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� �1 <br />,';' <br />��� , ;,;, <br />APPLIC�►i'ION FOR CONSTRI�:.TION <br />PERMIT <br />IM Evsryrsen overetl <br />CITY OF � <br />everett <br />BUILDING DEPARTMENT <br />258•8810 TO BE COMPLETED IN INK— PLEASE PRINT <br />OWNER M�ILADDRE55 ���Y 2�P PI�ONE <br />/ � t.7 ;�_ .. �i �v N�_h,.r L�..�_ E✓��..rf 9B2�3 35J-59H�' <br />MGH1IEGTOROE916NER \ M�IL�DD11E59 C�1Y LP PI�ONE <br />����in•+ JJ ! r� .?IR9 .�.2c.Eson �vercl% �iI!?a3 3SS'31oo <br />(iENEMI 011TRGCTOP M�IL�OONE55 CpY IIP PIIONE IIGENSE• <br />Al.���._ .�8�u S. /.r.kc. S%�c•+e � Euc..li 98,2vs` 33�- 3��5 -- -- <br />t <br />❑ NEW ❑ ADDITION pl ALT^AITION ❑ REPAIR ❑ DEMOLITION ❑ WOODSiOVE/FRPLINSERT ❑ BU�LDINGRELOCATION <br />TENNlTIMPROVEMENTGRINTE HREMODELONIY CONI�CTPERSON�NOPIIONENO <br />J V <br />,..,,.,e.�.o�.�.�o.,�K s�' � �� d y N� 1 e � <br />� <br />lOT_2— BLOCK OF �Ir� <br />i>>_/:..���,�• 5'nuCo .l.�/.tek <br />' PLUMlINO <br />� NO. T1fPE OF FUC <br />WATER CIOSET (iOIIE <br />BATHTUB <br />� UVATORY�WASH BASI <br />�1 SHOWER <br />(; KITCHENSINK6DISP. <br />DISHWASHER <br />�t LAUNDRYTPAY <br />� CLOTHES WASHER <br />' URINAI <br />t �RINKING FOUNTAIN <br />' FLOOR DRAIN <br />;�� <br />TYPEOf` NSt.� <br />AILpWAB�E/�CIUAI <br />1 V, <br />— RAINLEADERS <br />i <br />33 �-3778" <br />I HEREBY GERTIFV iMni i nnvt nenu nrvu cnhm��.�.. � r,�o..� ���..,.� �..�...�.,, <br />KNOW THE $AME TO BE TRUE AN� CORRECT. ALL PROVISIONS OF UWS AND <br />ORDINANCES GOYERNING THIS TVPE OF WORK WILL BE COMPLETED WITH <br />WHETHER SPECIFIED HEREIN OR NOT.THE ORANTING OF A PERMITDOES NOT <br />PRESUME TO GIVE AUiHORITY TO VIOLATE OR CANCEL LHE PROVISIONS OF <br />ANV OTHER STATE OR LOCAI LAW REGULATING CONSTRUCTION OR THE PER- <br />FORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BV THE OWNER OF <br />iHIS PROPERN TO PERFORM THE WORK FOR WHICH APPLICATION IS M�DE <br />AND I COMPLY WITii iHE STATE CONTRACTORS LAW 1827 RCW AND <br />zss.zoo wnc. O�-3(' 8,�, <br />SION�TUIIEOFCONiR�CtONORRU���ONIZEDAOENT OA1E <br />R� <br />FG • iSCITYBUSi E IC[NSENO.�NOBUSWESSN�ME <br />MECHANICIIL <br />FEE NO. TYPEOPEOUIPMENT <br />A/C— A/HNDLG UN�TS— H.P. <br />FORCEDAIRSYSTEMS—B.T.U. M <br />UNITHEATERS—&T.U. M <br />CLOTHESDRYERS <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />WOOD STOVE <br />METAL FIREPLACEB CHIMNEY <br />FIREPLACE INSF,�iT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN _ <br />SUBTOTAL 5 <br />PERMIT S <br />TOtAL FEE 5 <br />i5E1BI�GN SIOESEiOAGN r <br />PflEA V�LANi511E <br />O YES }'�NO <br />UV�NCYGROIIP NO.OFOWElLINOU <br />- � / <br />Di SLORIE9 BSMi. OCC.lOPO <br />❑Y <br />Z rY++ <br />suerorn� <br />PEflMIT <br />TOTAL FEE <br />FEE�� � <br />BUILDING <br />PLUMBING <br />MECHANICAL <br />OTHER <br />STATE BUILDING SURCH�RGE <br />STATEENERGVSURCHARGE <br />PUBLIC WORKS <br />rora� <br />a <br />S <br />S <br />l� \ <br />FEE <br />