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, �„, �,... <br /> r,:;,., ` ,� <br /> APPLIC�'�'ION FOR CONSTRI��t:T10N <br /> � � PERMIT . <br /> Ms ErerO�een rverctl <br /> CITY OF <br /> everett e <br /> BUILDING DEPARTMENT <br /> 259•9eto TO BE COMPLETED IN IVK— PLEAS� PRik f <br /> Eq AIqIL�DORE55 fY P PNONE <br /> � � � �� � ��� <br /> 7EN�NT MM PDDRESS LIIY 21P PNONE <br /> HITECTO DESIONE � MML�UDt1. /�^ CIIY JP PNOVE <br /> ,�',c,c�P�-s G • �� ,cc,�-�-Q ��—S'�°3 `�cS�'��S <br /> �LGON �CTOR 1 ��01� SS GiY 21� ( N[ ,Il���ry��T <br /> —s�-- ��� ��� i/ _ _ � � •�v � .i 7. <br /> ��,�,y.,i� <br /> I.H�NIG �NTp�CTOR M�ILAD E55 ptY-����� ! PIIO L� 4CENSE• <br /> �� R �r E P.n.�l��?,L 3 <br /> PLUMBINOGONLPACI( MAIL��OR[59 CRY ZIP PHONE tICENSE�� <br /> C 90FWOFN <br /> NEW ❑ AOOIT�ON ❑ ALTERATION ❑ REPAIR ❑ DEMOL�TION _ 1YOODS70VF1FRPLINSERT ❑ BUILDINGRELOCATION <br /> TEN iIMPROVEMENfORINTER10RflEMODELONIY Nl� 1�EfiSON�NDP110N[NO. <br /> QONTMGi VRICE OF WORK <br /> li pEBCRIBEWOHKANDSOUMEf00T�0EINVOlVEO <br /> I <br /> I PXOPOSED USE OF BUILDINO I HEREBV CERTIFV 7HAT I HAVE READ ANO EXAMI4ED THIS APPLICATION AND <br /> KNOW THE SAME TO BE TRUE AND CORRF.CT.ALL PROVISIONS OF LAWS AND <br />' LEWl0E9CA�PTIONOF PROPERTY�SMOWN BELOW OPQIACN FOURCOMES� ORDINANCES C.OVERNING THIS TVPE OF WORK WILL BE COMPIEiED Wlhl <br /> I WHETIIERSPECIFIEOHEREiNORNOT.THEGRANTINGOFAPERMITDOESNOT <br /> PRESUME TO GIVE�U7HORI7V TO VIOLATE OR CANCEL THE PROViSION3 OF <br /> I� �rn eLocK oF qNYOTHERSTATEORLOCALLAWREGULATINGCONSTRUCTIONORiNEPER• <br /> FOfiMANCE OF CONSTRUCTION.THAT I AM AUT40RIZED BV THE OWNER OF <br /> THIS PROPERN TO PERFORM THE WORK FOR WHICH APPLICATION I�rv111DE <br /> AND I COMPLY WITH THE STATE CONTRACTORS LAW 1827 RGJJ AND <br /> 1 298.200 WAG <br />"t S�GN�TUREOF iP�CiOqORAU1110 EOAGENT DAIE <br /> . � �,� � � ��- � <br /> ecreooness �iZf.fAl"7�"'lJ� � . <br /> �P IC TSGI;ttlU5ME55ULEN5ENO.ANDBUSINE55N�ME <br /> � <br /> � � PLUMBIN MECHANICAL <br /> NO. TYPEOF FIXTURE OR ITEM FEE NO. TVPE OF EOUIPMENT FEE <br /> WATER CLOSEI'�TOILE� A/C—A/HNDLG UNITS—H.P. <br /> BATHTUB FORCED AIR SVSTEMS—B.T.U. M EA <br />� � � LAVATORY�WASHBASIN) UNITHEATERS—&T.U. M <br /> ' SHOWER CLOTHESDRVERS <br /> KITCHEN SINK6 DISP. VENT�LAiiON FAN <br /> DISHWASHEP FANGE HOOD <br /> � LAUNORVTRAV WATERHEATER <br /> � CLOTHESWASHER � ' WOODSTOVE <br /> � URINAL METALFIREPLACEBCHIMNEY <br /> DRINKINO FOUNTAIN FIREPLACE iNSERT <br /> � FLOOR DRAIN NEAT PUMP <br />� BACKFLOW PREVENTEPS GAS PIPIN� <br /> � ROOFOfiAINS—RAINLEAUERS EXHAUSTFAN <br /> • 91NK�SERVICE—BAR,ETG) _ <br /> i — ' <br /> SUBTOTAL S SUBTOTAL S <br /> I <br /> PERMIT E PER!.AIT S <br /> j TOTAL FEE S TOTAL FEE $ <br /> i FHONiSETB�GK 11EANSETWICK SIDESETMCN PU�NCNECKNUMBEP FEE pECEIPTNO. <br /> I <br /> UuEZONE LOTAPEA VAGINTSIIE FEES VAI.UATION FEE <br /> J ❑YES ❑NO <br /> � BUILDING <br /> TYPLO'rGONST. OCCUPANCYONOUP NO.OFOWELLINOVNIT9 <br /> RLiOWABIFIACfUAL <br /> i <br /> PLUMBING <br /> � SREOFBLDQ N0.0FSIORIES BSMT. OLGLO�O <br /> o v MECHANICAL � <br /> ON <br /> � HEIOM�LIMItAiION OTHER <br /> I FIRESPRINNlEF9RE0UIpEC ❑YE9 O NO STATE BUILDING BURCHARGE <br /> 1 � STA1E ENERGY SURCHARGE <br /> AVPLIG�IION�CGBY PlAN911PPN.BY <br /> 1 PUBLIC WORKS <br /> � yh � TOTAL � <br /> i <br /> � <br /> t <br />