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!�� <br /> APPLIC�►,r'ION FOR CONSTRl�T10N <br /> PERMIT <br />.� fM Ewrpn�n everett <br /> GTY OF <br />� -�everett e <br />� .,' BUILDINCi DEPARTMENT <br />,� 268-8810 TO BE COMPLETED IN INK- PLEASE PRINT <br />��1 . ER M�II�ODRE9S CITY 21P PHONE � <br />'� �(� 1 <br /> � h T MIJLADDRESS GITY 21P PHONE <br />� % , �.�e _,.a,.�. a9.3� �,�.�. � ��.� 9gao � �s�'-//3� '' �� . <br /> ffEQO110E ONER IMIL�OORE55 GTY 21P PHONE�� � <br />� � � . <br /> - OENE0.LLGON7RACTON MAIL�DDRESS CITY 21P PHONE UGENSE• �� <br /> � MECMANICAICONTMGTOR �DORE95 _ �� ITY ZIP PHONE ^ LIG�1/����NJ <br /> . �,,,���,�{{{��-�1�;.� a,� q� �a/ G NF � 9�,y�s=y9oy c:oZy.. � � <br /> �'.KUMMyµ MGTON MMLAOOPE9S CITY ZIP PHONE � L�CENSE• I <br /> . V <br /> �CWOOFNORK <br />�� �� ❑ NEW ❑ ADOITION � ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPLINSEHT ❑ BUILDINORELOCATION "� � �� ' ' <br />�'i <br />,1+ . IIW WT IMPIIO'YEMENT OR INTERIOR PEMOGEL ONLY CONT�CT PERSON�ND PNONE NQ <br />* �" ODH1141CTMICEOFWORK <br /> .�OOC111!WORI[IW D BOUME FOOTACE INVOLVEII <br />� �-'.��IL� O��/�" � �i <br />� MqMNrMOSEOw IHEREBVCERTIFYTF!ATIHRVEREADANDE%AMINEDTHISAPPLICATIONAND ' <br /> KNOWTHESAMETOflETRUEANOCORRECLALLPROVI910NSOFUW3AND I <br /> D NOFPROPERTY�BNOWNBEIOWOR�it�CNFOURCOPIE9� ORDINANCES60VERNINGTHISTVPEOFWORKWIILBECOMPLETEDWITH <br /> WHETHER SPECIFIED HEREIN OR NOT.THEGRANTIN60FA PERMIT DOE9 NOT <br /> PRESUME TO 61VE AUTHORIN TO VIGLATE OR CANCEL THE PROVISIONS OF <br /> � �oT e�ocK oF ANYOTHERSTATEORLOCALLAWREGULATIN6CONSTRUCTIONORTMEPER� <br /> � � FORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BV THE OWNER OF <br /> THIS PROPERTV TO PERFORM 7HE WORK FOR WHICN APPLICATION IS MADE <br /> AND I COMPLY WITH THE STATE CONTRACTORS LAW 1&27�.RCW AND <br />� � � 296200 WAQ ' <br /> SION�TUREOFCANTRACTOiIORAUTMOPI2EDA0ENT O�TE <br /> '�i:�,� V i, <br /> A <br /> � FlIp.IECTMORE88 � _ •' � <br /> y `� APPLIC�N GIT SINE65LIC NO.ANDB NE&4 ME <br />� ••^"���''IWM\INO MECHANICAL � <br /> ��� NO. TYPB 0F FI%7URE OA ITEM FEE N0. TYPE OF EOUIPMENT FEE <br /> ' WATERCL09ET(TOILEn A/C—A/HNOLGUNITS—H.P. i <br /> BATHTUB FORCED AIR SYSTEMS—6LU. M EA I <br />� - UVATORYIW�SHBASIM UNITHEATEFS—flT.U. M i <br /> BHOWER CLOTHESDRVERS <br /> KITCHEN 91NK8 D19P. VENTILATION FAN <br /> DISHWA9HER FANOE HOOD <br />�� ,�` �� LAUNDRVTMY WATERHEATER <br /> ,1 CIOTMES WASHER WOOD STOVE <br /> ''`i����„ URINAL METALPIREPLACEBCHIMNEV <br /> ' DRINKINOFOUNTAIN FIFEPLACEINSERT <br /> � FLOORDMIN HEATPUMP <br /> � BACKFLOW PFEVENTERS OAS PIPING <br /> '� ROOF DRAINS—RAINLEAOER9 EXHAUST FAN <br /> � ;' 81NKl3ERVICc-. ?4R�ETQ) <br /> 1 " <br /> 1 <br /> I <br />� , <br /> 1 SUBTOTAL S SUBTOTAL S <br />� PERMIT S PEFMIT S <br />� ' TOTAL FEE S TOTAL FEE 5 <br />! <br /> fIqNTBETBI�CK REAH9Ef61C1( SI�ESET9ACK PIANCNECNNUMBER FEE MECEIPfNO. <br /> iUlE20NE LOiMG . VACANTSITE FEES VALUATION FEE <br /> O YES O NO <br />� . IYPEOFCON9T. OGCUPNICYOROIIP NO.OFDWELLINOUNIT9 BUILDING <br />� �������µ P�UMBING <br /> lIZEOIBLDO N0.0FBTONIE3 89ML OGGLOAD <br /> � o v MECHANICAL <br /> aN <br /> , NEIOHTLIMIT�TION OTHER <br /> fIPEBPRINNLERSREOUIRE� O YES O NO STATE BUILDING SURCHARGE <br /> STATEENERGYSURCHARGE <br /> AVM�CATION�CG BY PUNS APPR BY <br /> PUBLIC WORKS <br /> TOTAL <br /> ..C�� �:_ :'.i': ' ' ' ' + ':%i'. ;�f: ��),.:'i�i7 <br />