THAT I AM AUTHORI2ED BV THE OWNER OF <br /> � THIS PROPERiV i0 PERFORM THE WORK FOR WHICH APPLICATION IB MADE <br /> � � AND I COMPLI' WITH T4E STATE CONTRACTORS LAW 1827 RCW AND <br /> ") 286200 WAG !///�� <br /> SION�TUREOFCONfR�CTOROFAUTHOR2E0A6ENT D�TE <br /> i <br /> �{ PIqJECfMURE88 ��"'L / � �a�J J 7 <br /> .� APPLIC�NTS CITY BUSINE59 LICENSE NO�ND BUSINE&4 N�ME <br /> Z L�'�. �.✓ � L ��..G� v� <br /> I �WMSINp MECHANICAL <br /> � NO. TYPE OF FIXTURE OR ITEM FEE NO. 7YPE OF EQUIPMENT FEE <br /> �� WATERCL03ET(TOILEn A/C—A/HNDLGUNITS—H.P. <br /> j <br /> ! BATHTUB FORCEDAIRSYSTEMS-6T.U. MEA <br /> ;� LAVATORY(WASMBASIN) UNITHEATERS-6T.U. M <br /> �I 9HOWER CLOTHESDRVERS <br /> � KITCMEN SINK 8 DISP. VENTILATION FAN <br /> �� DISHWASHER qANGEHOOD <br /> �� LAUNORVTRAY WATER HEATER <br /> '� CLOTHES WA9HeR WOOD STOVE <br /> �' URINAL METAL FIREPLACEE CHIMNEY <br /> �� DRINKINO FOUNTAIN FIREPLACE INSERT <br /> FLOOR DMIN HEAT PUMP <br /> ��� BACKFLOW PqEVENTEFS GAS PIPING <br /> � ROOFDRAIN3—RAINLEADERS EXHAUSTFAN <br /> I SINK�SERVICE—BAR,ETG) <br /> co�'- <br /> , <br /> � SUBTOTAL S SUBTOTAL S <br /> PERMIT S PERMiT S i <br /> TOTALFEE S TOTALFEE E <br /> FFONTBETBACK REARSET&1CK SIDESETB�CIt PIANLNECKNUMBER FEE RECEIPfNp. � <br /> I <br /> UBEZONE LOT�HFA VACANTSItE � <br /> O YES a no FEES VALUATION FEE <br /> 7YFEOFCAN9T. OCCUPANCYQROUP NO.OFDWELL�NOUNITS BUILDING <br /> �� u�rnwe�u�crwu <br /> PLUMBING <br /> MSEOFBLO(i NO.OFS70RIE9 BSMT. OCGlORO <br /> �Y MECHANICAL <br /> ❑N <br /> I HEIONiLIMITRTION OTHER - <br /> FINEBPi11NNLEHSPEOUIRED O YES ❑NO STATE BUILDING SUFICHARGE <br /> , . _ __ <br /> STATE ENFRGY SURCHARGE <br /> ' MPLIC�TIONAC0.BY PI�NS�PPR.6Y <br /> i <br /> PUBLIC WORKS <br /> i — <br /> i TOTAL <br /> .� - <br /> d <br /> 1 <br /> 1 <br />