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� �,�•��.���� <br /> ; � � APPLIC�+r�'ION FOR CONSTRV►CTION <br /> ; PERMIT <br /> � fhsEvsrpnen ' <br /> 1 CITYOF everett <br /> '� � everett e <br /> i BUILDING DEPARTMENT <br /> , 269�BB10 TO BE COMPLETED IN INK—PLEASE PRINT <br /> :j <br /> 1 NER MAILAODPE59 �ITY 21P PNONE <br /> ! �112_Lf- N /�ioJT7 `�"� /'It_�NI}`1� Fll-iii E��Rs�� `lt'�Z��� 7 S.L-�.��� , <br /> � IEIUNT MAILAD�RESS CITY ZiP PHONE <br /> ; SHrvIF <br /> ,'� �RCMITECTORCElIONER M�ILAOORE95 �I�Y ZIP PHONE <br /> a <br /> � <br /> ,� OENEMLCANTR/�GTOR MAllA00RE55 �IiY 21P PNONE LICEN9E• <br /> , i cY� �i •�7t� 3�24-�7�lJw�o�kl4"�'�N <br /> (,�J��'17 �7 �VI�iSI((UGi/OAl {�2S')f-- VE;.A/� M�UzY�Y�U <br /> MECHIINIC�ICONTMCTOR AUII�DDNE53 GITY ZIP PHONE LICENSE• <br /> �I PLUM&N�CANTMCiOR M�IL�DDRESS CITY 21P PHONE LICENSE• <br /> : <br /> 1 C1A080FNORK <br /> � ❑ NEW �I. ADDITION ❑ ALTERATION � REPAIR ❑ DEMOLITION ❑ WOOOSTOVE/FRPL INSERT ❑ BUILDING RELOCATION <br /> 1 <br /> � TENNlTIMVROVEMENTORINTERIORPEMODEIONLY � //� CONT�CTPERSON�NDPMONENO. <br /> ��I CONTRACTPRICEOFWORIC /i�" '� e� � � ,�• • � ' �[�- - � � �� <br /> � OpCR1�EWORK�NO80U/uIEFOOT�OEIHVO� a �t�F`��r <br /> ' L• 2 O Y 1 T/G��l L H : _r <br /> , <br /> MOPOBED USE Of lUIlDINO <br /> I HEREBV CERTIFY THAT 1 HAVE READ AND EXAMINED THIS APPLICATION AND <br /> '� Q�! /irr���✓\. KNOWTNESAMETOBETRUEANDCORRECT.ALLPROVIg10N30FUW3AND <br /> y LEOIILOElCRIRqNOFM10PERtt�SMOWNBELOWORATACHFOURGORES� ORDINANCESGOVEFNINGTHISTYPEOFWORKWILIBECOMPLEfEDWI7H <br /> WHETHER9PECIFIED HEREIN OR NOT.THEORANTINOOFA PERMIT DOE9 NOT <br /> � H L � � � (� . �,�� PRESUME TOOIVE AUTHORINTO VIOLAiE OR CANCEL TME PROVISION9 OF <br /> �OT e�oc�cD.S�_ ov IZLS._ ANVOTHERSTATEORLOCALLAWREOULATINaCpN9TRUCT10NORTHEPER <br /> ,�� FORMANCE OF CONSTRUCTION.THAT I AM AUTHORI2ED BV THE OWNER OF <br /> 'I THIS PROPER7YT0 PERFORM THE WORK FOH WMICM APPLICATION 19 MADE <br /> � AND I COMPLV WITH THE STATE CANTRACTORS LAW 18.Y7 RCW ANO <br /> 298200 WAG <br /> &ONAtUREOFCONiMCTORONAUTHONREO�OENT pIRE <br /> i /� �Q.__�I —/r•✓%�-s r' (��.(�j <br /> � PIqJECTA00RES9 - �v� / R8 <br /> APP�IC�NT9CITY9USINE59LICE ENO.�NDBUSINE99NI1ME <br /> � S- F� ' k 1�NTh ��f — .z�� �S � � E•uc, co��� n c ,u <br /> � PWMBINO MECMANICAL <br /> NO. TYPE OF fl7(TURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILEn AIC—NHNOIG UNITS—H.P. <br /> � BATHNB FORCED AIR SYSTEMS—9T.U. M EA <br /> '� LAVATORYryVA$HBASIM UNITHEATERS—BT.U. M <br /> � SHOWER <br /> ;� CLOTHESDRYERS <br /> ti KITCHENSINKBDISP. VENTILATIONFAN ' <br /> ,� DI9NWASHER RANGEHOOD <br /> ��� UUNDRYTRAY <br /> WATER HEATER <br /> ti CLOTMES WA9HER WOOD STOVE <br /> �'-' URINAL METALFIREPLACEBCMIMNEY <br /> '� DRINKINO FOUNTAIN FIREPLACE INSERi <br /> � <br /> � FLOORDRAIN NEATPUMP <br /> � BACKFLOW PqEVENTERS GAS PIPING <br /> �� � ROOF DRAIN9—MINIEADERS EXHAUST FAN <br /> ;�1 SINKISERVICE—BAR,ETG) <br /> a <br /> � <br /> � <br /> 'i <br /> , <br /> � <br /> � SUBTOTAL S SUBTOTAL S <br /> j PERMIT S PERMIT S <br /> � TOTAL FEE S TOTAL FEE S <br /> .� fXONTBEfBI�CK pE�qgEffl�CK SIDESETBAGK M/1NCMECKN BER fE[ II[CORIq. <br /> � � ' 7�' o' 8-� a s< Q= 3 a- <br /> uSEzo LOTAPEA VAGNTSIIE FEES VALUATION FEE <br /> � � ❑YES�O <br /> : <br /> ' 7YPEOFCON9L _ p�UPANCYOBOUP NO.OFUWELLINOUNITS BUILDING I � <br /> ; ,����„��,� �.,� ,�_ 3 � <br /> � �' PLUMBING <br /> �� lIZEOF4Y6 A N0.0FSi0HIE5 BSML OGGLOAD <br /> � � �Y n/� MECHANICAL <br /> � N <br /> � - <br /> � . neiaNtuMrtenoN OTHER <br /> } FIREB►RINNlER9 REOUIRED O YE9 no / STATE BUILDING SURCHARGE <br /> i <br /> .j STATE ENERGY SURCHARGE <br /> ,� APF�ICATION�CGBY PIANS�PVRBY <br /> 1 PUBLIC WORKS <br /> SJ TOTAL <br /> 7 <br /> 1 <br /> �':""'"'rTS,}_; ^� :i:� j. , .�. � . �,�. .YT ry <br /> � � �7y�' <br />