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(.��rl' �r.:.,. ��1 ✓ <br /> APPLICi�:riON FOR CONSTR4'�TION <br /> ths Everprasn PE R M IT <br /> CITY OF <br /> everett everetl <br /> BUILDING DEPARTMENT � <br /> 259-8810 TO BE COMPLETED IN INK— PLEASE PRINT <br /> HER MML��ORE55 <br /> ^ _ �� GIiY ZiP PIIONE <br /> -��r �,��. 5 lCo13 �z(c�a-ixn��..t2. �wJ,er� �pl 3���Cv <br /> TEN NT MAIL�DDPE55 CIfY 21P I'110NE � <br /> �RCHITECTOqDES16NER M�IL�ODfiE55 CITy ZIP PNONE <br /> OENEMLCONfR�CTON M�IL�DORE55 CIiY ZIP PIIONE �IGENSE• <br /> MECN�NIC111,CONTRAC q MAILADDHE55 GITY 21P PIIONE LICENSE• <br /> l�Cl�-- 2l�05/�rer��c,�a�. �,-�zol 2�9'S492 Uq�C <br /> PLUM&NOCON croq MI11L��Of1[59 c�rr zm m�one ucEn� <br /> cussorwonK <br /> ❑ NEW ❑ ADDITION ALTERATION ❑ FEPAIR ❑ DEMOLITION ❑ WpODSTOVE/FRPLINSERL ❑ BUILDINGRELOGATION <br /> TENN/TIMPROVEMENTOqINTENIpp F'AODELONIY pONiACtPER50NANDPNONENO <br /> CANiMCT PIiICE OF WORK � <br /> DE9GRIBEWpp1(ANDSOUMEfOpT�OEINVOIVED � <br /> h�7� � GaCt.v p�� IYl UL�L� <br /> PRO EJWEOF aoi <br /> I HEREBY CERTIFY iHAT I HAVE READ AND G%AMINEO THIS APPLICATION AND <br /> �� NNOWTHESAM[iOBETAUEANDCORRECT.ALLPqOVISIONSOFLAWSAND <br /> LEMLGE IPTIONUFPPOPEPTY�SMOWNBELOWOPATT�CHFOUPCOFIES7 ORDINANCESGOVERNINGTHISNPEOFWORKWILLBECOMPLETEDWITH <br /> WHETHER SPECIFIED HEREIN OR NOT.THE GRANTING OF�PERMITDOES NOT <br /> tOt etocK oF F'RESUME TO GIVE AUTHORItt TO VIOLATE OFi CANCEL T'iE PROVISIONS OF <br /> ANY OTHER STATE OR LOCAL LAW REGULATING CONSTFUCTION OR THE PER- <br /> FORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE OWNER OF <br /> THIS PROPERTY i0 PERFORM THE WORK FOR WHICH APPLICATION IS MADE <br /> AND I COMPLY WITH THE STATE CONTRACTORS LAW 1827 RCW AND <br /> 296.200 WAC. <br /> SION�TUREOFCONTRACiORORA0IHOHIZEDAGENT O�TE <br /> PROJECTIIUDRE55 �������� �\ I�� <br /> /I � ) � � 4CANISCIfYO IN SSLIC SENO.Rt10BU51NES5NAME <br /> rcx� <br /> PLUMBINQ MECHANICAL <br /> NO. TVPE OF FIXTUNE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) A/C—lVHNDLG UNITS—H.P. <br /> BATMTUB FORCED AIR SVSiEMS—flT.U. M EA <br /> LAVATORY�WASHBASIN� UNITHEATERS-0.i.U. M <br /> SHOWER CLOTHESDRYERS <br /> _ KITCHENSINKSDISP. VENTILATION�AN <br /> DISHWASHER RANGE HOOD <br /> LAUNDRYTRAY WATER HEATER <br /> CLOTHES WASHER WOOD STOVE <br /> URINAL METAL FIREPLACEB CHIMNEY <br /> _ DRINKING FOUNTAIN FIREPLACE INSERT <br /> FLOOR DRAIN HEAT PUMP <br /> BACKFLOW PpEVENTERS GAS PIPING <br /> ROOF DHl.INS—RAINLEADERS E%HAUST FAN <br /> SINK�SERVICE—BAfi,ETC) <br /> SUBTOihL 5 SUBTOTAL S <br /> PERMIT S PERAIIT S <br /> TOTAL FEE S TOTAL FEE S <br /> FRUNTSETBI�GK RE�RSETBM:N SIpESE1B�CK PUINCHECI(NUMBER fEE RECEIPTNO. <br /> I.SEionE IOTARF� VACI�Nf511E FEES VALUATION FEE <br /> � O YES �NO <br /> TYPEOFCONST. OLCUPANGYOpOpP NOOipWELlINOUNITS BUILDING <br /> ALLOW�BLE/I�CTU�L <br /> PLUMBING <br /> S12EOFBLDG NO.OFSTORIES BSMT. OGGLO�O • <br /> �� MECHANICAL <br /> ON <br /> /IEIONTlIM1TAilON QTHER <br /> FIqESFRINHLEq4qEW11RED OYES ❑NO <br /> STATE BUILDING SURCHP7GE <br /> STATE ENERGY SURCHARGE <br /> MPIIG�TION.ICG BY PLAN911PPR BY <br /> PUBUC WORKS <br /> TOTAL <br />