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� <br /> �;�;;, �1 <br /> APPLICATION FOR CONS�RUCTION <br /> PERMIT <br /> fAs Ewrp�sen everett <br /> CITV OF � <br /> everett <br /> BUILDING DEPARTMENT <br /> 259•8810 TO BE COMPLETED IN INK T pLEASE PRINT <br /> OWNER M�II�UUf1E59 CIfY ZI� P��ONE <br /> Sfl/)z/� 127f1���L i'va� r�i,�� .�T. � =��-% ldA-- �r8zu/ Zsy.317S _ <br /> , IEN�NT M�IL��Of1E55 CIIY� ZIP PMONE <br /> � � C <br /> �. ARCMREGTp UE516NER M�ILAppRE55 ��TY ZIP PNONE <br /> i"� ��r.t��Li ��s z� �����;� Ly,u�,f��r�iif `�037 7�13 � �s.�s <br /> OENEP�L NTR�CIOR MAIL�DORE55 � / CIiY /�ZIP PNONE UCEN9E• 7 <br /> �c'��Zf��Li /��z/ '/l(�f1�% C�/!«�lG?7', l�i/ �k�� �"/3/.���' rAKr�79��; <br /> MECH�NIC�LCONTP�CTON M�IL�ODRE55 GRY 21P PHONE UCENSE• � <br /> �' PLUMBINOGONiP�C10R M�IL�OOBESS CItY 21P PHONE UGENSE• <br /> � CLA430FWORK <br /> � NEW ❑ AODITION AITERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVEIFRPLINSERT ❑ BUILDINORELOCAtION <br /> - iEN1WTIMPHOVEMENTORINTERI REMODELON�Y �ulp� �y � � CON CT��NDPMONENQ ��� � <br /> ' CONTRACTFRIGEOFWJi1K � �� �- N(S /y' �� r7�3 /5�.s'� <br /> pEg�q�gEWORK�NO REF T�pEINVOWED <br /> ' �Z� ���i`� . G .' <br /> i1pPo9EU USE OF BUILOINO 1 HEREBY CERTIFY THA71 HAVE READ AND E%AM�NED THIS APPLICATION AND <br /> �/�,AG�,� �i�f��L- KNOWTHESAMETOBETRUEANDCORRECT.ALLPROVISIONSOFLAWSAND <br /> i�/F— ORDINANCES GOVERNING THIS NPE OF WORK WILL BE COMPLETED WI7H <br /> � IEMLOESGFIP110NOF�AOPERTYI9NOWNBELOWOR�TUCNfOUf�C01'IE9 WHETHERSPECIFIEDHEREINORNOL7HEORANTIN(iOFAPERMITDOESNOT � <br /> /¢2A Gf� nl �f"���� PRESUMETOGIVEAUTHORINTOVIOLATEOHCANCELTHEPROVISIONSOF <br /> t07 e�oCK ��'' ?f t ANYOTHERSTATEORLOCALLAWPE6ULATINOCANSTRUCTIONORTHEPER� <br /> � � FORMANCE OF CONSTRUCTION.THAT I AM A�.�MORIZED BY THE OWNER OF <br /> „ll/ � THISPROPERTVTOPERFORMTHEWORKFGRWHICHAPPLICATIONI$MADE . <br /> ��/ AND 1 COMPLY WITH THE STATE CONTR4CTORS LAW 1827 RCW AND <br /> 296200 WAC. � <br /> SIONATUREOFCONTR/�CTORONAULN011RED�aFNT OATE �j j/�S� '+'y+' � <br /> � /� r <br /> fX � �� /�!C-�f//i�`--'�/ <br /> PROJEGTAODflE55 ��_� ,�� APMIC�NTSCITYBUSI E5�51��ENSENO.ANOBUSINESSNAME ' i .�; <br /> I O� �.UL �/ L2�� i! � �,U (�� � .�;�5 <br /> ; <br /> PLUMBINO MECMANICAI '� �:x, <br /> NO. TYPEOFFIXTUREORITEM FEE NO. TYPEOFEOUIPMENT FEE ; �-��-',� <br /> �� <br /> � WATERCLOSETITOILEn AIC—MHNDLOUNITS—H.R � <br /> � BATHTUB FORCED AIR SVSTEMS—BT.U. M EA ' <br /> LAVATORY�WASHBASIM UNITHEATERS—B.LU. M ' -'�'� <br /> SHOWER CLOTHESDRVEPS <br /> � KITCHEN SINKB DISP. VENTILATION FAN �. ��; <br /> DISHWASHER RANOE HOOD <br /> ' LAUNDRYTRAY WATERHEATER �, -:�, <br /> ' CLOTHES WASHER WOOD STOVE , <br /> 4 <br /> URINAL METAL FIREPIACE d CHIMNEY y <br /> . DRINKING fOUNTAIN FIREPLACE INSERT �. � :? <br /> FLOORDRAIN HEATPUMP � <br /> � BACKFLOW PREVENTERS GAS PIPING <br /> '> <br /> . ROOFDtiAINS—RAINLEADERS E%HAUSTFAN � <br /> SINK�SERVICE—BARETC_I � - <br /> � �i <br /> � <br /> SUBTOTAL E SUBTOTAL S �-.� <br /> PERMIT E PERMIT S �-� <br /> TOTAL FEE S TOTAL FEE S <br /> iRONT5ET6�.CK flEAP5ET8ACK SIOESEIBA,K , VUNCNECNNUMBER FEE�� n4 �E�E���•� <br /> - MA' S (U : S �) " ' o <br /> use zor+e �or u+� V�C�Ni SItE FEES VALUATION FEE <br /> ❑YES ❑ NO <br /> qa ew�o�r,c `%�. esr * <br /> TYPEOFCONST. OLCUPANCYGROUP NO.OiOWEILINOVNILS <br /> euowee���cTue �� M � � ;�_ PLUMBING <br /> SiZEOiBLIX3. NO.OFSTORIES esuc occ�oeo MECHANICAI <br /> !� � � �r�i N <br /> NcioNtu1'?�rWr+ OTHER <br /> ��( <br /> �mesrniNniensneouweo oves o STATEBUILOINGSURCHARGE <br /> STATE ENERGV SURCHARGE <br /> ,��,i�,�r�pN' puN5ArP0.BY PUBLICWORKS � � CP/ <br /> ��m �.(/ TOTAL �. <br /> � CYo���F fs ,v� QD��J)�A�1[Kll�n �1/iiA [�Ut� H.I <br />