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th� Everproen <br />CITY OF <br />everett <br />BUILDINCa DEPARTMENT <br />259•8810 <br />, <br />� <br />��� Z� <br />APPLIC��i'ION FOR CONSTRli�T10N <br />PERMIT <br />TO BE COAMPLETED IN INK— PLEASE PRINT <br />�ooPEsS cnr zlr <br />CL��' 19�� /�9�`�/ w• y�a�r� <br />�ooeess ` cnr z�P � <br />��j.7pn �'7'.Nf�/'iL�io ��epL,9� <br />.00nes� cnr zir <br />,,�. /92G- �+9�`//, �//l/LG%� 6lr,a <br />everctt <br />� <br />�v��o3-3�S �2 <br />r�wr+e <br />r 7� S- G� G9 - <br />6EHERqIGOhmnbwn � ..._._.__ <br />' � ���lf!%� �/Z— <br />� - <br />MEGN�NICALCANTR�CIOR � <br />MAILAO�PE55 CIiY ZiF ONON • <br />RUMBINOCANTR�CTOR MML�D��E�u GIIY Z!P P��ONE ULENSE� <br />� <br />❑ ADDITION ❑ ALTEMTION ❑ AEPP'R ❑ DEMOLITION CO❑^CWOOOOSNONpP10NENOSERT ❑ BUiL01NGRELOCA7iOt1 <br />VEMENTORINTEPIORR� F�L��I��! ��,�//,r ^ /��/l/, �C+/ / /� <br />r , L.y� C � �! <br />loT_.1.C1— eLOCK oF <br />FLUMlIN4 <br />Np, TYPE OF flX7UNF.OR <br />WATER CLOSET (TOILEn <br />� BATHTUB <br />� UVATORV(WASH BA91M <br />/ SHOWER <br />1 KITCHEN SINKB DISP. <br />� D18HWASHER <br />( LAUNDRYTRAV <br />J CLOTHES WASHER <br />URINAL <br />DRINKINO FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />ROOF DRRINS— RAINLEADER: <br />muvineovirtC_RAR FTCI <br />FPON <br />USEi <br />nve <br />1 A=�0 <br />82E <br />1 <br />FIRE <br />I1P% <br />72 �' <br />.� <br />SUBTOTAL S " <br />PERMIT S <br />TOTALFEE a <br />1GN NEARSE10AfR SIOESEIDAGR <br />Id� 2S� 7,5� <br />LOTAREA VAGNTSILE <br />S RvYES Cl NO <br />/ <br />IST. OGGUMNCYOROUP NOAFOWELIII <br />�oro.4r_ �/ 1Z- 3 / <br />AR/IGJ <br />REOUInEO ❑ <br />Z ION <br />..� (.�. � <br />MIG <br />I <br />I HEREBV CERTIFY THAT I HAVE READ AND E%A111NF:D THIS APPUCATIOI I AND <br />KNOW THE SAME TO �E TRUE AND COHRECI. RLL ^ROVISIONB OF lAW i AND <br />ORDINANCES GOVERNING THIS NPE OF WORK W'iL BE COMPLETED 1N�TM <br />PR SUME TO Q I�E AUTHORI7V O V�IOLP E OR CtiNGEL T E PROIN3I�ONS OF <br />ANYOTHER STATE OR LOCAL LAW REGULATIN6 CON9TRUCiION OR THE PEiF <br />FORMRNCE OF CONS7RUCTION. THAT 1 AM AUTHORIZED 0V THE OWNER OF <br />ANID IRCOMP VTWIiHRTHEMSTATE CONTR CTJORSHUWL B17 RCW ANU <br />296.200 WAC. <br />S��N�TUPEOFCONiRACTORORAU111GP12EDAGENT OATE <br />X ��l"�.,�G�- ���5� <br />�pP�IC�NI_� 5 �IC[NSE NO. AND BUSME55 N�ME <br />MECHANIGIL <br />TYPE OF F.OI <br />DLG UNITS— <br />i SYSTEMS— <br />RS— BT.U. <br />RYERS <br />N FAN <br />HEATPUMP <br />GAS PIPING <br />BUILDING <br />PLUMBINC <br />MECHANICAL <br />OTHER <br />STATE BU LOING SURCHARGE <br />STATE ENERGY SURCIIARGE <br />rueucwor�Ks <br />TOTAL <br />M EA <br />TOTAI <br />�AIT <br />�L FEE <br /><In l C` 5 <br />Z <br />FEE <br />