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.l.r <br />APPLI��►TION FOR CONSTR'.1CTION <br />PERMIT <br />;� <br />fhe EverO�een evCrell <br />CITY OF � <br />everett <br />BUILDING DEPARTMENT <br />259•8810 TO BE COMPLETED IN INK— PLEASE PRINT <br />pWNER MML�DORE55 GIIY Z�P PMONE • <br />�-_ .,. :�� �...0 �,,, cr_ „-� tt: ,. � 12 ti� �?,� F� iP r�l 9f� Zo3 �s-'3-5187 <br />µ�HITECTOR0E51GNEfl MAILADORE53 CITY ZIP PHONE <br />PLUM&NUGONTN�GtOR MM�AOONESS <br />CIIY 21P PHONE UGENSE• <br />❑ NEW <br />❑ ALTEPATION ❑ REPAIR ❑ DEMO11710N ❑ WOODSTOVE/FRPLINSERT ❑ BUILDINGRELOCATION <br />�NTRACTPRILEOF WORK / (p�VV v <br />�E�IBEj�pK�NpSOUMEF00T�GEINVOLyEO � � <br />ll1 µ�� <br />(�Q� 1/f` <br />ppOPOSEU U9E OF BUILUINO <br />dzci �f'oon� ��PQG Rm . <br />LEOALOE3CRIPTIONOFPR ERttISNONNBELOWOPRTiAG11FOURGOVIES� <br />�ory�— e�ocK or �� ' �y�.�r_y '1rNt.'S <br />P fU�� ' n l��uMP « e� �QC: <br />L <br />I M -.Snnc�h�rn�-��• r�,, �� ��c-,h� <br />�cs� <br />PfqJECTADORESS �`�'e ..IL�// /"1 <br />s�vb7 Flrn�la� R� � «T► <br />PLUMBINO <br />NO. TYPE OF FIXTURE OR ITEM FEE <br />WATER CLOSET (TOILET) <br />BATHTUB <br />UVATORY�WASH BASIM <br />SHOWER <br />KITCMEN SINKB DISP. <br />DISHWASHER <br />UUNDRY TRAY <br />CLOTHES WA9HER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PqEVENTERS <br />ROOF DRAINS — RAINLEADERS <br />ewv �ecovlCG _ weR FTf.I <br />SUBTOTAI E <br />PERMIT 5 <br />TOTAL FEE E <br />RFJ�RSEfB�CK � SIOESEI&�GN <br />� � _� � <br />LOT�REA� � V�GNi511E <br />� � '_ /� � ❑ YES '6[ NO <br />�LIOW�BLE/�CTt1AL � � ' <br />S12EOfBl�6 NQOFSi0�lE3 BSMT. OCGLORD <br />,1�� I OY <br />y 8'N <br />IIEIONT LIMI � <br />tI1E5PPINNLERSPEOUIREU OYES '�NO <br />�/ <br />i <br />APPIIGAlION�CCBY � PLANSAPPR.9Y <br />i � <br />-,[% � <br />� ` �,� � <br />� <br />—3R8 <br />1 HEREBY CERTIFV THAT I HAVE READ AND E%AMINED THIS APPLICATION AND <br />KNOW THE S�ME TO BE TRUE AND CORRECT. ALL PROViSIONS OF LAWS AND <br />ORDINANCES GOVERNING THIS TVPE OF WORK WILL BE COMPLETED WITH <br />WHETHER SPECIFIED HEREIN OR NOT.7HE �RANTINOOFA PERMIT DOES NOT <br />PRESUME TO GIVE AUTHORIN TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW REGULA7ING CONSTRUCTION OR THE PER� <br />FORMANCE OF CONSTRUCTION. THAT I AM PJTHORIZED BY THE OWNER OF <br />iHIS PROPERN TO PERFOFM THE WORK FOR W HICH APPLICATION IS MRDE <br />AND I COMPLY WITH THE STATE CONTRACTORS LAN 1827 RCW AND <br />296200 WAG <br />$IONATUREOFCONiR�C10N011PUINON�ZED�GENT D�TE /O — �� (]A <br />Q� <br />X li <br />�PPLIC�NTSGIt U51 ESSLICENSENO.�NDBUS�NESSN�ME <br />MECHANICAL <br />NO. TYPEOFEOUIPMENT FEE <br />A/C — A/HNDLG UNITS — H.P. <br />FORCED AIR SYSTEMS— B.T.U. M EA <br />UNITHEATERS—flT.U. M <br />CLOTHESDPYEPS <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />' WOODSTOVE <br />METAI FIREPLACE6 CHIMNEY <br />FIREPLACEINSEFiT <br />HEAT PUMP _ <br />GAS PIPIN6 <br />ExHAUSTFAN <br />TOTAL FEI <br />1MBER FEE <br />���1� ��� <br />FEES VALi <br />BUILDING <br />PLUMBINO <br />MECHANICAL <br />OTHER � <br />STATE BUILGING SURCHARGE <br />STATE ENERGY SURCHARGE <br />PUBLIC WORKS <br />TOTAL <br />A <br />S <br />E <br />E <br />FEE <br />r. <br />