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�K1y <br />��� <br />H�H <br />�7H� <br />ypy�LV O <br />ONd <br />��g <br />��-1� ��C�C��.. <br />ZH� <br />?H <br />H <br />N <br />nC N <br />Z�N <br />H O p� <br />APPLICI�ION FOR CONSTRC'�TION <br />PERMIT <br />tAe Evero�ean <br />CITY OF �'°������� <br />. everett g�,,`�,� ��,��t �q�:�� �tJ <br />BUILDING DEPARTMENT J <br />259-BBiO TO BE COMPLETED IN INK — PLEASE PRIN7 <br />pryrytq MAILAOpFE55 GIiY LP PNONE <br />� o � ti � �-i1-.�,� s � �c� rl�a �,.�,� "� a.�r�`�� � = 90 � . <br />iENnN1 MAllAD011E55 C�tY 2iP PIION[ <br />RRCMOEGTORDESIGNEP MAILADURE55 CiiY ZIP GNON[ <br />GEHEPRLCONTRAG�OB MAILPODRE55 CITY 21P PHONE UGENSE• <br />MECMANIG4LGONiRnGiOe M�ILADDaE55 CIiT ]m PIIONE LIC[NSE• <br />n��.������,.���� I m.� .,,,.,.,��., ..... � _.. ....,... .._...__. <br />SL lN.n i��w.U.�-�. ��•gDx _S2J /1Ja7��� �3_-2/Go i�,�LC L/5=j�)13 <br />NEW ❑ ADDITIOY ❑ ALiERATION ❑ REPPIR ❑ DEAtOLITION ❑ IVOODSTOVE/FPPL II�SERT ❑ BUILDING RELOCATION <br />CANiRACi PRIGEOF WORIE <br />ia.— _ e�oc� ov <br />PLUMBIN6 <br />J0. TVVEOFFI%TUREORITEM <br />� WATERCLOSET�TOILEp __ <br />BATMTUB <br />LAVATORV (WASH BASIN) <br />� SHOWER <br />/ KITCHENSINK8015P. <br />/ DISHWASHER <br />LAUNDRVTRAY <br />CLOiHES WASHER <br />URINPL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />ROOF DRAINS — RA�NLEADERS <br />RLOW�BLE/AGiUPL <br />SUB TOTAL 5 <br />PERMIT 5 <br />TOTALFEE 5 <br />ISEIBACN SIOESETfiALN <br />1REA VAC�NTSttE <br />❑ YES ❑ NO <br />JPANLYGROIIP NOOFOWELLII <br />)FSTORiES BSMt OGCLOeD <br />❑Y <br />❑N <br />FlPESPRMrcIERSREO111RED ❑YES ❑NO <br />I HEFEBY CERTIFV ?HAT I HAVE REA� AND E%AMIN Eb iH15 APPLICATION AND <br />KNOWTHESAMETOBETRUEANDCORRECTALLPROVISIONSOFLAWSAND <br />OROINANCES GOVERNING THIS T1'PE OF WOiiK WILL BE C01dPLETED WITH <br />WNETHER SPECIFIED HEREIN OR NpT. THE GRANTING OFA PERAIIT DOES NOT <br />PRESU6IE TO GIVE AUTNORIN Tb VIOLATE OR CANCEL THE PROVISIONS OF <br />ANV OTHER STATE 0�7 LOCAL LAV1 R[GULATING CONSTRUCTION OR THE PER� <br />FORMANC[ OF CONSTRUCTION THAT I AM AUTHOR12ED BV TNE OWNER OF <br />THIS P170PERTV TO PERPOFId THE WORK FOR WNICH APPLICATION IS MADE <br />AND I COMPLV WITH THE STATE CONTRACTORS LAW 1827 RCIN AND <br />296200 WAC. <br />$IGN�iUPL O� CONiNPCTOP P4:i1111 J�',ZlD qGCNI 04t[ <br />X ��% �%�/I — <br />MECHANICAI <br />FEE NO. TVPEOFEOUIPME <br />A/C — A/HNDLG UNITS — H.P. <br />� FORCEDAIRSYSTEMS—B.T.U. <br />UNIT HEATENS-- B.T.U. M <br />� __ CLOTHESDRYERS <br />VE�'JTILATION FAN <br />RANGEHOOD <br />5 IYATER HEAiER <br />WOOD STOVE <br />METAL FIREPLACE 8 CHIMNEV <br />FIREPLACEINSERi <br />HEAT PUMP <br />GAS PIPING <br />E%HAUSTFAN <br />FEE <br />PE(iM1T 5 <br />TOTALFEE 5 <br />FEE AECE�PTI10. <br />VALUATION FEE <br />BUILDING <br />PWMPING <br />MECHANICAL <br />OTFiER <br />STATE BUILDING SURCNARGE <br />STA7E ENERGV SUFCHARGE <br />AUBLIC WORKS <br />TOTAL <br />�d <br />V <br />