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. .;.. - <br /> APPLI�`;1►TION FOR CONSTRa�CT10N <br /> � PERMIT <br /> th�Erorpnen <br /> CITY OF <br /> everett ' CVefP" <br /> BUILDING DEPARTMENT � <br /> 259-eB10 TO BE COMPLETED IN INK— PLEASE PRINT <br /> . OWNEP MMLe�DRE55 Cl�v Zm P��ONE <br /> 5'To��� ST�ovES I %a� �-I�rrr' �-vt'YZeT''� rySZ�c� <br /> TENM/T M�I��DDPE55 . CIIY ZiP PNONE <br /> M`C111TF:IOROESqNEF MAIIADDRE55 CIIY IIP IMOHE <br /> J2NEWLLCONiR�CTOP M�Il�00f1E55 p1V 21P MIONE UGENSE• <br /> �Uf4LiT-Y Hi� 192� �iR '�N RV R't77E'rT' SYZn�( 7�(3-C-CZ$ <br /> ' �rt �nKxcoNm�cron MAa�oDneu arr zin fj�p'� `/�'!LD/Q � <br /> I�CEN � <br /> 1 V <br /> RUMlIHOCONIIUCTOR MML�DpNE53 CI1Y 2iP %IONE UGENSE• <br /> � a�eawwwn�c,/ — . <br /> � C� NEW Id./�DDITION ❑ �LTERATION ❑ REPA�R ❑ DEMOLITION ❑ WOODSTOVE/FRPL INSERT ❑ BUILDINO REIOCATION <br /> TENN/T IMMqVEMENT OR INTERIOR 11EMCDEL ONLY �pNi�Gi PEpSON�ND PIqNE Hp. <br /> CONTMGT PIIILE OF WOqK <br /> 011CMlEN011RM10 ME��p 1/�OEIMVOLVEO <br /> GAS'PI��NG�yo l �o �'�5 NEA'THf DiSP�A� <br /> n�o�Eo ueE a eunoirw I HEREBV CERTIFV THAT 1 HAVE REAO AND EXAMINED THIS APPLICATION AND <br /> �. 4 KNOW THE S/�ME TO BE TRUE AND CARRECt.ALl PROVISIONS pF LNNS AND <br /> L pPERTY�8110WNBELOWOP�TTI�CNFOUHGONES� ORDINANCES60VERNINOTHISiYPEOFWORKWILLBECOMf�LEiEDWIiH <br /> WHETHERSPECIFIEO HEREIN OR NOT.THE6RANTINOOFAPERMITDOE9 NOT <br /> PRESUME TO GIVE RUTHORIN TO VIOLATE OR CANCEI THE PROV1310N9 OF <br /> "� Lm e�oac Ov ANYOTHENSTATEORLOCALUWRE6UUTINOCON9TRUCTIONORiHEPEiF <br /> I FORMIINCE OF CONSiRUCTION.THAT 1 AM AUTHOHIZED BV TME OWNER OF <br /> ! THIS PROPERTV TO PERFORM THE WORK FOR WNICH APALIC�TION IS MADE <br /> ANU I COMPLV WI7H THF ST�TE CONTRACTORS IItlW iB27 RCW AND <br /> ' 298.200 WAC. �/T /v / <br /> ��� SION1TIIpEOiCONTR�CIORORFUTNOHI2ED�6ENT O�TE <br /> •� � �� <br /> ��.. <br /> ' � MIGIECf 11DDIIEJS <br /> - �VR�L SCITYBUSMEtl4UGEN9ENO�NDBU9INESSN�ME <br /> 1 <br /> � KUM�INO MECNANICAL <br /> � NO. Ttlr!OF FlXTUIIE OII ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> � WATERCL09ET(TOILEn NC—NHNDLOUNITS—H.P. <br /> + lATHNB FORCED AIR SYSTEMS—flT.U. M EA <br /> � <br /> i UVATORY�YYA9HBASIM UNITHEqTERS—flT.U. M <br /> � <br /> j BMOWER CLOTHESDRYERS <br /> KITCHEN SINK 8 DISP. VENTILATION FAN <br /> ;� DI9MWA9MER RANOE HOOD <br /> '� LAUNDRYTRAY WATERMEATER <br /> i; CLOTHE9 WASMER WOOD STOVE _ <br /> •� URINAL METALFIREPLACE6CHIMNEV <br /> DRINKINOFOUNiAIN FIREPLACEINSERT <br /> �� FLOORDMIN HEATPUMP <br /> } B11C1(FLOWPqEVENTER3 OASPIPINO <br /> + ROOFDRAINS—MINLEADER9 E%HAUSTFAN <br /> � SINK(SERVICE—BARETC.) <br /> 1 <br /> � <br /> �� SUBTOTAL S SUBTOTAL E <br /> � PERMIT 5 PERMIT S <br /> i <br /> + TOTAL FEE E TOTAL FEE S <br /> ifTONT9ETBGCR pEANSETBI�GN SIOESETB�GN yuNCNECKNUMpER FEE IIECEIPfNO. <br /> UBE20NE ior�nu V�GANTSIIE FEES VALUATION FEE <br /> O YE9 ❑NO <br /> TYPEpiCON9T. OLCUP�NGYONOIIP NO.OFOWELLINOUN�TS BUILDING <br /> �LLOW�BIE//�CTUAL <br /> PLUMBING <br /> : NZCOFBLDQ ND.OFSiONIES BSMi. pCClOAO <br /> � o v MECHANICAL /�— <br /> ON <br /> � NEIGHIUMI1ntiON OTHER <br /> FlNE9MiINKtEN5RE0UIRE� O YE9 O NO STATE BUILDING SURCHARGE <br /> i <br /> STATE ENERGV SURCHARGE <br /> �PFIIG�T10N�GGBY PLRNS�PPR6Y <br /> PUBLIC WORKS <br /> TOTAL g � <br />