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rne Evervreen <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />APPLIC...lION F�OR CuPlS'�'Rt�.�TION ;,;,f <br />.r�ERMIT �����` <br />TO BE <br />i �.� <br />��,1 U d11 rvPlct� <br />' �, <br />�,,,,, l, r„ s i- u�, z u <br />INK — PLE.ASE PRlNT ' <br />L',,:..t/ �(g.�(0/ �✓: S.�'- �-� � 2 <br />cnr tm ruor,F <br />`1-�_ —._ "_' '_.__'_-____-'_ ._.._ _. __. _'__ ....'_'__'_- ___ <br />tpnnr�t 1 nuLL.anoNLss � ci�r � nr� rMorvc <br />C-��JIG�.Ilt`�I'1 //�s-�l' --_-___ _ _-___ <br />ARGNIi[CTOAOESIGNER J T AIAILApOqC55 CIIY � lIP PIIJNE <br />� <br />GENERALGONiRAGiOF MAILAOD�[55 GIY ZIP PIIONE IICENSE� <br />`l C'� �j� ,.� � �=Ct T�-t;\ --- — -- - <br />MEQIANICNLCOR1flACiCR IARII.AOpRESS CIiY IIP PIIONC LICENSF• <br />PLOIABING!:�NTRACiOfl A14LL ApORC55 ----��--�- CIIY— ...-.. �.—ZIP---'--- FIIOIIE _--- LILENSE � -� <br />__ _-__'— -____".. ._. _. . <br />CL�SSOF1YOflK . . . . . . . . .. _.. ---- -"- - <br />❑ NEW ❑ AODITION �ALTEHATION ❑ RtPFIH ❑ I�LId01 IIUN I_�I WOOU5IUVHFHPI.INSLHI ❑ fiUILDINGNGIOGATION <br />T[NANIIMP(IOVFMENLORINiEHIORH[M1IOOELONIY � .'.OIIV.f.IPIi�5U11At11�P11(�NCt10 <br />' 3��-�, =- 5�'�.U��� L����, , <br />� �CONTRACTPRICCOf WOaK. � 1 =_��, �-- -�{TTTTq) ...__ ._.. _. . ....._ _ __ ___--____'._ <br />OESCRIBEN'OPHANOSOU4RE OOTT6E`11N IVEp /�, {'�-� � /�rnU �% I I ... - � • �,�. • . . . ---� --- - � <br />� � � i .'i, / �-, / ��l l �L(� <br />! <br />^ iot�— <br />JP�iY, IIOWNBEIP�YOBAllAC1l�IfiCOPiCS�.-..-- <br />��— oF -1���L� �� � �_' � L�7 �... <br />� _ <br />� �D� N <br />�Lu'c C �L 7 <br />PI.UMBING <br />NO. TYPE OF FIXTURE OH ITEM <br />_L WATER CLOSET ITOILET) _ _ . <br />BATH7UB <br />LAVATORY�WASH BASIN) <br />- — -- -- -- <br />j sHowea <br />KITCHEN SINK 8 DISP. <br />DISHWASHE{i <br />LAUIJDRY TRAY --' <br />CLOTHES WASIIER <br />UPINAL <br />DRINHING FOUN7AIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />flOOP ORAINS - flA W LEADE fi5 <br />SINK �S[RVICE -- BAfl, LTG I <br />--' _ SUBTOTAL.. . . <br />PEFMIT <br />TOTAL FEE <br />cnnu cr we�¢ nrpp5ET0ACH <br />I I IEHE9Y CER7IFY `HAT I I IAVE FEAD AND E%AM W ED THIS APPLICATION AN� <br />I<NO'N TIIE SAME TO BG iAUE AND COF7F7ECT ALL PROVISIONSOF LAWS AND <br />OfiDINANCES G(1VEHNING TIIIS TVPE OF C; 1pK WILL BE COIAPLETED WITH <br />WHEIHEHSPECIrIED IIEREINOR NOT.THEGf�A1JTINGOFAPERMITDOE5N0T <br />'� PPESUAfETOGIVEAUf110Fi1TYTOVIOLATEORCANCEL7HEPROV1510N50F <br />�'�qNY0711LH STA7G Ofi LUCAL I.AW REGULATING CONSTflUCTIONORTHE PER� <br />FOFIdANCE OF CONSTRUCTION. THq7 I AM AUTHORIZED BY THE OWNEF OF <br />THIS PROPEFTY TO PEFFORI.7 THE WORK FOR WHICH pppLICATION IS MADE <br />AND I COIdPLY WITII fHE STATE CON7RACTORS LAW 1827 RCW ANO <br />296200 WAC. [)/ p <br />9GN41l�REU�CONIHAGIOHlitlTlllliOqlZfDAGENi 0/IL D/ j(//p g <br />J ` <br />, � <br />��p� � �', .��� - — - ---- . <br />a iiCsrrtstM7�us�nrssurH+SCT+oarmuusu su�i.�.[ � <br />MECHANICAL <br />TYPE Of EOUIPMENT FEE <br />A,�C--N/IINDLGUNITS- HP <br />MR(EDAIfiS1S7CId5--6TU. h1EA ,�' __ '_ _ <br />UNIIIIEl.IERS B1,U_ M .__ _� � �� <br />c�ori{es naver�s --------- -- <br />VENTILATIONFAN . __'_ _' ___ � ' <br />RANG@ HOOD " ' - - <br />WATER HEATER � -� --'---'- --' ' -'- - <br />___.._. ._. . . _ '_ _. _.'______--._' <br />WOOD STOVE <br />...____-___ . __- _._____. -________ <br />I�.IETAI. fIR[PLAC`c 8 CIIIM11NEY_ __ <br />FIR[PLACE WSEHT <br />HEAT PUAtP ._ . .. ___. -_. _ --__- _ <br />GAS PIPING . . . -- - --- <br />EY.I IAIISI IlN! . . ..�-'-- -' ""� -- - <br />5 - _ _�G L� � suerotni. _' — --�'—rQ <br />5 P[R�dff S - <br />_ .. _ . _ .. . . .. . . . _ _.... . _ . . <br />5 '-� � IOIAL FEE 5 � <br />n- 31DES/Et`pACK PLANjLNECNNUMOEI`I� FEE /� AECEIPTNO. <br />C3� YO' (�i1 v.��iSJ Z.�D� t% � L Z�I <br />ALLOWABLE/AGiWL <br />�� � <br />s¢eoFo�oc i+oorsion¢s <br />�"`f2� S� 2 <br />FlPESPPINNLERSREOUIRE� ❑ YES /� NO <br />ai=ri �r.nuoH ncC nv <br />/�I IY1 <br />— vncnnrsrtE FEES VALUnTlON FEE <br />i i rEs �io `' <br />__ __ kiUILDING . J�i_G��C1_- -._.-�_I'1_ �� <br />No oF nwEu.ii+c or]lts � __ . . . . _ __. <br />_ '. � <br />r PLUh1BING Z.(�J QG <br />_ __.__-_-_ ...... ........__- _ . . -. __ . _ _. ..... _--" - <br />sert or.r, i one � S^1 <br />Cr ^/ A h1ECIlANICAI. <br />1N ff . ... . ._ . V <br />❑HGIIiIIMIiPtl01! UTI�GN <br />�i . .___ _ ____.. .__._._ __ ._______ _._ <br />__'_-_"_---L1.1.---_ .. STATE BUILDING SURCHARGE 3 SC} <br />S1AlL ENERGY SURCHAHG[ <br />— — � �.��a���. w�»�5 _ <br />TOTAL M �-I Z S(/ <br />