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� � --- - - --- <br /> APPLICATION FOR CONSTRliCT10N <br /> �ERMIT <br /> Ine Evarpreen everett <br /> GTY OF <br /> everett e <br /> BUILDING DEPARTMENT <br /> 259•8810 TO BE COMPLETED IN INK— PLEAuE PRINT <br /> �HEPr�'+r y� oP�^� MTILROOPESS GiV / 21P FHONE <br /> �uwe�f./h �� PRe i� `,s�//-aw� si s.c✓ �+7»-nnlaad �F�3(, 77y-�9S <br /> iEN�% � MULAppRE55 C'lY 21P PNUNE <br /> ^ '` � �NQ <br /> , <br /> AH NIT P ESIGNER MRII.RDDPESS G:tY IIP P�IONE <br /> 6ENEMlCAN1HACTOR MRILRUORE55 ,�• CiTY ZiP PHONE LIGENSE• <br /> EN9t/ �e �ssa �-a�s�/�rf N� w.w.�/nY �/C �'d0�� 765�$/06 <br /> MECHIINIC�LC N/TMCiOR '� MnILpADORE55 Glil' ZIP VHONE 4GENSE• <br /> E✓tr'+i J`�r�T�ne�i���.�. f.0. �tx .Z�57 E��e<I�" 95.�103 �2 ,.:t-/Y3y ��`Rf5/1/d/ DF' <br /> MUMBINpGONiMCT011 MRILAUOPESS GIIY ZIP PIIONE LIGENSE� <br /> ClASSOF WOPK <br /> � NEW ❑ A�DITION ❑ ALTERATION ❑ REPAIfl L� DEMOLITION ❑ WOO�STOVEJFRPLINSEHT ❑ BUILDINGRELOCPTIUN A <br /> IEN�NT IMPflOVEMENT OR INlERIOP REMOOEL ONLY CONUCf PER'uON RND PHONE NO. <br /> CANTIUCTFRICEOFWOqK r S . sa-�y3 <br /> UESGR�BENt`RK�ND90U�AEFOOTRGEINVOLVEU <br /> /l�e.✓ ���1 C. Svs��.,s . <br /> PPOPOSEO USE Of BUII�IN� I HEREBY CERTIFY THAT I HAVE READ ANO EXAMINED THIS APPLICATION AND <br /> a�`, KNOW THE SAME TO BE TRUE AND COFRECT.ALL PROVISIONS OF LAWS AND <br /> LEOALOtSCRIPTIONOFPpOPEP1Y�SHOWNBELOWORpiIRCHFOURCOPIES� OPDINpNCESGOVERNINGTHISTYPEOFWORKWILLBECOMPLET[OW�TH <br /> W HETHER SPECIFIED HEREIN OR NOT.THEGRANTING OFA Pf:RMIT DOES NO7 <br /> PRESUME i O GIVE AUTHORIN TO VIOLA7E OR CANCEL THE PROVISIONS OF <br /> �or a�xK oF ANYO7HERSTATEORLOCALLAWREGUTATINGCONSTRUC710NORTHEPER- <br /> FORMANCE OF CONSTRUCT�ON.THAT I AA9 AUTHGRIZED BY THE OWNER OF <br /> THIS PROPERi r f0 PERFORM THE WOFK FOR WHICH APPLICATION IS MA�E <br /> AND I COMPLY WITN THE STATE CONTRACTORS LAW 1827 RCW AND <br /> 296.200 WAG <br /> SiGNRiUREOFGONTPRCiONONAUTlIONIZED�GENT OATE <br /> X ' C�'%�t �o�a-p9 <br /> PROJECT�OOFE55 pPpLIGRN1iCITYBU51NE55LICENSENO.AND USINESSNAME <br /> SE. E�...fl .I �+-Mer�• � . <br /> PLUMBINd MECHANICAL ' <br /> NO. 7YPE OF FIXTUHE OH ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(iOILEn A/C—A/HNDLG UNITS—H.P. <br /> BATHTUB FORCEDAIRSYS7EMS—B.T.U. MEA <br /> LAVATORY(JJASH BASIM UNIT H EATERS—B.T.U.SoM <br /> SHOWER CLOTHES DtiYERS <br /> KITCHEN SINKS DISP. VENTILATION FAN <br /> DISHWASHER RANGE HOOD <br /> LAUNDRYTRAY WATER HEATER <br /> CLOTHESYIASHER � WOODSiOVE _ <br /> URINAL METAL FIREPLACE 6 CHIMNEY _ <br /> DRINKING FOUNTAIN FIREPLACEINSERT <br /> FLOOR DRAIN HEAT PUMP <br /> BACKFLOW PfiEVENTERS GAS FIPING <br /> ROOF DRAINS—RAINLEAOERS EXHAUST FAN <br /> � SINKISERVICE—BAR,ETG) <br /> SUBTOTAL S SUBTOTAL S <br /> PERMIT S PERMIT S <br /> TOTAL FEE $ TOTAL FEE S <br /> FRONTSET&1CK PE�NSETBACN SIOESETBRCft FLANCNECRHOMBEH FEE PECEIPfNO. <br /> usEzoNE toi�eEn wceNrSne FEES VALUATION FEE <br /> n <br /> O 1'ES ❑NO <br /> BUILDING <br /> �VFEOFLON9T. OLCUPANCYOROUP NO.OFOWFLlIN0UN115 — <br /> ALLOWR6LE/ACiURL PLUMBING <br /> 512EOFBLDO. NO.OFSTOPIES OSMi. OGGL0�0 <br /> o v MECHANICAL t <br /> ❑N <br /> uewnruuiratior+ , OTHER <br /> FlRESPRINNLENSREOUIRED ❑YES o Ho STATE BUILDING SURCHARGE <br /> .+ y \"' I7 I Il � STATEENERGYSURCHARGE <br /> APPLICQION�CGOY PL q. C IS I I I <br /> � �� PUBLICWORKS <br /> -��n 989 � - <br /> TOTAL <br /> L•V�RETT DUILDING DEPT. . <br />