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. APPLICi�:'rION FOR CONSTRI��TION <br /> � PERMIT . <br /> Mr Ewrynen evcrett <br /> CRY OF � <br /> everett <br /> BUILDING DEPARTMENT <br /> 259•eB10 TO BE COMPLETED IN INK— PLEASE PRINT <br /> Eq p j MAILADDPf :S GIIY ZIP PIIONE <br /> �✓ �tM�GI\ <br /> yT� ,�N MAIL�ODPESS GIIY TIP PNONE <br /> YA.G <br /> yi� ... S�{J 3 �iiz .E QRra�vO E�ck.�+— QS�a I -- <br /> MI;NITEGiOADE5IANEN MAILI1DOt1E59 CILY ZIP nMONE <br /> OENEMLCANTR�CfOR M�IL�OORE55 CITY 21P FHONE L�CENSE• <br /> �,��,�.� �,�� y�.o S ya� ,�...��.�- 4�2�3 �8-303� ��.cc�eQ��o�ru <br /> MEGN�NIC�LCONTRAGTOR M�IL�DORE55 GIIY 21P PNONE UGENSE• <br /> RUMNHOCONTP�GIOR M�R�ODRESS LIIY 21P PMONE IIGENSE• <br /> UASlOFNt`AK <br /> ❑ HEW ❑ ADDITION ❑ ALTENATION REPAIR CI OEMOLITION ❑ WOODSTOVE/FRPLINSEPT ❑ BUILDIN�RELOCATION <br /> 7EtUNT IMPROVEMENT ON INLEPIOR PEMDOE�ONLY CANI�Ci PERSON ANO PHONE NO. <br /> CC/1TIUCTP1110EOFNOFK �aG7/ . �s <br /> � pElG1118EN'OIMIINOSOUMEFOOT��EINVOLVEO <br /> �p/ic.e. �-dR+7'Qi.njou�tr.Sb�..�.�eh. <br /> �IIOP08E0/V!7E OF BL'ILOIHO I HEREBV CERTIFY THAT 1 HAVE READ AND EXAM�NED THIS APPLICATION AND <br /> /�tJ/�Gre L KNOWTHESAMETOBETRUEANDCORRECT.ALLPROV1810NSOFLAVYSAND <br /> IEWLDESCRIPfIONOiPROPERiY1gNpWNBELOWOR�TtACHNUIICOPIES� ORDINANCESGOVERN�NaTHISNPEOFWORKWILLBECOMPLETEDWITH <br /> WHETHER SPECIFIED HEREIN OR NOT.iHE GRANTINOOFAPERMiT DOE3 NOT <br /> PRESUME i0 GIVE AUTHORITV TO VIOLATE OR CANCEL THE PROVISIONB OF <br /> loT e�oGK Ov pNYOTHERSTATEORLOCALLAWREGULATIN�CONSTRUCT10NOR7HEPEP- <br /> FORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BV THE OWNER OF <br /> THIS PROPERN TO PERFORM THE WORK FOR WHICH APPIICATION IS MADE <br /> AND I COMPLY WITH THE STATE CONTRACTORS LAW �827 RCW AND <br /> 298200 WAC. <br /> SIGNATUNEOFCONTO�CTORORAUiNORIZEDRCENT O�IE <br /> � <br /> FlIpJ(OTAWPE94 ,p BU51 ESSLIGENSE �NOBUSINESSN�AIE <br /> // � �r .E,x..ald- <br /> . ;�� PWM�INO MECHANICAL <br /> N0. T�'PE OF FI%TUPE OR ITEM FEE N0. TYPE OF EOUIPMENT FEE <br /> � WATERCLOSEi(TOILET) A/C—A/HNDLGUNITS—H.P. <br /> �TMNB FORCED AIR SVSTEMS—B.T.U. M EA _ <br /> UVATOPYIWASHBASIM UNITHEATERS—D.T.U. M <br /> BHOWER CLOTHESDRYERS <br /> � KITCHEN91NK6DISP. VENTILATIONFAN <br /> DISHWASHER RANGEHOOD <br /> ' UUNDRVTRAY WATERHEATER <br /> �" CLOTME9 WA9HER WOOD STOVE <br /> '' URINIIL METALFIREPLACEBCHIMNEY <br /> � DRINKINO FOUNTAIN FIREPLACEINSERT <br /> ' FLOOR DRAIN HEAT PUMP <br /> � BACKFLOW PREVENTER9 GAS PIPING <br /> ROOF DRAINS—RAINLEADERS EXHAUST FAN <br /> 31NK(SERVICE—BAR ETC.) <br /> SUBTOtAL S SUBTO7AL E <br /> PERMIT S PERMIT E <br /> TOTAL FEE E TOiAI FEE S <br /> iRONTSETB�GK PFANSETB�CN SIOESEtBPCN PUNCNEI:ItNI1MBEP fEE RECEIPTNO. <br /> uSEZONe LOTAPEA vnc�Ntsire FEES VALUATION FEE <br /> O YES EfNO —� <br /> euaoiNG <br /> TYPEOFCANST. OC�UPANLYGPOUf` NO.OFpWELIINf.UHIiS , <br /> �LIOW�BLE/FCTUAL PLUMBING <br /> BIZEOF6lDO_ NO-0FSTOPiE3 BOSYT. OCGLO�O MECHANICAL <br /> pN <br /> ME1011ilIMiTAIION OTHER <br /> FIRESPPINKLERSPEOUIRE� ❑�E9 ❑No __ STATEBUILDINGSURCHARGE <br /> STATE ENERGY SURCHARGE <br /> APPUGAiION�CGBY PLAN9FPPR.BY PUBUCWORKS <br /> TOTAL <br />