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,;, .;:,. <br /> . APPLICi�.�ION FQR CO�NSTR���TION <br /> PERMIT � <br /> fh�Ewpn�n <br /> GTV OF <br /> everett . �"e'e" <br /> BUILDIN(i DEPARTMENT e <br /> 269-8B10 TO BE COMPLETED IN INK- PLEASE PRINT <br /> Ep 1T�l IMIIApDPE55 //� CIIY ZIP PNONE J <br /> �OI 1� ���� OI /�r/ ��L'/�-�lX � ���V��� r��/ Il -�r/ l r ' <br /> h�T MNL�DD E55 Gt IiP PNONE <br />, ARCMREQORDE9qNER MI11l�DDPE33 CITY IIP PNONE <br /> OENEMLCONTpACfOR MNLMDNESS CITY LIP PHONE LICENSE• <br /> AAi�M{ EUUIPMFNI�I,INC. /V A7Z�/ZCL=�,aOti��P <br /> M[Qtl�NICALCONiMCTON �t�je e �yy�p • -- CITY ZIP PNONE LIGEN9E• <br /> \ aV F 1�11� • <br /> EYMML WMMII�01►�Z�l <br /> rLYMlINOCONTR�CfOR 2�•11�pPES9 CIIY Z�P P110NE LICENlE• <br /> ClA!lOFN'Olil( ,�,� <br /> ❑ NEW ❑ ADDITION U'"ALTERA710N ❑ REPAIR ❑ DEMOLITION ❑ �wJODSTOVE/FRPLINSERT ❑ BUILDINOqELOCATION <br /> 7EWWT IMPIIOYEMENT OR IMERIOR IIEMODEI ONLY GONT�CT PERSON AND PHONE NO. <br /> oonrw�cr.��wome � ..QJ(_�L�l-Q <br /> OSDCII�lEMORKH/DOOUAREFOOTAOEI VED <br /> n �It.�c v ��[.n d- ,� u' �5�-a �/ <br /> �c�`�����/�� �y� I HEREBY CERTIFV THAT 1 HAVE pEpp AND EXAAIINLD THIS APPLICi1TON AND <br /> �ll� 4fNC. �� �� ' ) KNOWTHE9AMETOBETRUEANDCOppECT.ALLf'fiOV1910N$OFLAW9AND <br /> LEMLDElCNIPfqN�PqppEqry(BNOWN9ELOWOR�RACNFOUPCOPIE3� ORDINANCES60VERNINGTHISTVPEOFWORY.':11LLBECOMPLETEDWRF{ <br /> WHETHER SPECIFIED HEREINOR NOT.THEORANTINGOFAPERMITDOE9NpT <br /> w� e�ocK oF PRE9UMETOQIVEAUTHOqITYTOVI0UTE0RCANCELTHEPR0V1$IONBOF <br /> ANYOTHEHSTATEORLOCl11 LAWREGULATINpCONS"fRUCTIONORTHEPER- <br /> FORMANCE OF CANSTFiUCfION.THAT I AM AUTHORI2ED BVTHE OWNER OF <br /> THIS PROPERTV TO PEFFORM THE WORK FOR WHICH APPLICATION IS MADE <br /> AND I COMPLY WITH THE STATE CONTRACTORS LAW 1827 pCW AND <br /> � 288200 WAG <br /> SIONATUREOFCONTMCTOROR�UTHONILEDAGENT D�TE <br /> ��,� X' , Q,(��- �7 1�� 1 ; <br /> � �VPLIGUlT8d YBU91NE5 LICENSENO.MlOBUSINESSN�ME � <br /> � <br /> � �M��� MECHANICAL <br /> MG• TYP!OF FIX7UR!OR REM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATEq CIOSET(TOILE'1) A/C—NHNDLO UNITS—H.P. <br /> �TM�O FORCED AIR SYSTEMS—6T.U.� <br /> LAVATORY�YYASHBA9IN) UNITHEATERS—BT.U. M <br /> BHOWER CLOTHESDRYEFS <br /> KITCNEN 81NK6 DISP. VENTILATION FAN <br /> � D18HWABHER RANOEHOOD <br /> ' ' l.AUNDRYTRAY _ I WqTEHHEATER <br /> •- CLOTHES WABHER WOOD STOVE <br /> �R�� METAIFIREPLACEB CHIMNEV <br /> - DRINKINO FOUNTAIN FIREPLACE INSF,FiT <br /> FLOOA DRAIN HEAT PUMP <br /> BACKFLOW PpEVENTER9 GAS PIPINO <br /> � ROOFDRAINB—FWNLEADER3 E%HAUSTFP.N <br /> ' BINK�9ERVICE—BAR,ETG) <br /> SUBTOTAL S SUBTOTAL s <br /> PERMIT S PERMIT s <br /> TOTAL FEE S TOTAL FEE § <br /> fIpNT9ETBACN REARgETg4CK SIOESE7&1GR PIANCXEGKNUMBER FEE RECFIPTNO. <br /> UBEZONE . LOTMEA V�C�NTSITE FEE$ <br /> o re5 ❑No VALUATION FEE <br /> 7YPEOFfAN9T. OCCUPANCYOflOUP NO.OFDWEIIINQUNIiS BUILDING <br /> ALLOW�BLE/ACTUAL <br /> PLUMBING <br /> &2EOFBLOQ NO.OFSTORIES BSMi. OCGLOAD <br /> o N MECHANICAL �O <br /> MEIOHT4MIUlION OiHER <br /> flREBGPINKLEP91iEWIRED O YE5 ❑NO <br /> S7A1E BUILOING SURCHAqCaE <br /> STATE ENERGV SURCHAqGE <br /> MVLICRIONACGBY PI�NS�PPP.Bv <br /> � PUBLIC WORKS <br /> TOTAL <br />