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APPLI�TION FOR CONSTI�CTION <br /> PERMIT <br /> '� . CITYOF�n everett <br /> everett e <br /> BUILDIN(i DEPARTMENT <br /> 269�BB10 TO BE COMPLETED IN INK—PLEASE PRINT <br /> N p 1MIL�UDpE53 CITY LIP PHaNE <br /> t T�+ear; F�er�,a �Eu 6a6 ��� s.u,. E�c.esrr 4Bao� 77H- 33�3 ' <br /> .RNN1f I.WLI�OOPESY CI7Y LIF . PNONE <br /> ^� y'R14 r�C o /Orl d- f £UdA6-IzF6N cu� Ev,�f�rr �� 9B�ae <br /> NKJIITEC70RDEBIONEA pWLADDPES4� � CITY 21P PMONE <br /> p[MEMLCOMTMCIOR AWll10DRE5S GITY 21P pHONE LICENBE� <br /> " C�asca-c!� �owiwtE C�� 15T1 �f i41 �U.E . �+dl�••uib` 9Bo?3 994-3l�3 Gl9SCAtcUOPo_ <br /> d M6q1�NICKCONTMCR7R IMILAOGRESS QfY ZIP PHONE LICEN9E• <br /> � <br /> RUYMNOCONTM(.'fOM 1M�L�UUPESS CITY .:IP PHONE IICEN7E• <br /> , n,�n�.� w�M,c cP.u-Qa �laµ� Gre��ncv���C N� So_a��E `1Aro3 ��`v-y�xJ A.Vot[//1 a930N <br /> o►wonK ,../ <br /> Q NENr ❑ ADDITION L7 ALTEMTION ❑ REPAIR ❑ DEMOLITION ❑ N'OOD9TOVEIFRPLIN9ERT ❑ BUILOINOREIOCATION <br /> WWT MAFl�WfMlNT OR INTER1011 FEMODEL ONL� CONUCf PERSON ANU PNONE NQ � <br /> S � .CONTIIACTMICEOF W0111C <br /> p!/Cp1Y[MIORMANOl01MNE fOOT/i0E INVOWLD <br /> rp0�0lEO u![W suawn0 I NEREBV CERTIFY THAT I HAVE pEAD AND EXAMINED THI3 MPLICATION AND <br /> KNOW THE SAME TO BE THUE pND CORRECL ALl PROVI310N90F UYAlB AND <br /> ►tyl�p!lCNIPfIONOFPXOVEMYIONOWNBELOWOR�n�CNFOURCOPIE& OROINANCE3pOVERNIN4THI5TYPEOFWORKWILLBECOMPLETEDWITH <br /> WHETHER SPECIFIED HEREIN OH NOT.TMEGRANTINpOFA PERMIT DOE9 NOT <br /> PRESUME TO QIVE AUTHORIN TO VIOUTE OR CANCEL TME PROVISIONB OF <br /> t,pr Monc Of ANVOTHERSTATEORLOCALLAWRE6UUTINOCANSTRUCTIONORTHEPER� <br /> � FORMANCE OF CANSTRUCT�ON.THAT I AM AUTHORRED BY THE OWNER OF <br /> ' TMISPROPERiYTOPEHFORMTHEWORKFORWHICHAPPLICA710N18MADE. <br /> � AND I COMPLY WIiN THE 87ATE CONTPACTORS LNN 1827'fiCW AND <br /> . . 288200 WAC. <br /> . 516NATUREOFLONTIUCTO ONAUf110RIZEDMENT OATE B�1�I��JO . <br /> I'' � <br /> AOONEl6 APPLIC BCIT U ENSENQMIOBU&NE9SIMME <br /> oaosqa- F�N • mwFKoda B, . <br /> �.� M.UMlINO MECNANIGL <br /> �� pp,� TYrEOFfIXTU1IFORITEM FEE NO. TYPEOFEGUIPMENT FEE <br /> WATERCLOSET OIL j. /0• OU NC—NMNOL�UNITS—H.P. • <br /> BATHTUB FORCED AIR SVSTEMS—flT.U. M EA <br /> LAIMTORY ASH BA91M • t!O UNIT HEATERS—&T.U. M <br /> BHOWER CLJTMESDRVERS <br /> WTCHEN SINKB DISP. VENTILATION FAN <br /> DISMWA9NER RANGE HOOD <br /> LAUNDRVTMV WATER HEATER <br /> CLOTHE8 WASNER WOOD STOVE <br /> URINAL METAL FIREPLACE 8 CMIMNEY <br /> � � DRINKINQFOUNTNN fIREPLACEINSERT <br /> � FLOORDMIN HEATPUMP <br /> BACKFIOW PREVENTEHS OAS PIPIN6 <br /> � ROOFDRIUN9—FWNIEADERB E%MAUSTFAN <br /> 91NK 9ERVICE—BAR ETC.) <br /> � SUBTOTAL S O 00 SUBTOTAL t 6. S77 <br /> PERMIT S PERMIT S S. 00 <br /> � TOTAL FEE S r30 Od TOTAL FEE S �I• <br /> '�(IqNiBETMCN RFARBETBIICK 81DESET&1LK VIANCXECKNYYBER FEE IIEC61If1q. <br /> �WEZONE �Oi�a� v�c�ni8iie FEES VALUATION FEE <br /> O YE9 O NO <br /> eui�oiNa <br /> � 7Y/{pfCONSL OCW CTOROUP NO.OFOWELLINOUNIT9 <br /> �. 'LL�qwKU�tu'LL FIUMBINO <br /> - �gpF�pp NQOF9TONIEB esMt, occ�o�o MECMANICAL <br /> OY <br /> ON <br /> ;�� HE16HTLIM�TATION OTHER <br /> :�`I MEOPNINNLEN9REOUiREO a vEe o No gTATE BUILDINO SUflCHARGE <br /> t� STATE ENER6Y SURCHARGE <br /> if� �ppuCn7iar�CCav vwrs�wrrtav pUBLICWORKS <br /> � TOTAL <br /> ��r. <br /> r �- ..F , �x.. . �..�.�•kt ' �r.�;i. ... <•.:•�n'7 _ �.•t��. ' .;.r} .. <br />