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i:/�.yi�" M1 <br /> APPLIC�TION FOR CONSTR�TION <br /> PERMIT . <br /> fM Ew�pn�n � everett <br /> � CITYOF .. . , . � <br /> ��,verett <br /> BUILDING DEPARTMENT <br /> 269-BB10 TO BE COMPLETED IN INK— PLEASE PRINT I <br /> OWNE AUIL�DDRE55 GITY ZIP PHONE I' <br /> ��1 ��(�4�n��- ��oZ �m„d�� �a�u,er ����`f �1'�"�03 �i� <br /> ��T M�IL�OOflE54 ITY 21P PMJNE <br /> �.��� P I <br /> ANCNITECTORDESIQNER AUILA�pPE55 CITY ZIP PHONE <br /> /l�� NC' <br /> OENEIULGON7BACT.OF AURAUORESS CI�Y 21P PH E UCENSE• ! <br /> �G�� �o �b���cf.�oi�P �.� �y� �uv��ir 1�'��a-3 33��jzL� ��J�IZ�r3D3 ' <br /> MECl//�NICALCANTR TOR M�ILADDRE55 GITY ZIP HONE UCENSE• <br /> PLUM/&NOCONTPACTO/R MMlAU0NE55 GITV 21P F'+DNE . 11LENSE• I <br /> .�u.�f(,P�c�,,.r�� �b v.f/Nua�✓ <br /> CW�OFVARK � � <br /> ❑ NEW ❑ ADDITION ❑ A�TEMTION ❑ fiEPAIR ❑ DEMO:ITION ❑ WOODS70VE/FRPL INSERT ❑ BUILDING RELOCATION <br /> 1[NNlTIMYROVfMENTORINTEPIORREMODELONLY CANiACTPEH50N�NOPNONENO. c ` ' � <br /> CpqTM:TPRICEOfWORR � C� � _ � ` ` <br /> D[lCRIlE WORN�NOlOUME FOOTAOE INVOlVEO <br /> pRpPDOED U!E OF B/UILDINQ I HEPEBY CERTIFY THAT I HAVE READ AN9 EXAMINED THIS APPLICATION AND <br /> �C��/OP NCC KNOW THE SAME TO BE TRUE AND CORRECT.ALL PROVISIONS OF iAWS AND <br /> �awtD[ ITIONOFPROPEX7Y�9HOWNBELOWORATfAGNFOUNGOPIE3� ORDINANCESGOVERNINGTHIS7YPEOFWORKWILLBECOMPLE7cDWITH <br /> WHETHER SPECIFIED HEREIN OF NOT.THE GiANTIN00FA PERMR DOE9 NOT <br /> - PRESUME TO OIVE AUTHORIT/TO VIOLATE OR CANCEL THE PROVISIONS OF <br /> �pT ei,ocK or ANYOTHCRSTATEORLC�ALLAWREGULATINOCONSTRUCTIONORTHEPER- <br /> � FOPMANCE OF CONSTHJCTION.THAT I AM AUTHORIZED BV THE OWNER OF <br /> � THIS PROPER7Y TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE <br /> � AND I COMPLY WITH THE STATE CONfRACTORS LAW 182Y� RCW AND <br /> 296200 WAC. <br /> &ON�TUNEOFCONTPACTORORAUTNOR2EDAGENT U�TE <br /> X //.' � /` //�.Il�d�o ����,//�F <br /> MqJECTIWORESS �pp IC��SCITY�USTNETS9LIGEN ENO. DBUSIN SN�ME <br /> p 1 (�d U /�7 /�/ R <br /> M.UMBINO MECMANICAL <br /> � NO. TYPE OF fl%TURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> � WATERCL09ET OIlE7) AIC—NHNDL6UNIT5—H.P. <br /> �m�B FORCED AIR 9VSTEMS—dl'.U. M EA <br /> � ��,�''��'�" LAVATORY(WA9HBA91 UNITHEATEfiS•-&LU. M � <br /> � .:.�iir � 8MOWER CLOTHES DRYERS <br /> y ',;:�' � IGTCHEN SINK 6 DI9R � VENTILATION FAN <br /> � DI8HWA8MER RANOE HOOD <br /> � � � UUNDNVTRAY WATERHEATER <br /> �� CLOTNEB WASHER � WOOD STOVE <br /> URINAL METAL FIREPLACE 6 CH�MNEY <br /> �� ' � DRINKINO FOUNTAIN FIREPLACE INSERT <br /> FLOOfi DMIN HEAT PUMP <br /> BACKFLOW PREYENTER9 OAS PIPING <br /> ROOF DRAIN9—MINLEADERS EXHAUST FAN _ <br /> � SINK(SERVICE—BARETC.) — <br /> SUBTOTAL S SUBTOTAL S <br /> ' PERMiT S PERMIT S <br /> TOTAL FEE S TOTAL FEF. E i <br /> FRONT6EfB�CK REAR6ET6WK 910E&ETfi�LK KANCNECNNUMBER FEE NECEIPfNO. �, <br /> ueEione LOTARFA V�CANTSITE FEES VALUATION FEE � <br /> O YE9 o r+o <br /> BUILDINO <br /> ��.lypE W CONBT. OCGUPN/CYUROUP NO.OF DWElLINO UNIT9 <br /> 'LL�����i4 PLUMBING '�� <br /> lIZEOFBUQ NO.OFBTORIES BSMT, OGGLOAD MECHANICAL I <br /> �Y I <br /> ❑N <br /> MEIONiI�MIT�TION OTHER I ��� <br /> FIREBPNINMLER9PEWIREO OYES ❑NO STATEBW�DINGSURCHARGE ' i�q <br /> A <br /> . STATEENERGYSURCHARGE �I �� <br /> APPLICAfIONACGBY PLAN9APPRBY PUBUCWOFKS � �1 <br /> I <br /> TOTAL I <br /> I <br />