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-�,.;�; <br /> APPLIC%`�i'ION FOR CONSTRIi::T10N <br /> PERMIT <br /> IAe Ewrproen <br /> CITY OF everelt <br /> everett e <br /> BUILDING DEPARTMENT <br /> 259•Beto TO 8E COMPLETED IN INK— PLEASE PRINT <br /> OWNEN M�1�110UNE55 CI1Y 21P PHONE <br /> Rav�r.�a �� � �vawe�- 3Y3 � f`r.rirfas t��r� ���c�� �(8.201 Z 5 8�1// <br /> IENMlT M�I�ADDRE55 CIIY ZIP PNONE <br /> Sau� e <br /> AIIGNITEGTOflDE51GNEF M�ILADOflE55 GIiY 21P PMONE <br /> OENEMICANTN�CTOR MAIL�O�NESS CITY ZIP PHONE LIGENSE• <br /> MEGIANICAICONTRACTOH MAIL�ppfiE55 CITY ZIP VNONE IICENSE• <br /> f111�V11�1� <br /> � OCONT TOR MAllA0DRE55 CItY IIP PNONE 4GENSE• <br /> G1A9.90FNORK �q <br /> ❑ NEW ❑ ADDITION ❑ ALTERATIO�' ❑ REPAIR ❑ DEMOLITION p WOODSTOVE/FRPL INSEFT ❑ BUIL�ING REIOCATION <br /> TENNITIMPqOVEMENTOR�NIEPIORpEMOOEIONLY GON/t�CTPENSONA/NOPIIONENp <br /> CpNTpACTPRI�EOFWOFK �\QN�Q �\ ��ow�-- (ti-1y 9-Y3// <br /> DEBCRIBE M9PK AND SOUME FOOTAGE�NVOIVED <br /> - 7_ 5g-�z r r <br /> PNOPOBED U9E OF BUIL�INO I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION ANO <br /> KNOW THE SAME TO BE TRUE AND CORRECT.AlL PFOVISIONS OF LAWS AND <br /> LEWLDE9CPIPTIONOFPROPENTT�SNO�VNBEIOWORATT�GHFOUPCOPIES� ORDINANCESGOVERNINGTHIS7VPEOFWORKWILLBECOMPLETEDWI7H <br /> WHETHER SPECIFIED HEREIN OR NOT.THE GRANTING OFA PERMIT DOES NOT <br /> PRESUME TO GIVE AUTHORIN TO VIOLATE OR CANCEL THE PRONSIONS OF <br /> �07 e�ocK ov ANYOTHERSTATEORLOCALI.AWREGULATINGCONSTRUCT�ONORTHEPER� <br /> FORMANCE OF CONSTRUCT�:JN.THAT I AM AUTHORIZED BY THE OWNER OF <br /> TH�S PROPERN TO PERFORM THE WORK FOR WH�CH APPLICATION IS MADE <br /> ANO 1 COMPLY WITH THE STATE CONTRACTORS LAW 18.27 RCW AND <br /> 296.200 WAG <br /> SION�tUNEOFCONiP�CTORONAU1110R12EDAGENT �RTE <br /> RqJECT AODPESS ��PIICANTS pIY�LICE�AND�55 N�M�G <br /> 3y 3� F���la ��� E�e��7i' �,vA <br /> PWMBINP MECHANICAL <br /> NO. TYPEOFFIXTUHEORITEM FEE NO. TYPEOFEOUIPMENT FEE <br /> WATER CLOSET(TOILET) A/C—A/HNDLG UNITS—M.P. <br /> BATHTUB FORCED AIR SYSTEMS—&T.U. M EA <br /> LAVATORYryVASH BIISIM UNIT HEATERS—6T.V. M <br /> SlIOWER CLOTHES DRYERS <br /> KITCHEN SINKB DISP. VENTILATION FAN <br /> DISHWASHER RANGE HOOD <br /> LAUNDRY TMV WATER HEATER <br /> CLOTHES WASHER WOOD STOVE �' <br /> URINAL METAL FIREPLACEB CHIMNEY <br /> ORINKIN�FOUNTAIN FIREPLACE INSERT <br /> FLOOP DMIN HEAT PUMP <br /> BACKFLOW PREVENTERS GAS PIPING <br /> ROOF DRAINS—RAINLEADERS EXHAUST FAN <br /> SINK�SERVICE—BAR ETC.) <br /> SUBTOTAL S SUBTOTAL S � <br /> PERMIT S PERMIT S <br /> TOTAL FEE S TOTAL FEE S — <br /> F1qNT8ET8�CK REARSET&1GK SIDESETBI�Ck VIANCNECNNUMBER FEC NECEIPTNO. <br /> USESONE tor1wu V�CANTSIIE FEES VALUATION FEE <br /> O YES ❑NO <br /> BUILDIN6 <br /> IYPEOFCON9T. OCCUPANCYOIiOUP NOOfUWELL�N0UN115 <br /> NLOMNlIF/ACfUI�L <br /> PLUMBING <br /> MZEOfBLOQ IIQOFSi0RiE5 BSMl. OLGIO�D <br /> o v MECHANICAL <br /> ON <br /> HEIONTLIMIT�i1QN OTHER <br /> FlRESPRINNIERSREWIRE� ❑YES ONO <br /> STATE BIi�LDINd SUflCHARGE <br /> � STATE ENERGY SURCHARGB <br /> �rx�unoer�cc ar ruws nvra er <br /> � PUBLIC WORKS <br /> TOTAL <br />