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.-ti r <br /> APPLICATION FOR CONSTRUCTION <br /> PERMIT <br /> the Evero�een <br /> CITY OF <br /> everett <br /> everett e <br /> BUILDING DEPARTMENT <br /> 259•BB10 TO BE COMPLETED IN INK- PLEASE PRINT <br /> OWNE��„r wV! ov�^� MRIL�OOPESS GIIY ilP PIIONE <br /> E�wi f � Re ni S61/1�.7a��s S�' S. [�i. �.ti�r��i�✓o+�I. 98�3� ]]f/-ou9g <br /> h�T M�LL��ORE55 CIIY ZIP PHONE <br /> , " P `l�� , <br /> ARGHIIECI6HOESIGNER AI�IL�pOf1E5S CILY ZIP PIIONE <br /> 6ENEN�LCONTP�CTOR MRII.AOORE55 CIiY 21P PI�ONE 4CENSE• <br /> En9e�. �r. lsS.q /-ZoS��`/� �e NE� �t/.,��r r '��� �a°7� 7ss-S/o� <br /> MECH�NIGILC NTRACtOIi I MqILA00RE55 CI1Y ZIP PMONE LICENSE• <br /> E✓t�-e�f Sj��e�'�..el���� . �'.o. ��v .Z557 E�e�e ��' 9S.�n3 as�-��sv E1f,'R[S7/R <br /> PLUM&NOCONiMC10R MM1��011E59 CIIY ZIP PIIpNE LICENSEL—F <br /> f.1�53OF NV RN <br /> � NEN' ❑ ADDITION ❑ ALTEFATION ❑ REPAIR ❑ OEMOLITION ❑ WOODSTOVE/FRPLINSERT ❑ BUILOINGRELOCATION <br /> TENNIT�MPPOVEMENT ON INiERIOR PEMOOEL ONIY CANtACT PEq50N�ND PHONE NO. <br /> fANTP�CT PpIGE OF WOqK A r n S� ��Ltf ^ <br /> DESGRIBEWORK�Np$pUAREF00T�0EINVOlVEO "- +�—�1— �5o�—�y'3� <br /> A�e.✓ rI UflG S �. <br /> PNOP09E0 USk OF BUILOINQ <br /> 1 HEREBV CERTIFV THAT I HAVE READ AND EaAMINED THIS APPLtCATION AND <br /> �i KNOW THE SAME TO BE TRUE AND CORRECT.ALL PROVISIONS OF LAWS AND <br /> LEMLDESCqIPTIONOFFROPENiY�SMOWNBEIOWOfIARACHFOUfiCOPIES� ORDINqNCESGOVERNMGTHISTVPEOFWORKWILIBECOMPLETEDWITH <br /> WHEiHER SPECIFIED HEREIN OR NOT.THE GRANTINOOFA PERMIT DOES NOT <br /> �or e�ocK ov PRESUMETOGIVEAUTHORITYTOVIOLATEORCANCEITHEPROVI510NSOF <br /> ANV UTHER STA1E OR LOCAL LAW RE(3ULATINO CONSTRUCTION OR THE PER- <br /> FORMANCE OF CONSTRUCf10N,THAT 1 AM AUTHORIZEO BY THE OWNER OF <br /> THIS PROPERNTO PERFORM THE WORK FOR WHICHAPPLICATION IS MADE <br /> AND I COMPLY WITH TI1E STATF CONTRACTORS LAW 1827 RCW AND <br /> 296200 WAG <br /> SIONRUREOFCONTR�piONONAUI110RIZF.D�GENT DALE <br /> X �� �� /o ao-Y9 <br /> raaea�ooneu <br /> ♦PPLIC�MSQtYBUSINE554G[NSENO.�ND USMESSNAME <br /> .�. Fv<«.'N /Yltl� .i.... d-/�er�i /� i <br /> PLUMBINO MECHANICAL . <br /> N7. TYpE OF FI%TURE OR ITEM FEE NO.� TYPE OF EOUIPMENT FEE <br /> WATEfl CLOSET(TO�LET) A/C—A/HNDLG UNITS—H.P. <br /> BATHTUB FORCED AIR SYSTEMS—9T.U. M EA <br /> IAVATORV(WASHBASIN) � UNITHEATERS—flT.U.$oM <br /> SHOWER CLOTHESDRYERS <br /> KITCHEN SINKB DISP. VENTILAT�ON FAN <br /> DISHWASHER flANGE HOOD <br /> LAUNDRY TRAI' WqTER HEATER <br /> CLOTHES WASHER WOOD STOVE <br /> URINAL METAL FIREPLACE d CHIMNEV <br /> DRINKINO FOUNTAIN FIREPLACEINSERT � <br /> FLOOR DRAIN NEAT PUMP � <br /> BACKFLOW PREVENTERS GAS PIPING � <br /> ROOF DRAINS—RAINLEADERS E%HAUST FAN <br /> SINK(SERVICE—Bqp,ETC.� ' <br /> SUBTOTAL S SUBTOTAL S � <br /> PERMIT $ PERMIT 5 — <br /> TOTAL FEE E TGTAL FEE $ <br /> FqONtSETB.�GK REAqSEiWCK SIOESEiUACK PIANCNEGNNUMBEN FEE qECE1PTN0. ' <br /> uSEZONE lotu�e� VAC�N151iE FEES VALUATION FEE <br /> ❑VES ❑NO ' <br /> IYPEOFGONST. OCGUPANCYGBOUP NOOFOW[LLINOUNItS BUILDING � <br /> AIlOW�9lE/�CN�L � <br /> PLUMBING <br /> SIZEOFBIOQ NO.OFSiOR�ES &SMT. OCGLO�D . <br /> o v MECHANICAL <br /> ON • <br /> � NEIGNTLIMIGi1pN OTHER <br /> �IPESPRINKlEB5BE0UI0E0 OYES ❑NO — ' <br /> STATE BU�LDING SURCHARGE <br /> h " � U � �� STATEENERGYSURCHARGE — <br /> nrp�icniloN�CGor rl q - <br /> —r—��� PUBLIC WORKS <br /> �CT ^ n 989 TOTA� <br /> CVcRETT [3UILDING DEPT. <br />