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AQPI,IV.:�'�`IOId FQR CONSTRUGTION <br /> PERMIT <br /> fhe Eve�greon <br /> CITY OF <br /> everetl <br /> everett e <br /> BUILDING DEPARTMENT <br /> 259-8810 TO BE COfNPLETED IN INK— PLEASE PRINT <br /> OWVER/ � MaILnD�PE55 Giiv /� ZiPy PHONE <br /> iENnN`P {hSG4/ I1��/ RES�VT,___Q�� G V/ /D f4O/ PHONE J / ' /I�� <br /> AFGHIiELTOR0E51GNEP MRILADDR[SS CITV ZIP PNONE <br /> GENEPNLCONifVACiOR MAILAOOPE55 GITY ZIP PHONE LICENSEs <br /> MECHt�NICALLONTRnGTOR MAILG�DRESS GItY ZiP PHONE LiCENSE� <br /> N��lt,w«�- U��w �4jw.� 3��� -��. Q�� F�r ��LJ �s�-s;�� Nn�,��W� i�r 2.� <br /> �tUMBINOGONiRACiOd MAILAOORESS pTY ZIP PMONE LIGENSE• <br /> CUSS OF WOIiN <br /> NEW ❑ ADDITION ❑ ALTERATION G REPAIR ❑ DE1.10LITION ❑ WOOOSTOVE/FRPLINSEflT ❑ BUILDINGRELOCATION <br /> NANT IMPROVEM[NT OF INTEFIOfi RFMOOEL ONLY CONiRCi PERSON PN�PHONE NO <br /> CANTRAGT PiiICE OF WORK <br /> �ESGRI3E WOflN AND SOUAHE IOOTAGC INVOLVEO <br /> ��;,sraa� F,.,�NAc� <br /> ROPOSEO USE OF BUILOINO <br /> I HEREBV CERTIFV THAT I HAVE READ AND EXAMINED THIS APPLICATION AND <br /> S����p /—_g�� � � KNOW7HESAh1E70BETRUEANDCOFRECT.ALLPROVISIONSOFLAWSAND <br /> LEGAL DCSCRi�� y } ORDINANf,ES GOVERNING THIS TYPE OF WORK WILL BE COMPLETEO WITH <br /> ��WUNOFPRCPERtt�`i NBE.OWORATTACHFOURCOPIES� WHE7HERSPECIFIEDHEREINORNOLTHEGFANTINGOFAPERMITDOESNOT <br /> PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br /> toT e�oGK oF ANYOTHERSTATEURLOCALLAWFEGULATINGCONSTRUCTIONORTHEPER� <br /> FORMANCE OF l;ONSTRUCT10N.THAT I AM AUTHORIZED BY THE OWNER OF <br /> THIS PROPERT'i0 PEHFORM THE WORK FOR WHICH APPLICATION IS MADE <br /> —' AND I COrviPLV WITH THE S7ATE CONTRAC70R5 LAW 18.27 RCW AND <br /> .^96200\VAG <br /> SIGNRit1FE0 RACtOPORAUtHORI2E0AGENT OnTE <br /> PROJECT�OORE55 -�,_I/f�'���� //�// / / <br /> / � — ' / A� APPLICANTSCIiY8U5�H.E55 Bp51NESSNPME <br /> 7 %� <br /> PLUMBING MECHANICAI <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATEq CLOSET(TOILET) A/C—A/HNDLG UNITS—H.P. <br /> _ BATHTUB � FORCEOAIRSY^-T=MS—B.T.V.7 MEA � <br /> LAVATOHVIWASHBASINI UNITHEATERS—B.7.U. M <br /> SHOWER CIOTHESDRVERS <br /> KITCHEN SINKB DISP. VENTILAiION FAN <br /> L`ISHWASHER RANGE HOOD <br /> ___ L4UNDRYTRAV _L WATER HEATEH <br /> GLOTHES WASHER WOOD STOVE �� <br /> URINRL METAL FIAEPLACE 8 CHIMNEY <br /> DRINKING FOUNTAIN FIREPLACEINSERT <br /> FLOOP DFAIN HEAT PUMP <br /> BACKFLOW PREVENTERS Z GAS PIPING <br /> ROOF DRAINS—RAINLEADEfiS EXHAUST FAN <br /> SINK(SERVICE—BAR,ETC.) <br /> -IS_5 Q <br /> SUBTOTAL S SUBTOTAL 5 <br /> PERMIT S PERMIT 5 ��G _ <br /> TOTAL FEE 5 TOTAL FEE S � <br /> lRJNiSETpAGK qEAflSEiBFCK SIOESElOACK PIANCHECKNUMOEH FEE RECEIMNO. <br /> usezor+E �ornnee wc.�+rsrte FEES VALUATION FEE <br /> ❑YES ❑ NO _ <br /> iVPEOfCONST. OLGUP�NCYGROUP NO.OFDWELLINGUNITS BUILDING <br /> PLLOWABLCUCTU�L <br /> PLUM�ING <br /> 512[OF pLOG NO.OF STORI[5 ASMi. OCC.LOAD <br /> ❑ Y MECHANICAL �7 (�(� <br /> ❑ N lL,JSC_ <br /> HEIGMT�IMiTRTION OTHER <br /> FIRE SPf11NNLEPS PEOUIRED ❑YES ❑NO STATE BUILOING SURCHARGE <br /> O7ATC CNERGY^-l�RCHAR,E <br /> AV�vLIC4110NACG0Y P��NS�PPN.BY - <br /> PUBLIC WORKS <br /> �` �I � _ TOTAL 'C) � <br />