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h.:• . ;,-,� � <br /> APPLIC/�►1'ION FOR CONSTRU�TION � <br /> PERIWIT � <br /> �he Evero�een <br /> :ITV OF everetl . <br /> everett e <br /> 9UILDING DEPARTMENT <br /> ?59-e810 TO BE COMFLETED IN INK— F�LEASE PRINT <br /> �W+NER MAIL�DORE55 CITY ZI� PHONE ' <br /> �us5 yoci,uG I�wsr 3ll f/E,�n��z �.� �r/�ecrr `�1zo3 zSZ- Y38y ' <br /> - �f.N�NT MAILADpRE55 CITY i.IP FHONE <br /> Sr9r>E AS A�o✓E <br /> . �RCHItECTOHDES10NER MRILRODRE55 CITY ZIP PHONE � <br /> � •.ENERRLCONTP�CtOR MAILRDORE55 GIiY 2iP PHONE LICENSE• <br /> 'AECN�NIC�LGOHiRRGiOR M�LL�OOf1E55 QTY ZIP VHONE 4GENSE• j <br /> �4E /62S E.i`lH�i,uE ui�,t�,P. EYE.ee� !`�'2�l 2S$•Zyyl iV.�TU,PGE/iaP� <br /> �LUMBINOGONiRACTOA MRIL�OOf1E55 CITY ZIP PMONE LICENSE• <br /> . GL1590�M'OBK <br /> � ❑ NEW ❑ AD�ITION ❑ ALTEflATION ❑ i7EPAIR ❑ OEMOLITION ❑ WOODSTOVE/FRPLINSERT ❑ BUILOINaRELOCATION � <br /> � IEN�NIIMPROVEMEMORINTEHIONPEMODELONLY CONT�GTPEPSON�NDPMONENO <br /> - CONTMCTPRICEOFWORK 12�Q� �')C <br /> � OE IE�WORKMlDSOURflEF00�0EINVOIVED <br /> ` j� _ <br /> '� eouseoreuiioi IHEPEBYCERTIFYTHATIHAVEREADANDE%AMINEDTHISAPPLICATIONAND <br /> . � �5���� KNOWTHESRMETOBETRUEANDCORRECT.ALLPROVISIONSOFLAWSAND � <br /> � LEG�I UESCRIPTION Oi PROPERTYISHO'NN BELOW OR�TTACH i011�GOPIESI ORDINANCES GOVERNING TNIS TYPE OF WORK WILL BE COMPLEfED WffH . <br /> . WHETHERSPECIFIEDHEREINORNOLTHE6RANTINOOFAPERMRDOESNOT . . <br /> PqESUMETOGIVEAUTHORIT/TOVIOLATEORCANCEI.THEPR01�310NSOF . ..�:� <br /> , �oT e�ocK or ANYOTHERSTATEORLOCALLAWREGULATINOCONSTRUC710NORTHEPER- <br /> FORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE OWNER OF � � <br /> . THISPROPERTVTOPERFORMTHEWORKFOHWHICHAPPLICATIONISMADE � ����-��� <br /> , � AND I COMPLY WITH THE STATE CONTRACTORS LAW 1827 RCW AND � :-`.�� <br /> 298200 WAG ' : .a <br /> ' SI�N�TOHEOFGONTRACfOflORAUTNOR12E0�QENT OATE ' �,;;�' , <br /> /� .�`� <br /> � PAOJECiA0DRE55 � ^Y+� ii��,:� /fN�C�G� I//I .� �'�': <br /> � �FPLC TS BUSI IG EN0.11NDBUSINE391UME ,�'�'� <br /> I <br /> PLUMBINO MECHANICAL �� <br /> NO. T'PE OF FIXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE � <br /> � WATERCL09ET�TOILEi) A/C—A/HNDLGUNITS—H.R �, �u� <br /> � BATHTUB FORCED AIR SYSTEMS—&T.U. M EA Opp . <br /> . IAVATORYpMASH8A5�M UNITHEATERS—&T.U. M ��%;dzj � <br /> � SHOWER CIOTHES DRYERS _ ,,.;�' <br /> . KITCHENSINKBDISP. VENTILATIONFAN � ; �� <br /> � DISHWASHER RANGE HOOD ���.,{. <br /> � LAUNDRYTRAY WATER HEATER '� - <br /> �� CLOTHES WASHER WOOD STOVE : �'�'"�� <br /> . URINAI METALFIREPLACEdCHIMNEY � <br /> �. DRINKIN6FOUNTAIN FIREPLACEINSE(7T , �i;c; <br /> FLOOR DRAIN HEA7 PUMP ;r`�' <br /> � BACKFLOWPREVENTEFS CaASPIPING � <br /> � ROOFDRAINS—RAINLEADERS EXHAUSTFAN <br /> SINK(SERVICE—BAR,ETC.) �. <br /> — ;A� <br /> �;'S <br /> �� <br /> / Ia0 <br /> SUBTOTAL S SUBTOTAL 5 O <br /> PERMIT 5 PERMIT 5 � �.��.;'ti� <br /> TO1AL FEE S TOTAL FEE 5 � �� <br /> fRONiSEiBACR NEAPSETB/�tl< SIOESEiBACN PUNCNELKNUMBEq FEE NECEIPfNO. � � -�;.'(� <br /> (`�; <br /> useioNE ��T�AE� ❑ESTSOCNO FEES VALUATION FEE � ,,-"#. <br /> R <br /> BUILDING -.�-ei.:n <br /> IYFEOfCONST. OGCUFANGYGHOUP NO-0FDWELI.INGUNIIS '_.Th� <br /> QLOWABLE/�CTU�L <br /> PLUMBING `��;,,.�,�' <br /> SREOFBLDG NO-0FSiOPIES 65Mt. OGGLOAO ',.fi"a� <br /> . ❑v MECHANICAL Ir : y� <br /> nN <br /> MEIG1nLIlAIiAIION OTHER ..�� � <br /> fINESPRINMlEf15(1EOUIREO ❑YES O NO STATE BUILDING SURCHAfiGE <br /> S7A7E ENERGY SURCHARGE � <br /> APPL!CN110NACGBY PLANSAPPH.BY .';y!, <br /> PUBLIC WORKS . <br /> TOTAL s Q <br />