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�;:�� ����,.��,���: <br /> � APPLIC1�aT10N FOR CONSTRIyr�T10N <br /> " PERMIT <br /> � <br /> : 7 tA�Ewrpnen <br /> �.-� CITYOF everett <br /> ; :; everett e <br /> � BUILDING DEPARTMENT <br /> 259-8810 TO BE COMPLETED IN INK— PLEASE PRINT <br /> � : <br /> �� r /� y�IL� P:SS , CITY LIP PHONE � <br /> � J � <br /> i Nl <br /> ;1 7p�µT M�ILAD�RESS CITY 21V PMOHE , . <br /> 1 <br /> � <br /> ��� MC CTOPD 810NEN IM�L�DDflE55 CIIY ZIP PHONE <br /> � 'f/�� /OGL/ til'c.'r.�l.� ��.�nG'tfi 1.I1� G�/9/ <br /> .y OENEMLCONTR OR M�IL�ODRCSS GIY 21P PHONE 4CENSE• <br /> M <br /> 1� <br /> ' C NI CONT TOR � M�p1100RES4 ' CITY `�' F;ONE LICENSE• <br /> !1 /T <br /> ,� /�n .t Yi1 0.. .�i�,,�_�(..�i r.�eC�-i' � Y..✓r.a,/� _ .1".0 A1/y'1 <br /> ' UMNNOCONT CTOq ^T M�Ill1U0RE59 CITY IIP,-,�Td/ PMONE � �ICEN9E• <br /> �) � " r•,�,f(;/.d��AN%S1G,Z <br /> �a CU990FNORN � <br /> ❑ NEW ❑ ADDITION ALTEM710N ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPLINSERT ❑ BUILDIN6RELOCATION <br /> '�J IENANTIMPROVEMENTORINTERIqiREMOUELONIY CONT�CiPEN50N�NDPNONENO <br /> ! <br /> �� CONTMCTPRICEOFWORR <br /> �'� DEBCRIlEWORKANDDOWJIEFOOTAf3E VOL U <br /> � <br /> � <br /> nq ao e su iHo IHEPEBVCERTIFYTHATIHAVEREAOANUEXAMINEDTHISAPPLICATIONAND <br /> ,� � KNOWTHESAMETOBETRUEANDCORRECT.ALLPROV1910NSOFLAWSANO <br /> ) �cawoeecn� OFPROPERTYIBMONNBELOWORATT/�GNFOUflCOPIES� ORDINANCES60VEHNINaTHISTVPEOFWOHKWIILBECOMPLETEOWIiH <br /> j WHETHEPSPECIFIEDHEREINORNOT.THEORANTINOOFAPERMITDOESNOT <br /> � �oi BLOGK_ OF PRESUMETO�IVEAUTHORITYTOVIOLATEORCANCELTHEPROVI&ONSOF <br /> ,t ANV OTHER STATE OR LOCAL LAW qEQULATINO CONSTRUCTION OR TME PER� <br /> �1 � FORMANCE OF CONSTHUCTION.TMAT I AM AUTHORI2ED BV THE OWNER OF <br /> � THIS PROPERiV TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE <br /> .�g AND 1 COMPLV WITH THE STATE CANTqACTOR3 VLV 1&27 RCW AND <br /> ; zse.2oo wnc. ��1/Y� <br /> SION�fUREOFCONTP�CTORnRAUTHOR�OMiENT O�TE <br /> � �/��/f <br /> �� MqJECf ACDRESS � ��[/�[I.i�+M�r•' ��� <br /> 1 �PPLIC�NTSGITYBUSINESSLICENSE O�NDBUSINE �ME <br /> :� <br /> �999ggg� PLUMSINO MECHANICAL <br /> � N0. TYPEOFFIXTUREORITEM FEE NO. TYPEOFEOUIPMENT FEE <br /> WATER CLOSET(TOILEn AIC—AIHNDLG UNITS—H.P. <br /> +� 811THNB FORCED AIR SYSTEMS—BLU. M EA <br /> A UVATORY(WASHBASIN) UNITHEATERS—B.T.U. M <br /> �� SHOWER CLOTHESDFVERS <br /> KITCHEN 91NK6 DISP. VENTILATION FAN <br /> DIBHWASHER RANGE HOOD <br /> ,� UUNDRVTRAY WATE(iHEATER <br /> �'.j CLOTHESWA9HER WOODSTOVE <br /> q URINAL METAL FIREPLACE 8 CHIMNEY <br /> ��g DRINKINO FOUNTAIN FIREPIACEINSEHT <br /> E FLOORDMIN HEATPUMP <br /> �1� BACKFLOW PREVENTERS OAS PIPING <br /> ROOF DRAIN9—RAINLEADERS E%HAUST FAN <br /> SINK�SERVICE—BAR,EfG) <br /> .i <br /> �� <br /> J <br /> { <br /> S <br /> ,� <br /> �j SUBTOTAL S SUBTOTAL S <br /> i PERMIT E PERMIT S <br /> TOTAL FEE S TOTAL FEE S <br /> � FFONTBETBI�GK flEARSETB�CN SIOESET&1GK PIANCNECRNUMBEq FEE �ECfIRNO. <br /> � <br /> :� useiONe �otnarw VAC�NTSITE FEES VALUATION FEE <br /> � ❑YES O NO <br /> � IYPEOFCONST, OGCUPANCYOROUP NO.OfOWEILINOUNITS BUILDING <br /> � ALIOW�BLE/�CTU�L <br /> �rj PLUMBIN6 <br /> :1 &2EOFBLDQ NO.OFSTORIE9 BSMT. OLGLOAO <br /> �1 o v MECHANICAL <br /> a r+ <br /> � . HEIONTLIMIT�iION OTHER <br /> i <br /> ,j FIREBPRINMLENSREOUIRfD ❑YES ❑No STATE BUILDING SURCHARGE <br /> 1 . <br /> ., <br /> �� � STATE ENERGV SURCHARGE <br /> i <br /> � APRICATIONACGBY PLAN9�PPRBY <br /> PI!BLIC WORKS <br /> 1 <br /> °� TOTAL <br /> 7 <br /> STSF:�.���7)LX+AKAiN�c. l: Y:�.. � i' ,,:�1::' :�'AC•.:58�" �'.��. .^ ' , -.,. - - -v••w� ..r' �..1! :�•�= <br />