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� <br />y O H <br />� h � <br />a��x <br />� H <br />ay�n <br />y�H <br />tC f9 <br />H �1 <br />� �� <br />Hrp� t�C}'' <br />W: 1.7. L'J <br />OHd�y <br />H L�T! O <br />HV �qqg <br />rHz <br />HH <br />gy <br />H <br />C] C7 V1 <br />��� <br />Hn� <br />�d'i iw <br />� ' <br />t"a: ..s <br />+e.. � <br />1..�R,,,� � <br />s `�"a <br />., <br />A,PPLeEt:,rsTIOW �F�R C:`:t;yS'r6��CTe0�9 <br />P�R�,o; � <br />Iho Everprea•t ����'�r�� <br />CITY OF � <br />ev�rett <br />BUILQING DEPARTME�T <br />pFg.gg�p TO BE COMPLETED IN IPIK— PLEASE PRINT <br />OW NER LwIL PDUFE°.5 <br />CIiT ZIP PIIOt1E <br />/ ( I/f /�� �(. �+v�a/:'YSli �c/l= 4�Z��� '=, ;y �_Y.3� _ <br />�-i'i%!iS ) ���li'11 % 1'- (•�l��x �� GTY ZIP PHONE <br />iE11ANi I.IAIL AO�RElS <br />�.�6NIT[GTC'UESIqNEF 61AILP005E55 <br />GtY ZIP PMONE <br />—y��� 7 p PHONE LICENSE M <br />GENERALLONTFACTOP MNILR�ORE55 — ' ' l ^-^ ' <br />f.IiY ZIP PNONE LIGENSE � <br />PLUMBINGCONTRACiOP MAILROORE55 <br />:,�LA(55 UF WOIK <br />�'y NEW ❑ ADUITION ❑ AITEFOTION ❑ REPAIR C� DEMOLITION ❑ WOODSTOVE�FRPLINSERT ❑ BUI�DINGRELOCATION <br />�^�e� � � CONiACTPER50NFN�PHONENO <br />IENANTiA1PFOVEMENTOHINTEPIORREMOOELONiY N 1� �pL`. C6 <br />f.ONTRACTPPICEOFWORK _ U�� �'�fy� <br />�p{��_ BLOCK OF <br />reo:ec* aooriess � <br />-7//1c, nli _i�..,n._D,n/.., ,P/� <br />PLUMBING <br />TVPE <br />LAUNDRVTRAV <br />:LOTIIES WASHER <br />URINAL <br />�RINKING FOUNTAIN <br />FLOOR DFlAIN <br />BACKFLOW PREVENTERS <br />ROOF C1RAI NS — FAINLEADERS <br />SI NN (SERVICE — BAR. ETC.) <br />SUBTOTAL S <br />--' PER�d1T 5 <br />TOiAL FEE `+ <br />f9ACH WE�ST �[AlVSETOACN / � NC <br />�r'1 / I / i7 <br />2 -, <br />6 <br />qHtN <br />�� /�5 <br />:U.PNNCYGROt1P <br />�ur sror+iEs osin <br />� �r <br />N <br />FIPESFRPlNLERSREOUIPEO ❑ YES J�NO <br />1 MEREBV CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AN� <br />KNO W�HE SA�.�E TO BE TFU E ANO CJRRECT. ALL PROVISIONS OF LAWS AN D <br />ORDINANCES GOVERNING THIS TYFE Of WORK WILL BE COMPLETED WITH <br />W HETH ER SPECIFIED HEREIN OR �OT. THE GRANTI NG OF A PERMIT DOES NOT <br />ANYOTHER3 A EEORLO'A�� �"1REGULATIONGCO STRUCTIONORi'HOEP RF <br />FORIAANCE OF CONSiRUCTION. THFT I AM AUTHORI7.ED BV THE OWNER OF <br />THIS Pf70PERTV TO PERFORM THE WORK FOR WHICH �PPLICATION IS MADE <br />AND I C0IAPLY W�TH THE STATE CONTRACTORS LFW te^'7 RCW FND <br />296200 WAC. <br />9GN4WPEO:CONiiinGlOR FFUiHCAREDAGENT DALE <br />Y. !�{ <br />'�-_��/-�``-"1 ---- <br />�, xi,p�''.nvrs ci(�' eu`+�n6s uCENSE No -rvD �usuEbs NquE <br />MECMANICAL <br />fEE NO. NPEOFEOUIPMENT <br />� _ _ _ q�C— Wt�NDLG UNITS �- H.P. _ <br />1�� FURCEO A�R SYSTEMS — 9.T.U. M tA <br />i _ _— _ _ <br />UNITHEhTERS—N_T.0 M <br />CLOTHESDRYERS <br />VENTILATION FAN <br />1 RANGEHOOD <br />WATEF HEATER <br />__l�__ WOODSTOVE <br />METi�LFIREPLACEBCHIMNEY _ <br />FIPEPLACEINSERT <br />HEAT PUMP <br />GAS PIPING <br />cvunllST FAN — <br />/ FEES <br />BUILDING ___ <br />PLUMBING <br />MECHANICAL _ <br />oTHea _ <br />STATE 6UILDIAC SUFCHARGE <br />STldEENERGYuURCHARGE <br />Pt1BLIC WORKS <br />TOTAL <br />T <br />5j <br />G� <br />