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j . a;� � 4�,., t,•i,:.. <br />.1� +� AppL1��T10N FOR CONSTR�CTION <br />!11{� PERMIT <br /> Tr '���M�Erorprosn . . . <br />,� .�CITVOF everett <br />� ;;everett . e <br />� . ''BUILDING DEPARTMENT <br />�� ; 269-8810 TO BE COMPLETED IN INK— PLEASE PRINT <br />,/ � pypEp MRIL�DDNE54 GIIY ZIP PMONE <br /> i <br />�I �j,fl—,-s.�o,s:r�r�4�`�:�ss> �tUZ9 '��Cwn�TASvJiv� �-nc�'r' <br /> F'+ TEN�NT . M!'4�D05E9S ITY ZIP PNONE <br /> 7 <br />� MCMREGTORDES�aNER :AAIL�ODRES9 CItY 21P PMONE <br /> j� <br /> 1 <br />�4 'OENEfULCONRUCTON M�IL�DORESS CITY ZIP PHONE LIGENSEI <br />�� <br /> yEp1A,:��':A�CpNTF11CTOR MAILAO�RE53 CITY 21P PMONE LICENBE• <br /> y� �� . <br /> ( <br /> 7 �.i R lINOCONTMGTOR MNLADORESS CITY ZIP PHONE � LiGENlE• <br /> ' � ��E�2�ac�- MAcoc�•.ac7�✓\ C� Y�3�c�xs�SC � .�.54 oY103 ���f"q(.CA Av0�2M2'i�611 <br /> 1� t2 <br />'�� ��� ClA!!O. MORN . . <br /> �' ❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOU710N ❑ WOODSiOVE/FRPL INSERT ❑ BUILDINO RELOCATION <br /> r iTENM1iIMPRpYEMFNTORMfEFIqIPE"J�EIONLY CONTACTPENSON�NDPHONENO. <br />�1 � .. <br /> 1 ����ppNTRACTPRIGEOFWIXIK <br />'�1' DEBCpIBEYIOpK�NDSOUMEF00i�QEINVOLVED <br /> t'f <br /> � � � 1 <br />•�� MqPoSEous OF&IILDINA IHEREBYCERTIFVTHATIHAVEREADANDEXAMINEDTHISAFPLICATIONAND <br />'�j� � � . �,G �4���_ � KNOWTHESAMETOBETRUEANDCORRECT.ALLFROVISIONSOFLMYSAND <br /> 1� �� �IEWLDEBGR IONOFPROPEPtt�BNOWNBELOWORATTACNFOURCO1qE3� ORDINANCESGOVEaNINGTHISTYPEOFWORKWi�. nEGOMPI,ETEDWITH <br /> �' IYHETHER SPECIFIE�HEREIN OR NOT.THE ORANTiNG OFA PERMIT DOES NOT <br /> � PRESUME TO OIVE AUTHORITY TO VIOLAiE OR CANCEL THF,PROVISIONB OF <br /> � �LOi e�a:a oF _ ANYOTHERSTATEORLOCALIAWREGULATINOCONSTRUCTIONOR7HEPER� <br /> � � i FORMANCE OF CONSTRUCTION.THAT 1 AM AUTHORIZEU BV THE OWNEH OF <br /> � ;�j " THIS PROPER7YT0 PERPORM THE WORK FOR WHICH APPUCATION 19 MADE <br /> AND I COMPLY WITH THE STATE CONTRACTORS LAW 1827 RCW AND <br /> � i1. 286200 WAG <br /> . SION�NREOfGONTR�CiOROR�UTMORIZEDAOENi OAiE <br /> J <br />, ;.,, . <br /> �, .p�,- • ii ; �1�� <br /> ' '��odem�oo�as �, . � <br /> � / 11PPLIC�NT9CI BUBIN ICENSENO.�NOBUS�NESSNAME <br /> 1'i:J�� � :QC�Zq K.l ' Ti�l M� i � , . . <br /> � � I^' PLUMlINO �, . MECHANICAL <br /> ���� �l> pp. � TYPE OF FUITURE OR ITEM FEE ND. TYPE OF EOUIPMENT PEE <br /> WATER CL09ET(TOILET) AIC—A/HNDL6 UNITS—H.P. <br /> ? � �� � �p{nJg �� FORCED AIR SY9TEMS—BT.U. M EA <br /> � LAVATORV(WASHBASIM UNITHEATERS—flT.U. M <br /> :' �f�� ° SHOWER � � CLOTHESORVERS <br />� � " KITCHEN SINKB DISP. � � VENTILATION FAN <br /> i � -- <br /> i � � '�i� S �- DI9HWA9HER � RANGE HOOD <br /> j. � �i ��• LAUNDRYTRAY � � ' WATERHEATER <br />�i� ' ��� ` CLOTHE9WASHER ' � � WOODSTOVE <br />��S �' URINA� ��� - METAIFIRFPLACEdCHIMNEY ' <br /> � I� �+" � DRINKINQ FOUNTAIN FIREPLACE INSERT <br /> �� � �'� ° FLOORDRAIN ' HEATPUMP <br /> i? ��.� t.l ' BACKFLOW PREVENTERS � GAS PIPING <br /> �,� �) �'i 1 � p00FORAINS—RAINLEADERS EXHAUSTFAN <br /> �,� e 1 ' 7'I SINK(SERVICE—BAR,ETC.) � � <br /> � I . . i <br /> � �� � ; I <br /> `I �' i'. I <br /> �� � ��� . . � . � <br /> �I ���" SUPTOTAL S SUBTOTAL S <br /> �I j �-• � ' " PERMIT S PERMIT 5 <br /> `j '' `%� �; TOTAIFEE S TOTALFEE S <br /> '� FRONTBETB�CN PEANShTWCK SI�ESETBACK PUNCNECSNOMBER FEE PECEIPiNO. <br /> y• I� • . I I <br /> !� �� �:,� . i . . . . <br /> �IVSE20NE �� LOTMFA . ��GNTSITE FEES VALUAtION FEE <br /> ' I �' ❑YE9 ❑NO <br /> �� �i�� ' �� BWLDING <br /> ItYPEOFCANSi. OLCUPANCYOROUP NO.OFOWELlIN0UNITS <br /> ;; 'I�upw�lt��ctue� � �, PWMBING <br /> I <br /> � � �'lIZEOFlLDO. ; NO.OFeTOP1E9 BSML OCGLO�O - <br /> �I ,'� .., a N MECHANICAL <br /> � - � �' � <br /> �, ('. ; , � � . HEIOHTlIM17ALION OTHER <br /> � � flPE9PRINNIERSREOUIpED OYES ONO <br /> � �i , STATE BNLDING SURCHARGE <br /> � <br /> : 'Ij � �' " � STATEENERGYSURCHARGE <br /> �:� 'APPLIC�iIONAGGBY PUHSAVP0.BY <br /> I �. .i, , � PUBLICWORKS _ <br /> J � <br /> t �i TOTAL <br /> F� I ;, <br /> �� <br /> . <br />