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,�q ^> <br /> APPLICATION FOR CONSTRUCTION � <br /> PERMIT <br /> � tne Everprean .� <br /> � CITYOF ��� � � j.,,.� <br /> ; everett ,;_.� <br /> BUILDING DEPARTMENT <br /> 259•BB�O TO BE COMPLETED IN INK— PLEASE PRINT °' <br /> UWVER M I RDDRE55 GITY ZIP FMONE �� � �� <br /> /�11KE f/C��o.�/ ���0 �c�1��2 ��c=r7" 9�zo3 339-Z�z� � '.�':, <br /> 2 ; �;;�: <br /> TENRNT � /,��M,AILP�ORE55 CITV ZIP PHON[ . - <br /> �/�j/� /T� /7GTl��C I "'•.��3'f,L <br /> ARCHITECiOR ESIGNER MAILRDORESS CiTY ZiP P40NE i ��i''� <br /> �?: : r. <br /> e, D, <br /> '� GENERALCONTRRCTOR MAILADOPE55 C4Y ZIP VHONE LILENS[• �d1J.�y <br /> �'• <br /> .� <br /> �'a MECM�NIC�LCONTRRCTOfl MML��DRESS CITY 21P PHONF. LILENSE� <br />``; ,U/�TU�i9t li/�S Fli�uil�r�ivi /l�2S�/'9A,�in� �ic-'�v:�2 F[�'F-rl %4zo/ ZS��yyl ,��tTu,e6c-iro P� <br /> MIIMBINGCONiRACTOR MAILAODRESS CITV 21P PHONE LILENSE• <br /> ! <br /> � CLASSOiWORK � <br /> : ❑ NEW ❑ ADDITION � ALTERATION ❑ REPAIR ❑ DEMOLITIOM ❑ WOODSTOVE/FRPL INSERT ❑ BUILDING RELOCATION <br /> i IEN�NTIMPROVEMENTOHMTERIORREMOOELONLU WNTAGTPLRSONRNpPHONENO . ����.•��� <br /> �: CANTR�GTPRICEOFWORK 3��0/ '� . �`� <br /> UESCRIBEWORNRNDSOU�REFOOT EINVOLVEO " e� <br /> 4 �''.5 <br /> � PROVOSEDUSEOFBWLDING �� ����I <br /> IHEREBVCERTIFY?HATIHAVEREADANDEXAMINEDTHISAPPLICATIONAND , <br /> � — KNOWTHESAMETOBETRUEANDCORRECT.ALLPROVISIONSOFLAWSAND ����.r� <br /> i LEG�LDESCNIPTIONOFPROPEBTV�SNOWNBELOWORATT�GNFOURGOPIES� OFDINANCESGOVERNINGTHI.STVPEOFWORKWILLBECOMPLETEDWITH � �I��=���. <br /> W HETH ER SPECIFIED HEREIN OR NOT.THE GRANTING OF A PERMIT DOES NOT <br /> - � PRESUME TO GIVE AUTHOI7IT'TG VIOLATE GR CANCEL THE PROVISIONS OF � - <br /> 9 �ot B�ocK oF ANYOTHERSTATEORLOCA�LAWREGULATINGCONSTRUCTIONORTHEPER• � � � <br /> FORMANCE OF CONSTRUCTIO�.THAT I AM AUTHORIZED BY THE OWNER OF � <br /> THISPROPERIYTOPERFORMTHEWORKFORWHICHAPPLICATIONISMADE � ;� ',I <br />� AND I COMPLV WITH THE STATE CONTRACTORS LAW 18.27 RCW AND ' ' <br /> 296.200 WAC � <br /> SIGNetUPEOPGONTPFCTJRORnUTHOR12E0AGENT D�TE C �'������ <br /> � "'.J�.. <br /> /�{J� . - ':-�i�I� <br /> PROJECTeDORESS � ��(E��21___i��'/_(V!�P( �p � �" � i . _I�`:,-..n� <br />� �� PPPUCRNTS �USINES_ NS``ONNOBUSINESSNAME •� � =i,C� <br /> � ��� �D!<J v� � ;,�:�t�. <br /> �� PLUMBING MECMANICAL ; � �''�� <br /> NO. NPEOFFIXNREORITEM FEE NO. TVPEOFEOUIPMENT FEE �y '���:?�� <br /> WATERCLOSETQOILEn A/C—A/HNDLGUNITS—H.P. � ;.S <br />- � BATHTUB FORCEDAIRSYSTEMS—B.T.U. MEA �.;.;�} <br /> I LAVATORVpNASHBASIN) UNITHEATERS—B.T.U. M �� t <br /> �:I <br /> '� SHOWER CLOTHESDRYERS ! , : � <br /> . KITCHENSINKBDISP. VENTILATIONFAN � ���'���i�� <br /> r <br /> DISHWASHER RANGE I100D ' <br /> LAUNDRYTRAY WATERHEATER � ,,,b+, " <br /> CLOTHESWASHER WOODSTOVE 1 �'.',�;�. <br /> � UfiINAL MEfAL FIREPLACEB CHIMNEY � <br /> � DRINKING FOUNTAIN FIREPLACEINSERT � <br /> � FLOOR�RAIN HEATPUMP � �����i; <br /> BACKFLOW PREVENTERS 2 l.�S PIPING - `-A:i,� <br /> ROOFDRA�NS—FAINLEADERS EXHAUSTFAN � .� _;..5'�" <br /> SINK(SERVICE—BAR,ETG) ; <br /> . ' ,',`4,'.. <br /> 1 i '� <br /> i — <br /> .�,�.;,�, - <br /> _ r <br /> SUBTOTAL 5 SUBTOTAL 5 ��_ , <br /> . PERMIT 5 PERMIT 5 � , _ - <br /> TOTALFEE S TOTALFEE 5 '— <br /> FRONTSETBiICN FFARSEfMCK SIDESETONGN PLANCHECKNUMBEq FEE AECEIVTNO. .i �� ,� <br /> Y� <br /> �i <br /> u5E2oNE LOTAREN vnCaNrsirE � FEES VALUATION FEE � ���'-.� <br /> ❑YES ❑ NO <br /> BUILDING <br /> lYPEOFCONST. UCLUPANCYGROUP NO.OFOWELLINGUNITS �' <br /> NLLOWABLE/ACTUAI PLUM BING '+}". <br /> :�. <br /> SREOFBLDG NOOiSTORIES &SMi. OCGLOAD i ' <br /> n v MECHANICAI � - <br /> n N -- <br /> MEIGHTLIMITATION OTHER I <br /> ''r <br /> FIP[SPRINHLERSRLOUIpED ❑YES ❑NO ' � i �� <br /> STATE BUILDING SURCHARGE �, <br /> STATE ENERGV SURCHARGE � �-- <br /> •PPLICRIONRCCBY PUNSAPPN.BY - -- � ,'�'•�'•'� <br /> rueuc woaKs �� <br /> rora� <br />