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� • � <br /> APPLICATION �OR CONSTRUCTiON <br /> P�RMIT <br /> rne e�reroreen <br /> CITY OF evere[t <br /> everett � <br /> BUILDING DEPARTMENT <br /> 259-88to TO BE COMPLETED IiN INK— PLEASE PRINT <br /> �NEW, � `�1 ���� I )l�- I � 1.�- IODEV` l�f//, LIA.VIV + `VIiYI� V � /��L/ /� P��,�����k.� <br /> TE��NT MAILPpORE55 � CItY ZIP PHONE <br /> ����_p/ <br /> AiiCHITEGTOflDE51GNER MAILAODRE55 CITV ZIP PXONE <br /> GENEN�LCONIAACTOR MAILA �FESS CITY ZIP PHONE LIGENSEs <br /> vA�i��,��- an- �c�c�s 1�1� .c���Q,4-�l- t�✓-i ���c� � ���-5�9a <br /> MECH�NICALCO pCTOP MAllAODR 55 CITY 21P PHONE 4CENSE• <br /> U�I�NC�l�3 L;Z �4—r3—� ( <br /> PLlIM61NGWNTR�CTOR MARAODflESS GT'! ZIP PNONE LILENSE• <br /> ClA%OF WOHN ��f <br /> ❑ NEW ❑ ADDITION�JS�ITERATION ❑ REPAIR ❑ UEMOLITION ❑ WOODSTOVEJFFPL INSERT ❑ BUILDING RELOCATION <br /> TEN�NTIMPROVEMENTORINTEpHI�OR�MOOELONIY LONTRGTPERSONRNDPNONENO <br /> COYTR�CTPRICEOFWORK C/ ��. � <br /> —�{E�SCRIBEWORK�ND$(p UARE OOTAGEINVOWED <br /> 1 � / x / <br /> `aaovoSEo usc�oF eUlLol�+c I H EREBY CERTIFV THAT I HAVE READ AND EXAMINED THIS APPLICATION AND <br /> �• �^�n KNOWTHESAMETOBETr7UEANDCORRECT.ALLPi70VISION50FU1WSAND <br /> ������ ORDINANCES GOVERNING THIS TVPE OF WOFK WILL BE COMPLETED WITH <br /> LEGALOESLRIPTIONUFPROPENttISNOWNBELOWORATfAGNiOUflCOP�ES� WHETHERSPECIF�EDHEREINORNOT.THEGRANTINGOFAPERMITDOESNOT <br /> PRESUME TO GIVE AUTHORIN TO VIOLATE OR CANCEL THE PROVISIONS OF <br /> �or e�oCK oF ANYOTHERSTFTEORLOCALLAWREGULATINGCONSTRUCTIONOfiTHEPER• <br /> FORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE OWNER OF <br /> THIS PROPERTV TO PERFORM THE WORK FOR W HICH APPLICATION IS MADE <br /> AND I COMPLY K'iTH THE STATE CONTRACTORS LAW 1827 RCW ANO <br /> 296.200 WAG <br /> SIGNAi0PE0FCONTRRG70RONAUTNORIZEDRGENT DQE <br /> �c.k�.�,';� ����� �l��L� <br /> PIqJEGTADORESS� � ��� � APP4 A TSCITYBUSINE IC SENO(�X BOSINESSN�ME <br /> �M��� MECHANICAL <br /> Np, TYPE OF FIXTUNE OR ITEM PEE NO. TYPE OF EOUtPMENY FEE <br /> WATEH CLOSET(TOILEf) A/C—A/HNDLG UNITS—H.P. <br /> BATHTUB FORCED AIR SYSTEMS—BT.U.IO�M EA <br /> LAVATORYIWASH BASIN) UNIT HEATERS—B.T.U. t�1 <br /> SHOWER CLOTHESDRYERS <br /> KITCHEN SINK 8 DISP. VENTILATION FAN <br /> DISHWASHER RANGE HOOD <br /> LAUNORY TRAV WATER HEATER <br /> CLOTHES WASHER WOOD STOVE <br /> URINAL METAL FIREPLACE 8 CHIMNEV <br /> DRINKING FOUNTAIN FIREPLACE INSERT <br /> FLOOR DRAIN HEAT PUMP <br /> BACKFLOW PREVENTERS GAS PIPING <br /> ROOF DRAINS—RAIIJLEADERS E%HAUST FAN <br /> SINK(SERVICE—BAR,ETG) <br /> SUBTOTAL S _ SUBTOTAL S <br /> PERMIT $ PERMIT g _ � <br /> i <br /> TOTALFEE S - TOTALFEE S G S <br /> FHONTSETBAGK REIRSETB�CK SIOESETBhGK VUNCNECKNIIMBER FEE AECEIPfNO. <br /> usezor+e �orea� YRC�NTSITE FEES YAWATION FEE <br /> ❑VES ❑NO <br /> BUILDING <br /> tt'EOFCQNST. OCCUPANGYGflOUY NO.OFGWELIIN�UNITS <br /> QLOW�BLE/ACTUA� pLUMBING <br /> 52EOFBLDG NOAFSTORIES BSMt. OCCLOAp MECHANICAL L � <br /> UY <br /> ft N <br /> NEiGk�LIMITRTION OiHER <br /> FIFESPNINNLERSFEOUIREO ❑YES O NO S'fATE BUILDING SURCHARGE <br /> STATE ENERGY SURCHARGE <br /> APPIICRTION�GGBY PUNSAPPR.BY PUBLICWORKS <br /> Tora� �� <br /> � <br />