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APPLIC�u►'TION �OR COI�lSTRm�CT10N <br /> PERMIT <br /> everett <br /> Ihe Evelpresn � <br /> GITY OF <br /> everett <br /> BUILDING DEPARTMENT <br /> 259-8810 TO BE COMPLETED IN INK— PLEASE PRINT <br /> - MAILADDRE55 GITY ZIP PHONE �p /� <br /> OWNEP �Su � 3� _I Z <br /> R�V Mo�t� !��=n�T�sN 13t� Lo,�8a2., ��Cer��i <br /> CITY ZIP PMONE <br /> TENRNT MaLa�DAE55 � <br /> GILY ZIP VHONE <br /> ARGHITECTOFOESIONEP MAILR�ONESS ' <br /> MRIIPDONE55 CIiY `21P PMONE V::E,:SE• � <br /> 4ENERRLGONTRRGTOF S r C?V ��� �v 7�75 Lm.hic �Y�yPq. <br /> [oo��S CoruS I• �,, �u�� P/12rC �vo l�ov1�S l� (� , <br /> MECH�NIGr1L GONTRACTOP <br /> MRILAODFESS CITY 21P PHONE LIGENSE+ <br /> PLUMBINOCONTR�CtOR <br /> MAILPDORE55 CITV 21P PMONE LICENSE• , <br /> OLASSOF WOflN . <br /> �NEW ❑ ADDITION ❑ ALTERATION ❑ HEPAIR ❑ DEMOLITION COOACWO pDONOANpPNOr+E oSERT � BUILDING RELOCAiION <br /> TEN�NTIMPROVEMENTORINTENIONNEMODEIONLY .��'� /yJ��( � <br /> 1 / a' L <br /> GONTMCTPRICEOFWORIQ r ' fOZU — . <br /> DESCRIBEWOflK�NDSOUPPEFOOtAGEI VOWEO ��� � � ^� ��^ ` • <br /> Z cAa 1�•9� 4G�� � i ._� <br /> PPOPOSED USE OF BUIL�INO I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLiCATION AND <br /> P^�K� ^ ��S KNOW?HESAMETOBETRUEANDGORRECT.ALLPFlOVISIONSOFLAWSAND <br /> rl ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLETED WITH <br /> LECULUESCRIPTIONOFP ERTYISMOWNBELOWQRp,rt�N����.�OP�E� �NYOTHERSATEORLOCAL AWROEGULATINGCONSRUCEONOVP HEPERF <br /> �J� � l�O� 1(J-�� 11il, <br /> LOT__I— BLOCH�L OF � �� <br /> FORMANCE OF CONSTRUCTION.THAT�AM AUTHORIZF.D BY THE OWNER OF <br /> THISPROPERIYTOPERFORMTHEWORKFORWHICHAPPLICAiIONISPAADE - <br /> Z � D '�OO AND I COMPLY I7H THE STAiE CONTRACTORS LAW 7827 RCW AND <br /> �/ 296200�VAC. <br /> I CD� Z� 1 �� LC SIGNATUfiEOFGO PN RUiHORIZEOAGENT OAiE <br /> !�] �2 F1� D(� <br /> cor z� Q� K Z � X a-�y —8�� <br /> PHOJECTROOflE55 APPLI NTSCITY 1 SSLICENSENO.IND905�NESSNFME � <br /> l 3 l (o �orh (3�9 2/� <br /> MECHANICAL <br /> PLUMBING � <br /> NO. TYPE OF FIXTUHE OR ITEM <br /> FEE NO. TYPE OF EQUIPMENT FEE <br /> WATER CLOSET(TOILE'� A/C—A/HNOLG UNITS—H.P. <br /> FOFiCED AIR SYSTEMS—B.T.U. M EA <br /> BATHTUB <br /> LANATORY(bVASH BASIN) UNIT HEATERS—B.T.U. M <br /> — CLOTHES DFiYERS <br /> SHOWER <br /> KITCHEN SINKB DISP. VENTILATION FAN � �� <br /> RANGEHOOD <br /> DISHWASHER WpTER HEATER <br /> IAUNDRYTRAY — <br /> CLOTHES WASHER WOOD STOVE <br /> METAL FIREPLACE 8 CHIMNEY <br /> URINAL <br /> DFINKING FOUNTAIN _ FIREPLACEINSERT <br /> HEAT PUMP <br /> FLOOF DRAIN —— <br /> BACKFLOW PREVENTERS GAS PIPING � <br /> ROOF DRAINS—RAINLEADERS <br /> E%HAUSTFAN I <br /> SINK(SERVICE—BAR,ETC.) — <br /> SUBTOTAL S SUBTOTAL $ ':� <br /> PERMI'f 5 PERMIT g <br /> TOTAL FEE g <br /> TOTALFEE S F�� �� pEGElvrno:� <br /> FRONTSETBACH RERRSETBACK 910ESETBACN PUNCH CNNOMBER �r�� I/–' <br /> � a - s - �1 aa�tC�3 �-�`� J <br /> uSEZONE �oraaen VACRNTSIi� FEES �ALUATION FEE <br /> ❑YES q310 ��a3 ��o ,� <br /> � S�� `�•� BUILDIN <br /> ttPEOFCANST. OCCUPFNCYGROUP NO.OF�WELIINGVNITS <br /> ALLOWAB�E/ALT n� � � PLUMBING <br /> _r( /�- <br /> SIZEOFBLDO. NO.OFSTORIES OSMT. OGGLOPD MECHANICAL <br /> ❑Y __ <br /> S�4 / n <br /> MEIGHTLIMIiPTI�N OTHER <br /> / � _ <br /> FIRESPRINNLEFS REOf11RED ❑YES NO �S STATE BUILDING SURCHARGE <br /> STATE ENERGY SURCFIARGE <br /> / <br /> pPPUCRTIONA GBY PLANSAPPF.BY PUBLICWORKS O ; <br /> ��„p TOTAL , ' <br /> -� a 3 :�o �� ���c� � v�►�ru � F� � <br /> E�'t�-✓i�- c� I�JU CX � ' <br /> < <br /> �c�2 0�.��� _ .. _ , __�--::. <br /> , .._.� _ . _ . :. <br /> . _.... .. ... . . .. .1 . : . . ... <br /> :'lT�' ":TI�'j� ..�_ . <br />