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APPLIC�ION FOR CONSTRt�CT10N <br /> PERM17 <br /> fAs Evsrprom everett <br /> CITY OF <br /> . everett e <br /> :i BUILDING DEPARTMENT <br /> � 259•BB10 TO BE COMPLETED IN INK— PLE�?SE PRINT <br /> ; qy M�ILIIDORESS GITY 21P PNONE 1 <br /> �; �-t' ��'ur'tx� dl'1P� �� SJnZ �c�� St GG�cel�• c<!�(/- <br /> 7Eq�ry7 MML��pRE55 CIIY ZIP PHONE <br /> � <br /> � ARGHRECTORUESIGNER MML�D�RE55 CIIY ZIP PNONE <br /> � OENEIIAL ONiR�GTOR M�IL�DDRE55 CIIY 21P E IL NS • <br /> ! ��2 f2. So w.. �/ �nc�i �/' f' "� � 1� ' T/'3v�K t <br /> . A ��. c� s - /��� .�d- « n,r u«e <br /> � MECH�,NICALCONTR�CTOR M�IL�ODRE59 GII ZIP NONE LILENSE• <br /> , <br /> PLUM&NOGONTMCTOfl M�IL�DUPE55 CITY ZIP PNONE LICENSE• <br /> CVSSOFNORI( <br /> � ❑ NEW ❑ ADDITION ❑ ALTERATION REPAIR ❑ DEMOLITION ❑ WOO�STOVE/FflPLINSERT ❑ BUILOINGRELOCATION <br /> TENANT IMPRpVEMENT OR INTEHIOR PEMOOEL ONLY CONGCT PERSON RNO PIIONE NO. <br /> • CONTN�CiPRIGEOFWORk /�C G� <br /> •; RIBEWORNANO UAPEFOOU INVOWEO �� <br /> �p - i2 -�c l'of.rJ Ac�(e.� W�tLc � _ d <br /> .'� Plq EDUDEOFBUILDIN 3-Z qp('�p� IHEREBYCERTIFYTHATIHFVERE.IDANUE%AMINEDTHISAPPLICATIONANJ <br /> KNOW THE SAME TO BE TRUE ANU CORRECT.ALL PROVISIONS OF LAWS AND <br /> IEMLo69GnirTi � PR PEF1Y19NOWNBELOW OH�IT�CH FOUNCOPIES� �RDINANCES GOVERNING THIS T/PE OF WORK WILL BE COMPLETED WITH <br /> WHETHER SPEC"IED HEFiEIN OR NOT.THE6RANTING OFA PERMITDOES N0T <br /> PRESUME TO C c AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br /> , �oi e�.ocK oF ANYOTHERSTAIEORLOCALLAWREGULATINGCONSTRUCT10NORTHEPER• <br /> / FORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE OWNER OF <br /> 'S \n C.� ' � G�,� THIS PRUPERTY TO PERFURM THE WORK FOR WHICH APPLICATION IS MADE <br /> bL�•� AND I COMPLV WITH THE STAiE CONTRACTORS LAW 1827 RCW AND <br /> � 2P6200 WAC. <br /> SION� NEOFCONIMIGTORONRUtNOR12E0�0ENT D�TE <br /> / <br /> '' X /IC� �: io � <br /> •' PROJECT�DURESS PLI NTSGiY0051NE55LICEN5EN0.� BU$NESSN� <br /> 1 �C' J <br /> 1 PLUMBINO MECHANICAL <br /> Np. TYPE OF FI%TUHE OR ITEM fEE NO. 7YPE OF EOUIPMENT FEE <br /> + WATERCLOSETITOILEn A/C—A/HNDLGUNITS—H.P. <br /> BATMTUB FORCEDAIRSYSTEMS-6.T.U. MEA <br /> UVATORY�WASH BA91N) UNIT HEATERS—B.T.U. M <br /> � 9HOWER C�OTHESOPVERS _ <br /> I KITCHEN91NK8DISP. VENTILATIONFAN <br /> i DI3HWASHER RANGEHOOD <br /> LAUNORYTRAY WATER HEATEH <br /> � CLOTHE9 WASHER WOOD STOVE <br /> URINAL METAL FIREPLACE 8 CHIMNEV <br /> DRINKINO FOUNTAIN FIREPLACE INSERT <br /> FLOOR DRAIN HEAT PUMP <br /> BACKFLOW PREVENTERS GAS PIPING <br /> ROOF DRAINS—RAINLEADERS EXHAUST FAN <br /> � SINKISERVICE—BAR,ETC.) <br /> SUBTOTAL 5 SUBTOTAL 5 <br /> PERMIT S PERMIT S <br /> TOTAL FEE S TOTAL FEE E <br /> FIi0NT8ETB/�CK REARSET&1CK SIDESEIBACN VIANCHECKNUMBER FEE RECEIPfNO. <br /> U5E2oNe IOTFRE� VACANTSITE FEES VALUATION FEE <br /> �YES ❑NO <br /> BUILDING <br /> � iYPEOFCONSi, OCCUP�NLYpROUP NO.OFOWElLiNOUNli3 <br /> ALIOWABLE/�GTUAI PLUMBING <br /> BREOFBLDO. NO.OFSI0RIE5 OSMi. OGGLO�O <br /> ❑v MECHANICAL <br /> ❑N <br /> NEIG1114MIT�TION OTHER <br /> FIRESPRINMlER9PE0UI�ED 0 YES O NO STATE Bi11LDING SURCIIARGE <br /> STATF_ENEfiGY SURCHARGE <br /> APPLIGQIONACGBY PL�NSAPVR.BY <br /> PUBLIC WOFKS <br /> rn� ( P TOTAL <br />