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� � <br /> APPLICATION FOR CONSTRUCTION <br /> fAe Everpraen PE R M IT <br /> CITY OF evcre[t <br /> everett e <br /> BUILDING DEPARTMENT <br /> 2�'e810 TO BE COMPLETED IN INK— PLEASE PRINT <br /> RAn-in✓L I)6vdL�i� r.+�7 n�li J-.•tih'J� .$�-J- �.� �a n �fVo3L 77l' V�' `la' <br /> OWNER M�IL�DORESS �IiY ZIP FMONE <br /> TEN�NT MRILAODPE55 CITY 21P PNONE <br /> c. c� - �9 - �N.�w4.,,� �a�3� �� ,-23.-� <br /> MCHItECTORDE5IGNEP M�ILAUORE53 GIiY ZIP PNONE <br /> �ENERALGONiqFClOfI MAILAOORE55 \ �IIY 2iP PHONE ULENSEi <br /> LN�7 . �•��. /TF� i ,,o�n, �.� ' J��OIJ .r.((C �GJ07Z ?88-5�a� t1NC�cL� /GR^�3 <br /> MECM�NII:�LLf,NTR�GtOq MRIlA0pPE55 GIY ZIP PIIONE �',CENSE• <br /> PI/UMBINOCONIP�CTOR _ MMI�DDRE55 CI1Y ZIP PMONE 4ClNSE• <br /> b��-�A./•5��o wonK ��rYHrl,.., �,it. /86oL n�oicve�,t l �xr/Hin � 672 �/G-O �A4sa.+� 26aLc� <br /> LI NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ �EMOLIiION ❑ WOODSTOVFJFRPLINSERT ❑ BUILDINGRFLpCATiON <br /> IENNIT IMPRpyEMENT OR INfERIOR REMODEL ONIY fANiRCi PERSON�ND PHONE N0. <br /> CONTHAGT PRICE Oi WOIi1C <br /> UESCRIBE WORI(�NO SOU�FE fOOTApE INVOLYEO — <br /> PRO SE UI <br /> I HEREBY CERTIFY THAT I HAVE READ A1;0 EXAMINED THIS APNLICATION AND <br /> KNOW THE SAME TO BE TRUE AND W�1RECT.ALL F 70V�51045 OF UWS AND <br /> �ecu� U IPTIONOFPq � R1Y�SHOWNBELOWORATT�CIIFOIIPCpPIES� ORDINANCESGOVERNINGTHISfYP'_OFWORKW.LLBECOMPLETEDWITH <br /> WHETNER SPECIFIED HEREII�OR N��T.THE GRANTING OFA PERMITCOES NOT <br /> �ot a�ocn oF PRESUME TO GIVC::J*HORIT'TO V�OLATE OR CANCEL THE PROVISIONS OF <br /> ANY OTHER STATF OR LOI:aL lAW PEGULATING CONSTRUCTION OR THE PER- <br /> FURMANCE OF CUNSTRUCT�ON.THAT I AM AUTHORIZED BV THE OWNER OF <br /> THIu PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MRDE <br /> ���� ���1�� /'� '. _ AND I COMPLY WITH THE STATE CONTRACTORS LAW 1827 RCW AND <br /> � 296.200 WAG <br /> L J SIGNRTUREOFCONTMCIORORaU1110tiIZEO�GENT D�TE <br /> �..�. �..��,,.�_ <br /> ��.,�oAS � a i �J X 6 1-, � ,ti� /a -2� - e r <br /> �PPYICANLSCITYBUSINESSl1�,EN5ENO.�NOBO51NE55N�ME —r— <br /> PLUMBINO MECHANICAL <br /> NO. TYPEOFFIY.NREORITLM FEE NO. TYPEOFE�UIPMENT FEE <br /> WATER CLOSET(TOILET) A/C—A/HNDLG UNITS—H.P. <br /> BATHTUB FORCEDAIRSYSTEMS—B.T.U. MEA <br /> LAVATORV(WqSH BASIN) UNIT HFJ�.TERS—flT.U. M <br /> SHOWER CLOTHESDRYERS <br /> KITCHEN SINKB DISP. VENTILATION FAN <br /> DISHWASHER RANGEHOOD <br /> LAUNORY TRr1Y WATEP HEATEF <br /> CLOTHES WASHER WOOU STOVE <br /> URINAL IdETAL FIREPLACEB CHIMNEY <br /> DRINKI`IG FOUNTAtN FIREPLACE INSERT <br /> FLOOR DRAIN HEAT PUMP � <br /> BACKFLCW PREVENTERS AS PIPING <br /> ROOF DRAINS—RAINLEADERS E%HAUST FAN <br /> SINK(SERVICE—BAR,ETG) <br /> SUBTOTAL S SUBTOTAL E <br /> PERMIT S PERMIT 5 <br /> TOTf.L FEE S TOTAL FEE E <br /> FRONTSE7B�CK RFJ�NSEiB�GN SIDESEIMGN pUNCNEGRIIUMBEfl FEE qECEIPTNO. <br /> uSezoNe LOTAREA vntnNrsne FEES VALUATION FEE <br /> o res ❑No <br /> TYVEOFfANST. OCGUP�NCYOROUP NO.OFDWELLINpUNpS BWIDING <br /> ALLOWABLE/AC11:1L <br /> PLUMBING <br /> SRE OF BLD(i. NO OF SfOf11E5 0$MT. OCG LOAD <br /> o v MECHANICAL <br /> ON <br /> NEIGMTLIMIiALION OTHER <br /> flliESPRINNLEf1SPE0UIPED ❑YES ONO <br /> STATE BUILDING SURCHARGE <br /> STATEENERGYSURCHARGE <br /> �PPLIC�LION�CGOY PLRNSAPP0.BY — <br /> �\� PUBUC WOflKS <br /> TOTAL <br />