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APPLECN�'ION FOR �ONSTRI..:T10N <br /> RERMIT <br /> fnc Ererqrean reci��ll <br /> QTY OF � <br /> everett <br /> BUILDING DEPARTMENT <br /> 259�BBt0 TO BE COMPLETED IN INK— PLEASE PRINT <br /> C�tY ZIi� PMON[ <br /> LriNLN M1IAILPOORL55 /�3/ <br /> Fi�,�f w�u✓4 rn�ca f43G �L.cis'i�oc � EZ�Nc��` �7�3-�- 4 7 _ <br /> QiY Z�P 1'HUNL <br /> � � �„� iCYANi AIAIL��ORE55 - <br /> b <br /> � � C,IY 2�P PMONE <br /> p AnCM1LEGiOADE5IGNER M�IIADDRE55 <br /> � H N <br /> G ER�LC NTRAGi MAILAODRE55 01Y Z�P PNONE LICENSL• <br /> K � H ���o �J �rLyA�a �as� r/ �.��--�fiict�►'Oi� //�sr.c. f�» G�s--�u� if�icov�uzi�r� <br /> y MECN�NIGALCONT9�LTOR MnIL�ODRE55 CIIY ZIP PHON[ LiGENSE• <br /> O C O <br /> � N N <br /> � CITY ZIP PMONE LIGENSE• <br /> � � PWMBINOGONTRAGiOP FIPILADORE55 <br /> M <br /> eh C1A550FN'ONK <br /> (�~j :b j5 ❑ NEW ❑ AODITION ❑ NITERAT10N REPAIR ❑ OEMOLITION ❑ WOODSTOVE/FRPLINSERT ❑ BUILDINGRELOCATION <br /> �¢"'� y � 1F.NPNTIMPROVEMENiORIMER10AAEMOOELONLY I' <br /> CONTPGIVERSON�NOOHONENO <br /> [� M y GONTqAGiPRI�EOFWORK ��RL S � y <br /> �py y OESGHIBEWO/R/K��NOSOWREfOOU EINVOLUED <br /> n O N /` � — i"'� --- <br /> �y PROPOSED CUSE yOF p6U�LDING I HEREBY CERTIFY THAT I MAVE REAO AND EXAMINED THIS APPLICATION AND <br /> � y y // (`� ' ORD NANCES GOVOERNING TNB TV E OF\NORK WLOL BEIOCOMPLE ED W TN� <br /> C +� LEGALDESCFlIPTIONOFPPOPERTYISHOWNBELOWOR�TIAGNFOUALOPIE51 �•;yE'MERSPEGFlEDNEREWORNOT.THEGRANTII'GOFAPERMITDOESNOT <br /> PRF:SUME TO GIVE AUTMORIN TO VIOLATE OF�ANCEI THE PROVIS�ONS OF <br /> �o� e�ocrc Or AN�OTHERSTATEORLOCALLAWREGULATINGCONSTRUCTIONORTHePEF� <br /> FORMANCE OF CONSTFUCTION.THAT I AM AUTHORIZED BY THE OWHER OF <br /> THIS PROPEtiTY10 P[RFORM THE WORK FOR WHICH APPUCATION IS MADE <br /> AND I COMPLV INITH THE STATE CONTRACIORS LAW 1827 RCW AND <br /> 296200 WAC. ��(L �j /f b'�j <br /> SIGNnTpPEOF ONinACt: ORnl1 �OR'.EOAGENi 04iL <br /> PROJEC �OP S APPLIWNLSLIiYpUSNESSLIC[N ENO.PNOBUSINESSNAME <br /> �1�� �LEi✓/t�00 (I� L'�t2E'7? <br /> MECHANICAL <br /> PLUMBING <br /> NO. 1VPE OF FIXTURE OR I7EM <br /> FEE NO. TYPE OF E�UIPMENT FEE <br /> i" -. q/G—A/HNDLGUNITS—H.P. _ <br /> i \ WA7ER CLOSE7ITOILETI <br /> I �� BATHTUB FORCLDAIRSYSTEMS—B.T.U. MEA = <br /> LAVATORY�WASHBASIN) UNITHEATERS—BT.U. M <br /> 1 , SHOWER CL0IHESORVEfiS � <br /> KITCHEN SINK6�ISP. VEN7ILATION FAN <br /> � � �1 DISHWASHER _ RANGEHOOD <br /> ' _� LAUN�F7YTRAV WATERHEAiER _— <br /> � CLOTHESWASHER _ WOODSTOVE <br /> ME7AL FIREPLACE 8 CHIMNEY <br /> URINAL <br /> I _� • DRINKING FOUNTAIN — FIREPLACE INSERT — <br /> ��1 FLOOR�RAIN HEAT PUMP <br /> BHCKFLOW PREVENTERS GAS PIPING — <br /> ' fi00F DRAINS—F7A�NLEADERS E%HAUST FAN <br /> =1�' SINK ISERVICE—BAR.E7C1 <br /> •� ' 1 1 SUBTOTAL S SUBTOTAL S <br /> I PERMIT $ _ PERMIT 5 — <br /> '� TOTAL FEE 5 TOiAL FEE 5 <br /> FRONTSEfBPGK FEARSEI�ACH SIOE:ETBAGR <br /> PIANCNECItNUMBEP FEE PECEIITNO. <br /> �'. <br /> USEZON'_ L01APE� <br /> vncaHrsitE FEES VAlUAT10N FEE <br /> ❑YES ❑NO <br /> BUILDING <br /> ttPEO��NST. OGGUP�NCY6ROlIP NOAfOWELLiNGUN1t5 <br /> ALLOWABLE/ACTUAL PLUMBING <br /> SiiEOFBtoG. No.OrSroRicS O�SYT. OGCLOAp MECHANICAL <br /> ❑N <br /> IIEIOMiLIMITAiION OTHER �_ <br /> rwesvniHK�easneowneo ❑Y�s ❑rvo STATE BUILDING SURCHARGE <br /> . STATE ENERGY SURCHARGE _ <br /> ♦PPLICATION�L4BY PUNS�PPRBY FUBLICWORKS <br /> TOTAL <br />