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...,, <br /> APPLIL.�ITION FOR COI�IST�'JCTION <br /> PERMIT <br /> rne e�ero�een everett <br /> CITI'OF <br /> everett e <br /> BUILDING DEPARTMENT <br /> 25 eeto TO BE COMPLETED IN INK— PLEASE PRINT <br /> ��Yi�'��..�!\l/' �� �`C��'C��'� � <br /> ay p M�ILAD�BE55 CI 21P PMONE <br /> �i�d ee �' /,/1. /�d:r <br /> µT MMLADDNE55 CITY ZIP PMONE <br /> Ai1GHITEGTOqDE51GNE0 M�ILPpDRE55 CITY ZIP PNONE <br /> UENEP�LGONTPIGTOH M�II�ODRE55 CIiY ZIP PMONE UCENSE• <br /> 1,�MECNAV.:.ALGONTMCTOR M�IL��OPE55 CITY 21P PHONE 4CENSE• � <br /> l��ar�o�� rs'lrc���,r��.,f r�� /srr o� No.�7'�_a�Q—.Q�i�_// 9 rrrt,, G71 �i ut� <br /> PLUM&NOGONTR� TO_E R — MAIL�UUfVE55 CIiY ZIP PMO LICENSE• , <br /> C1A540FNtlR1t <br /> �EW ❑ ADDITION ❑ A�IERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPLINSERT ❑ BUILDINGRELOCATION <br /> TENMiTIMVNpVEMENTORINTER10qREMO�ELONLY � CONTRCTPERSONANOPIIONENQ <br /> CONTPAGT PPIGE Oi WORK <br /> pE9�p�gE WOqK�NO SOU�RE FOOTAOE INVOLVED <br /> � � <br /> ROPOSED�SE OF BUILDINO I HEREBY CERTIFY TNAT I HAVE NEAD AND EXAMINED THIS APPLICATION AND <br /> ���ar � S�ZON P ` Y.NOW?HESAMETOBETRUEANDCORRECT.ALLPROVISIONSOFUWSAND <br /> EWLOE9GRIFTIONOFPflOPEP1Y13MOWN BEIUW ONAiTAC1i FOUflG(�PIES) ORDINANCES GOVERNING THIS NPE OF WORK WILL BE COMPLETED WITH <br /> WHETNER SPECIFIED HEREIN Ofi NOT.THEGRANTINOOFA PERMIT DOES NOT <br /> PRESUME TO GIVE AUTHORIN TO VIOLATE OR CANCEL THE PHOVISIONS OF <br /> �oi BtOCK oF ANVOTHERSTATEORIOCALLAWREGULATINGCONSTRUCTIONORTHEPER- <br /> FORMANCE OF CONSTRUCTION.THAT I AM AUTHOH12=0 BY THE OW NER OF <br /> THIS PROPENN TO PERFORM TNE WORK FOR W HICH APPLICATION IS MI1DE <br /> AND I COMPLY WITH THE STATE CONTRACTORS LAW 1827 FCW ANO <br /> 296200 WAC. <br /> Si4N�TUREOFGONTPACTOAORAUT110NRE0AGENT ORE <br /> PRf}IECf ADONE55 APPL CRN4C17Y pU51N�.A��NE�ME <br /> X /D i�i7 ar r7/1/I L2 f C � � �1 . <br /> PLUMBINO `� MECNANICAL /gQa _ di'� ��o� <br /> NO. TYPE OF FIXTURE OR ITEM � FEE NO. TYPE OF EOUIPMENT EE <br /> WATER CLOSEf(TOILEf) A/C-AIHNDLG UNITS-H.P. <br /> BATMTUB FORCED AIR SYSTEMS-B.T.U. M EA �� <br /> LAVATORY(WASHBASIN) � _ UNITHEATERS-BT.U. M _ <br /> SHOWER CLOTHESDRYERS <br /> KITLHEN SINKd DISP. VENTILATION FAN <br /> DISHWASHER RANGE HOOD <br /> LAUNDRYTFAY WATER HEATER <br /> CLOTHES WASHEH — WOOD STOVE <br /> LRINAL _ METAL FIREPLACE d CHIMNEY _ <br /> DRINKING FOUNTAIN FIREPLACEINSERT <br /> FLOOR DRAIN HEAT PUMP <br /> 9ACKF:OW PREVENTERS GAS PIPING <br /> ROOFDRAINS-RAINLEADERS _ ExHAUSTFAN <br /> SINK(SERVICE-PAR,ETC.) - <br /> SUBTOTAL S � SUBTOTAL S <br /> PERMIT E PERMIT 5 <br /> TOTAL FEE S r TOTAL FEE 5 <br /> iIiONTSETBACN REAIISETBI�CN SIDESE7BAG1t PIANCNECNNUMBER FEE PECEIPTNO. <br /> uSEzonE to7�RE� VAGANTSITE FEES VALUATION FEE <br /> ❑YES ❑NO <br /> eui�owc <br /> lYPEOFCANST. OLLUPANCYGflOUP NOOFOWELLINOUNITS <br /> euow�o�vetme� PLUMBING _�� ��/'� <br /> 512EOFO�DO. NOOFSTORiES �SMT. OCCIOAD MECHANICAL ___�l c /�J <br /> ❑Y <br /> ❑N <br /> MEIGNTtIMIfAiION OTHER <br /> FIIIE9PRINNLERS PEOUINEU O YES 0 NO STATE BUILDING SURCHARGE <br /> STATE ENERGY SURCHARGE <br /> �PPlIG�110N�tGBY PUNSAPPPBY PUBLICWOflKS <br /> TOTAL <br />