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. . . .._. <br /> . ... ... . . .. .. . .. . ..:. .:: .. <br /> , .�. <br /> _. . _ . . _ .. . . .. _ . ._ r <br /> � r' <br /> APPLIC�.t10N FOR CONSTR�CTION <br /> PERMIT <br /> Ne Erergreen everett <br /> CITY OF � i <br /> everett � <br /> BUILDING DEPARTMENT ' <br /> 259•8810 TO BE COMPLETED IN INK— PLEASE PRINT i, <br /> OWNEH 1 a M�IL�OORESG CITY ZIP PMONE 7/�/ -� <br /> �`�/�L�`(C� n✓l��1i� M�ILA pR� " !� �yonf`I�/4 ��1421P�1<U.f�Vu.NIc.�E W� /�lW� � <br /> 1/�D�t.t/S5 F�S�la/f./1— /4n/D �l�'JA�IES 1v�/ /N�•e_ hA��� �d �7S-G87J 1 <br /> I1qCNREGTORDE516NEP M�IL�O�RE55 WTY 21P PMONE � <br /> � '�, �• ;� y Nr�xc�� !kc /Sr� !Y�'�'F�Fv� alr� 1��./u� Wr�- `Is� 7Y?-r7zG � <br /> OE�IEMLGONRiACTOR M��LAUURESS pTY 21P PNONE IICENSE � <br /> �rrr��ri26Dn <br /> MECHANIC�LCONTR�GTOR MAIL A�OPE55 CITY 21P PNONE LICENSE• <br /> �� <br /> "—� <br /> PLUM&hOCONTF�GTOR MAIL�ODPESS CITY 21P PNONE LICENSE• , <br /> i, <br /> ^�— <br /> GL�.43OFNONI( S <br /> ��EW ❑ ADDiiION ❑ ALTERATION ❑ REPFIR ❑ DFMOLITION ❑ �NOODSTOVE/FRPL INSERT ❑ BUILDING�ELOCATION r' <br /> TENAYTIMPPOVEMENIOflINTEP PNEMO�OELONLYOv CONTACTPERSON�NDPHONE110 �7� <br /> �:ONTPAGTPIIIGF.OFWORIC � �C/«� _'_ """JIL. G�.�/_J.!/Tl�'NVI ��/ I��� �, <br /> DEBC�fEWON ND EF00T1�0 INVOWE\U �` <br /> � �9Eo �Na _ (I IHEREBYCEFTIFYTHATIHAVEREADANDEXAMINEDTH�SAPPLICATIONAND �'. <br /> lJ KNOW?HESAMETOBETRUEANDCORREC2AlLPROV1510NSOFUWSANO �'• <br /> LEMlDEBCN�PTIONOFFROPER7Y15NOWNBELfWlOHA1T�GHFOURCOPIES� ORDINANCESGOVERNINGTHIS7YPEOFWOFKWILLBECOMPLETEDWITH � <br /> WHETHERSPECIFIEDHEREINORNOT.THEGRANTINGOFAPERMITDOESNOT � <br /> L �7> PRESUMETOGIVEAUTHORIttTOVIOLATEORCANCELTHEPROVI510NSOF <br /> �oi�� e�ocK oc ANVOTHE.y:T4TEORLOCALLAWREGULATINGCONSTRUCTIONORTHEPER• �. <br /> FORMANCE G�CONSTRUCTION.THAT I AM AUTHORIZED BY THE OWNER OF � <br /> � (�.�,�j, s [� �7?� � QD/SD (O�/D-u4' TH�SPROPER7YTOPERFCRMTHEWORKFORWHICHAPPLICATIONISMADE � <br /> AI J I COMPLY WITH THE STATE CONTFACTORS LAW 1827 HCW AND <br /> i ,/ L 296.200 WAG � <br /> KD �llv�pS LbS R��n� �r S �• /�OI/"�rG � SIGNATUPEOPCONTR�GTOROR�UTNORIEEDAGENT O�TE <br /> ; � 9 R . �i s,�3s r�r �r ,e, v�. � - � �7 � <br /> �N F 5 . Y . �.�� <br /> i �ECT�OOflE55 (� (� �PP4C�NTSqTYBlI51NE5SlICENS"cNO.�NdBUSINE5�5,Np�M^E <br /> r� �� � � J L�.. tt� d-(i L' C1�87 �`r <br /> ..(qapf�llQv q � C <br /> PLUMBINO MECHANICAL F <br /> NO. TVPEOFFI%7LREOHITEM FEE NO. TYPEOFEOUIPMENT FEE �; <br /> WATER CLOSET(TOILEn A/C—A/HNDLCa UNITS—H.P. 1�, <br /> BATHTUB FORCED AIR SYSTEMS—B.T.U. M EA � <br /> UVATORYlWASH BASIN) UNIT HEATERS—9T.U. M �' <br /> 9HOWER CLOTHESDRYERS �[� <br /> KITCHEN SINKB DISP. 'JENTILATION FAN F; <br /> RANGEHOOD F� <br /> DISHWA9HER �" <br /> LAUNDRY TR4V WATER HEATER �; <br /> CLOTHES WASHEF WOOD STOVE "( <br /> URINAL __ METAL FIREPLACE6 CHIMNEY i` <br /> ORINKINOFOUNTAIN __ _ FIREPLACEINSERT �� <br /> FLOOR DRAIN HEAT PUMP ._ � <br /> , BACKFLOW PREVENT[RS GAS PIPING I.� <br /> ! ROOFDFAINS—RAINIEADERS _ EXHAUSTFAN <br /> � ___ l: <br /> SINK(SERVICE—BAR.ETC.1 <br /> �:. <br /> � kr <br /> i (; <br /> F <br /> SUBTOTAL b SUBTOTPL S i" <br /> PERMIT 5 PERMIT S i. <br /> TOTAL FEE 5 TOTAL FEE s �'� <br /> FRONTSET9AGN REAFSEfB/�GK SIOESETBACK PUNCMECNNUMBEP FEE <br /> RECFIFf NO. <br /> � ^ � � <br /> WCANTSITE FEES VALUATION FEE �'. <br /> USE20NE LOTAPEA '� <br /> ❑YES ❑NO i. <br /> 5 BUILDING � ��(� � 0�_ " <br /> ttPEOFCAN9T. OGCUP�NCYGROUP NO.OFOWElLIN0UN1T5 (• <br /> euowee���cru�� pLl1MBiNG i <br /> , I <br /> SREOFBl00. NOAFSTORIES BSMI. OCCl0�0 MECHANICAL <br /> ❑Y �' <br /> ❑N j� <br /> NEIOMTLIMITATION QTHER E. <br /> iIPE 9PRINKLERS PEOUIRED O YE9 ❑ NO STATE BUILDING SURCHARGE _ <br /> F' <br /> STATE ENEFGY SURCHARGE S� <br /> _ �. <br /> �PPLICRIONAC�OY PL�NSAPPR.QI{ PUBLICWORKS I <br /> �/�/� I <br /> /L/ ' <br /> rp.. TOTAI. I S C �. <br />