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� Y`1.e.c� : / <br /> ' APPLICw`�110N FOR GONSTR4:�lON �� <br /> � PEI�MIT <br /> � the Evorpreen <br /> CITY OF everell <br /> � everett � <br /> � BUILDING DEPARTMENT <br /> 259-8810 TO BE C0117PLETED IN INK— PLEASE PRIN i <br /> + �le�n McR-I pir�v �a,7lasior����' ue,°'l�.�f q��ol ���-���9 <br /> ; <br /> , MAILADDRE55 CITY ZIP PHONE <br /> ( TENpNi <br /> � <br /> i MCHITECTONOESIGNER MAILAO�RESS GTY ZIP PHONE <br /> 1 <br /> � OENEFALCONTRFLTOR MFILR�ORE55 CITY ZIP PMONE LICENSE• <br /> 1 CH�171G�LCON1 CTON MAIIAD�PESS CITY PHONE UCENSE• <br /> � ��`a� I�'�_�.i.�,�t�. Q.v��J�# � �4� <br /> � UMBIN� IiRpCiOR MAILAO RESS CITY zir rr���Ll��� <br /> i <br /> '� GUSSOFWORN <br /> + ❑ NEW ❑ ADDITION ALTEPATION ❑ REPAIR ❑ DEMOLITION ❑ WOOJSTOVE/FRPLINSERT ❑ BUILDINGRELOCATION <br /> j TENRNTIMPPOVEMENTOflINTERlO ODELONLY CONIRGTP1.450NFNDPHONENU <br /> i CANTRAGTPRICEOFWONK <br /> � DESGPIBEWOPK�NDSOUAREFOOTAGEINVOLVED ( <br /> i -�y_Q_ 5 _ <br /> j ovo5eou5E 6UIlDIN IHEREf3YCERTIFYTHATIHAVEREADANDEXAMINEDTHISAPPLICATIONAND <br /> � KNOW THE SAME TO BE TAUE AND CORRECT.ALL PROVISIONS OF LAWS AND <br /> �� ORDINANCES GOVERNING THIS NPE OF WORK WIIL BE COMPLETED WITH <br /> 1 LE(iAL0E5LflIP oN FPROPERTY�SHOWNOcLOWUNFTtACHF011PCOPiES� yyHETHERSPECIFIEDHEREINORNOLTHEGFANTINGOFAPERMITDOE5N0T <br /> ' PRESUME TO GIVE AUTHORIN TO VIOLATE OR CANCEL THE PROVISIONS OF <br /> � loT B�ocrc cF ANYOTHERSTATEORLOCALLAWR[GULATINGCONSTRUCTIONORTHEPER� <br /> 1 FORt.9ANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE OWNER OF <br /> � THIS F'FlOPERN TO PERFORM THE WORK FOR W HICH ANPLICATION IS MADE <br /> � AND I COMPLY WITH THE STATE CONTRACTORS LAW 1827 RCW AND <br /> � 296.200 WAC. <br /> �� SIGNRUIlEOFCONTRALTORORAUTNONqEDRGENT OATE <br /> � � ��2�� I/► 2-/�b� <br /> {( PflOJEGT�R�55 �� qPPLIC��1T5 ITY6USWESSLGENSENO.ANppU51NES511PME <br /> 1 j <br /> �� b <br /> PLUMBINO MECHANICAL <br /> � NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> � WATERCLOSET(TOILET) fVC—AIHNDLGUNITS—H.P. <br /> � <br /> I BATHTUB FORCEDAIRSYSTEMS—B.T. EA <br /> : LAVATORYIWASHBASIN) UNITHEATERS—B.T.U. M <br /> d SHOWER CLOTHESDRYERS <br /> � _ KITCHEN SINKB DISP. VENTILATION FAN <br /> ( DISHWASHER FiANGEHOOD <br /> � LAUNDRYTRAY WATER HEATER <br /> ', CLOTHES WASHER WOOD STOVE <br /> i{{{ <br /> � URINAL METAL FIfiEPLACE 8 CHIMNEY <br /> DRINKING FOUNTAIN FIREPLACE INSE(iT <br /> � FLOORDRAIIJ _ fIEATPUMP <br /> BACKFLOW PREVENTERS C1A5 PIPING <br /> ' ROOFD(iAINS—RAINLEADERS E%HAUSTFAN <br /> ,f� SINK�SERVICE—BAR,ETC.) <br /> 1 <br /> � <br /> � SU9TOTAL $ SUBTOTAL $ <br /> �� PERMIT S PERMIT S _ <br /> �� TOTAL FEE S TOTAI FEE S <br /> FROHTSETFIACN flERFSETBACH S�OESETBACH PUNCHECKNUMBEfl FEE HECEIPiNO. <br /> � <br /> � usezaNe IOTAPEA VRCRNi51TE FEES VALUATION FEE <br /> ❑YES ❑NO <br /> �� BUILDING <br /> ! TYPEOFCONST. G`CCUPANCYOflOUP NO.OFDWELLINOUNITS <br /> i QLOW�oLE/ACTUAL <br /> PLUMBING <br /> SIZEOFBLDQ NO.OFSTORIES BSMT. OCGLOID <br /> i ❑v MECHANICAL <br /> ❑ N <br /> �� HE�GNTLIMILRTION OTHER <br /> � fIFE SPRINNLERS REOUIREp O VES ❑NO STATE BUILDING SURCHARGE <br /> 1 <br /> STATE ENERGY SURCHARGE <br /> RPPLIC�TION�CGBY PUNSAPVP.BY <br /> i PUBL�C WORKS <br /> i <br /> TOTAL <br /> i <br />