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; ;i�,1 <br /> APRLIC�.'�IOI� FOR CONSTRI�'+CTIOl�1 <br /> �h.E,�ro.ee� P�RMIT <br /> CITY OF <br /> everett <br /> everett e <br /> BUILDING DEPARTMENT <br /> 259•BB10 TO BE COMPLETED IN INK— PLEASE PRINT <br /> ON'YER MAILADOfiE55 CIiT IIP PNONE <br /> gfRGsA��.c. CoNSTR, �'�. I/l�2 ���'—' �uE. 5,�. �uer�� �S�o� 33�-0727 <br /> IEIUNT MAIL�OORESS pTY �ZIP PMONE <br /> !� �t <br /> NICMITECf090E51GNER MAILADOR[55 �IiY 21P PMONE <br /> << � � <br /> OENEMLGONTR�CTOR M�IL�DORESS GIIY ZIP PMONE UCENSE• <br /> ' ` '� 8£R�rcc i3soB <br /> MEGN�NICALGONTRIGTOR� MAIL�ODflE55 CITY 21V PNO4E IICENSE• <br /> �l 4 <br /> RUMBIAOS.iNTR�C}pi� � MAILADOflESS CIiY 21P PNONE IICENSE• <br /> 4 � <br /> CLASS OF WOpK <br /> �I NEW ❑ ,1��;ilOA ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVUFRPLINSEPi � BUILDINGRELOCATION <br /> 7EN�NT IMPpOVEMENT OR iNTEPIOfl HEMOPEL ONLY GONi�Gi PERSON AND PHONE NO <br /> O�O <br /> CONTpACTPIIICEOFWORK �X 7S ���L R. �F_/1GSAG�_ �77'd7iZ7 <br /> DE9CRIBEWORN�NOSOU�REfOOTA INYOLVED <br /> BK�IA N.E.4) /37$ s�K'.��F� t . <br /> 7a RF.,,rt— a�,c1 <br /> PROPOBEDUSEOFBUILDINO � � IHEREBVCERTIFYTHATIHAVEREADANDEXAMINEDTIiISAPPIICATIONAND <br /> �Sl�� OG��T� KNOWTMESAMETOBETRUEANDCORRECT.ALLPflOVIS10NSOFLAWSAND i <br /> LEM�DE9GRIPTIONOfPROPEH7Y�SNOWNB OWORAR�CHFOIIflGOV1E5� ORDIN4NCESGOVERNINGTHiSTYPEOFWORKWILLBECOMPLETEOWRH <br /> WHETHERSPECIFIEDHEREINORNOT,THEGRqNTINGOFAPERMITDOEBNOT � <br /> �oi� etocr.__ Or I PRESUMETOGIVEAUTHORI7YTOVIOLATEORCANCELTHEPROVISIONSOF <br /> ANYOTHEF STATE OR LOCAL LAW RECaULATING CONSTRUCTION OR THE PEiF <br /> V(J�K/n� I I . F�ii�+R— SIp ► FORMANCE OF CONSTRUCT�ON.THAT 1 AM AUTHOFI2ED BY THE OWNER OF <br /> THIS PROPER7Y TO PERFORM TME WORK FOR W HICH APPLICATION IS MADE <br /> AND I COMPLY WITH THE STATE CONTRACTORS LAW 1827 RCW AND <br /> 296200 WAG <br /> SIGNATtIPEOFCONTRACTOPOR�UT110R12EDAGENT OATE <br /> �o�xXg p�.�r �'��r-�{3, X �cQ. Q�..e,,�..�dL_ Y�y�l�9 <br /> 9^�O� �PPI NTSCITYBUSIVESSLI NSEN �NDBUSINESSN�ME <br /> 'a� BER6S/164.C. �NST�.C.o, 1 <br /> PLUMBIN� MECHANICAL <br /> NO. TYPE OF FI)(7URE OH ITEM FEE N0. 7YPE OF EOUIPMENT FEE <br /> �� WATERCLOSETROILEi) � A/C—A/HNDLGUNITS—H.P. ' <br /> I BATHTUB FORCED AIR SYSTEMS—6T.U. M EA <br /> LAVATORY�WASH 6ASIN) UNIT HEATERS—BT.U. M <br /> SHOWEIi CIOTHES DRYERS <br /> iZ KITCHEN SINK d DISP. �' ,� VENTILATION FAN . <br /> Z DISH�NASHER � RANGE HOOD � <br /> LAUNDRY TRAY WATER HEATER <br /> CLOTHES WASHER � WOOD STOVE � <br /> URINAL METAL FIREPLACE 8 CHIMNEY � <br /> DRINKINCaFOUNTAIN FIREPLACEINSERT <br /> I FLO�:.•?DRAIN HEAT PUMP <br /> BACKFLOW PREVENTERS GAS PIPIN� <br /> ROOF OflAINS—RAINLEADERS EXHAUST FAN <br /> SINK�SERVICE—BAR ETC� <br /> SUBTOTAL E SUBTOTAI S <br /> PERMIT E PEqM1T 5 <br /> TOTAL FEE S � TOTAL FEE 5 <br /> FRONTSETB� N PE�RSEfB�CK SIOESETpAC PIANCNE KNUMBEP FEE qECEIPTNO. <br /> 2o-a'` �Afc� � ' .5• a.�- .3 a ss a 3 <br /> USEZONE LOT�REA VAGNTSITE � <br /> ,nl Q vEs ❑ No FEES VALUATION FEE <br /> —"` � � r� �� BUILDING � <br /> TYPEOFCANS7. OLGUP GYGROUP NOOFDWELLIIIGUNITS ���.'�'�I �,� Z7� <br /> /�LIOWA lE/ACTU�L <br /> b=r r�,c �� 3 2 PLUMBING <br /> SREOFBID . NO.OFSTOAIE9 MT. OCGLOAD <br /> v MECHANICAL <br /> ❑N <br /> 7�?G IIEIGMTLIMIT�TION � OTHER '/ <br /> FIRESPRINrtLERSREOUInEO ❑1'ES NO N(Ti �U STATEBUI DINGSURCHARGE ✓7 1 <br /> i�i1 <br /> STATEENERGYSURCHARGE �� <br /> �PPLIC�TION�CGOY PL�N9APPq.OY � ' <br /> runuc woaKs <br /> �N, � TOTAL ' <br />