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.� �-. / <br /> APPLICATION FOR CONS'TRU�TION 512 � <br /> PERMIT <br /> �he Eve�O�oen <br /> CITY OF everetl <br /> everett e <br /> BUILDING DEPARTMENT <br /> 259•8810 TO BE COMPLETED IN INK— PLEASE PRINT <br /> OWNER MNIl.A00flE55 CIiY 21P PNONE <br /> a 1�n �-+ rt� r 332! �ron-�r' A�l'. ��r�{+ �2cJ ���'- i2'74 <br /> iENANi MAILAOORE55 CITY ZIP PHONE <br /> �RCMITEGiORDESiGNER M�ILADOPESS G�iY 2iP PMONE <br /> GENERA�GONTP�GTOR M�IUpOHESS CrtV ZiP PNONE UCENSE• <br /> MECNAMC�LCONiRACTOP M�ILRODPES$ C�TY ZIP PMONE LICENSE• <br /> �-��1��cr�l � 2[tU�, P!icC�u�t �-�retl .�'32aI z�'-`ft-`� VAuLT1cl�3�r <br /> PLl1MBINGCONRACTOR MAILRpDPESS CITY ZIP PMONE LICENSE• <br /> CLASS OF WOpN <br /> ❑ NEW ❑ ADDITION ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ YJOODSTOVE/FRPL INSERT ❑ BUILDING RELOCATION <br /> iENANTIMVROVEMENTORINiE I /RE�MO/JDE/L�ONL,Yr GONTACTPEHSONRNOPNONENO <br /> CONTR�CT PRiCE OF WORK � (�GL�• V D <br /> DESGPIBE WORNANO SOU� E FOOTAGE INVOLVEO � <br /> Zn� - Il u.►-r,ace� � h <br /> vaovg5eo u9E oF eui�oi+� I HEREBV CER7IFV THAT I HAVE READ AND E%AMINEO THI3 APPLICATION AND <br /> C Y"'��I KNOWTHESAMETOBETRUEANDCORRECT.ALLPROVISIONSOFLAWSAND <br /> '—�f' OROINANCES GOVERNING THIS 7VPE OF WORK N9LL BE COMPLETED WI7H <br /> LECNL�ESGRIPIIONI]FVPOPEflTY�SHOWNBELOWO(1ATfAGNFOURCOPIE51 WHETHERSPECIFIEDHEREINORNOT.7HEGRANTINGOFAPERMITDOESN07 <br /> PRESUME TO GIVE AUTHORI7Y 70 VIOLATE OR CANCEL THE PROVISIONS OF <br /> ioT e�ocK or ANVOTHERS7AT[ORLOCALLAWREGULATINGCONS7RUCTIONORTHEPER- <br /> FORMANCE OF CONSTRUCTION.THAT 1 AM AUTHORIZED BY THE OW NER OF <br /> THIS PROPERTV TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE <br /> �� AND I COMPLY WITH THE STATE CONTRACTORS LAW 1827 RCW AND <br /> � 296200 WAC. <br /> � SIGNA UPEOF�CNiflAGiORONA iN0 IZEO�GENT DATE <br /> II /� <br /> 1 _ X �) n,.�%�-1 / � f/ ' �i'�C)'r=(l� L/����� <br /> i Y <br /> 1 PpWEGfADDRE55 APP G�NTSdiOBUSIN 55 ICEI ENOAND9USINESSN�ME T <br /> I , I Kr�r��� ��u�� <br /> j PLUMBINQ MECHANICAL <br /> µp, TYPEOFFl%TUREORITEM FEE NO. TYPEOFEOUIP6CENT FEE <br /> WATEH CLOSE7(TOILET) A/C—A/HN�LG UNiTS—H.P. <br /> BATHTUB FORCED AIR SYSTEMS—B.T.U. �M EA <br /> LAVATORVIW�HBASIN) UNITMEATERS—B7.U. M <br /> ! SHOWER CLO7HESDRYERS <br /> � KITCHEN SINK 8 DISP. VENTILATION FHN <br /> DISHWASHER RANGE HOOD _ <br /> LAUNDRYTFAY r WqTER HEATER <br /> CLOTHES WASHEfl WOOD STOVE _ <br /> URINAL METAL FIREPLACE 8 CHIMNEY <br /> '� DRINKING FOUNTA�N FIREPLACE INSERT <br /> FLOOR DRAIN HEAT PUMP <br /> BACKFLOW PRF.VENTEFS GAS PIPING _ <br /> ROOF DRAINS—RAINLEADERS EXHAUST FAN <br /> SINK�SERVICE—BAR,ETQ) — <br /> i <br /> SUBTOTAL S SUBTO7AL 5 <br /> PERMIT S PERMI7 5 <br /> TOTAL FEE S 70TAL FEE S <br /> F(MNTSETBnCK REFRSEfBnGN SIO[SEt&1GK PIANCMECKNUMBEfl FEE PEC[IFiNO. <br /> u5ezorve LOTAHU VAC�NTSIiE FEES VALUATION FEE <br /> ; O VES ❑NO <br /> BUILDING <br /> ttPEOFGONST. WCIIPANGYGROIIP NOOFDWELLINGUN�TS <br /> ALLOWABLE/�GTURL pLUMBING <br /> SREOFBLpO. NO.OFSNRiES &SML OCGI.OPD MECHANICAL <br /> uv <br /> ❑ N <br /> MEiGNTLIMIIAiION OTHER <br /> FIRESPRWNlER5NE0UIflE� �YES ❑ MO STATEBUI!_DINGSURCHARGE <br /> STATEENEFGVSURCHARGE <br /> •PPL'CFiIONACC BY PLANSAPPR BY PUBLIC WORKS <br /> Tora� <br /> � <br />