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APPLICATION FOR CONSTRUCTION <br /> PERMIT <br /> MsEwrpreen <br /> CITY OF <br /> everett <br /> everett �1 e <br /> BUILDING DEPARTMENT � l���. <br /> 259-88�o TO BE COMPLETED IN INK— PLEASE PRINT <br /> ER M^ILApOfl�SS /1 ^�' C,�TY � 21P �� VMONE��� <br /> � /9 1 1 i ) /... n /� <br /> ��i.Ll�_ •i 7�w tt <br /> T ^A MAIL�DORESS CITY 21P PMONE <br /> �V l.N . I ""4� <br /> MCNttECTOXUE510NER MMI �O�RE55 GIiY 21P PMONE <br /> OENE L ONTRRCfOR �, M�ILAO E55 � � CITY IP ��' PMONE — ^_� EN� <br /> ��� L/'� �� <br /> MECM�NIGALLO �CTON M�IL�DDPE55 _ CJTy���Z� /��� pHpNE �I_�� J�� Q� <br /> `V/ � 6 =; _� � <br /> �f� 7 <br /> PLUM&NOGONTMLTOR MAILADDRE55 CITY ilp PMON �IC�18E• <br /> GlA9SOFNOPK <br /> ❑ NEW ❑ ADDITION �ALFERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVFJFRPLINSERT ❑ BUILDINGRELOCATION <br /> IENMIT IMPROVEMENT OR INTEAIOR�FE�M�O�EL ONp fANUCi PERSON ANO PNONE NO. <br /> COIITMCTPRICEOFWJRK � J "j'� C/ <br /> OElCPIBE PK DpOUM OOTAOEINVOLVED� I <br /> "�-- ' � i„i <br /> P09EDUSE auiye�No IHEREBVCERTIFYTHATIHAVEREADANDE%AMINEDTHISAPPLICAT�ONAND <br /> l KNOW THE SAME TO BE TRUE AND CORHECT.ALL PROVISIONS OF LAYVS AND <br /> �"� ORDINANCES GOVERNING THIS 7YPE OF WORK WILL BE CAMPLETED WI7H <br /> IEMLDESGRIPfIONUFPPOPERTY�SHOWNBELOWOPATTACNFOURCOPIESI yyHETHERSPECIFIEDHEREINORNOT.THEGRANTIN00�APERMITDOE3NOT <br /> PRESUME TO GIVE AUTHORITV TO VIOLATE OR CANCEL THE PRON910NS OF <br /> �m B�ocK or ANYOTHERSTATEORLOCALLAWREGULATINGCONSTRUCTIONORTHEPER <br /> FORMANCE OF CONSTRUCTION.THAT I AM AUTHORI2E0 BY THE OWNER OF <br /> THIS PROPERTV TO PERFORM THE WORK FOR`.�HICH APPLICATION IS MADE <br /> AND I COMPLV WITH THE STATE CONTRACTORS LAW 1827 RCW AND <br /> 296200 WAC. <br /> SIGN�TUFEOFCONTRALTOROHAIITMOH12E0�6ENT D�TE <br /> ��,�� X��up- �� ��..��� �I�'I9Cj <br /> ��/� I ^�(� APPLICNiT9CITYBU E95LICEN9ENO./J/DBUSINE95N�ME <br /> J L�-i `� <br /> RININNO MECXANICAL <br /> NQ, T'P[OFFl7ITUIIEOIIRlM FEE NO. TYPEOFEOUIPM[NT FEE <br /> WATER CL09ET(TOILEI) NC—NHNDLO UNITS—H.P. <br /> B11TY.TUB FORCEDAIRSYSTEMS—flT.U. EA <br /> LAVATORYIWASHBA3IN) UNITHEATERS—BT.U. M <br /> SHOWER CLOTHESDRYEFS <br /> KITCHEN SINKB DISP. VENTILATION FAN <br /> DISHWASHER RANCaEHOOD <br /> LAUNDRY TRAV WATER HEATER <br /> CLOTHES WASHER WOOD STOVE <br /> URINAL METAL FIREPLACE d CHIMNEY <br /> URINKINGfOUNTAIN FIREPLACEINSERT <br /> FLOOR ORAIN HEAT PUMP <br /> BACKFLOW PREVENTERS GAS PIPING <br /> ROOF DRAINS—RAINLEADERS EXHAUST FAN <br /> SINK(SERVICE—BAR,ETG) <br /> SUBTOTAL S SUBTOTAL S � <br /> PERMIT S PERMIT S <br /> TOTAL FEE S TOTAL FEE S <br /> FNONTSETfi�CK PEARSETB.�CN SIDESETBACK MANCNECRNUMlER FEE 11ECEIRNO. <br /> usexoNe LOi�REA vnur+isrte FEES VALUATION FEE <br /> ❑YES ❑ NO <br /> BUILDING <br /> ttPEOFCANST. OCCUPANCYOpOUP NOOFDWELLIN6UNIi5 <br /> ALLOW�BIE/�CTU�I PLUMBING <br /> 512EOFBlD(3 NOOFSTORIES 0.5MT. OCGLO�O <br /> u y MECHANICAL <br /> ❑N <br /> MEiONTLIMIT�TION OTHEF <br /> FINESPRINMLERSREOUIRED ❑YES ❑NO STATEBUILDINGSURCHARGE <br /> STATE ENERGY SURCNARGE <br /> APPLIG�iION�GG BY Pl�NS�PPR 9Y <br /> PUBLIC WORKS <br /> TOTAL V S <br /> t <br />