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� APPLICATION FOR CONSTR�TION <br /> PERMIT <br /> � fh�EnryrNn <br /> � CITYOF everett <br /> � evF,rett e <br /> ' BUILDINO DEPARTMENT <br /> ; 269-8810 TO BE COMPLETED IN INK— PLEAS? PRINT <br /> � <br /> N p M�IL�DOHE55 GIiY 2�P P ONE � <br /> i QRI,PN fi NtL�E cE�'� , 2z�tf P��'C srnE� E�.e�r; W+� 9F�or �za�2�— �p� , <br /> i 7(NMIT M�iL��0f1E53 CIIY I�P PHONE <br /> i MCMITECTOPOESIONER M�ILA�OREf' CITY 21P MONE <br /> � <br /> I _ <br /> OENEN�LCON7N�GTOR M�ILAUDPESS GTY 21P GHON IIGENSE• <br /> ; ViSTULA CDKs/'RU(.�ronl� fBoG -�{ 2ofsr pc,�s.b.� ,go�-NEGC� la�4 %b�z C�}�S�883 VISTUC*IPI <br /> MEOIUNICALfANTMCTOR IMRADDRE55 CI1Y 21P PHONE LICENSE• <br /> iLUM81NOCANTM:TOR MAILADOFE53 CITY 21P PHONE LIGENSE• <br /> ClA/lOfNORK <br /> NEW ❑ ADDITION ❑ ALTEM710N ❑ REPAIR ❑ DEMOLIiION ❑ WOODSTOVFJFRPLINSERT ❑ BUILDINORELOC�TION <br /> � TlNN/TIMAIpVEMENTORIN7ERqRpEMOOELONIY CONT�CTPERSON�NDFHONENO. <br /> ; ��.���E��K �l��b�tG� o./�nd��w 4��`S —!d'J-3 <br /> 0!lp11�EWORN�N080UMEf00T�0EINVOIVE� �G � G ILY /,m.� <br /> /JF.H/ CON ST�QI.�n�/N S( s. . <br /> P110101ED UBE OF BUIlUINO I HEREBY CERTIFY THAT 1 HAVE READ AND E%AMINED THIS APPLICATION AND <br /> KNOW THE SAME TO BE TRUE AND CORRECT.ALL PROVISION9 OF LAW9 AND <br /> LEOKOEBCNIPfIONOFP110PENfY�&IONNBEIOWOR�TUCMFOUNGONES) ORDINANCESOOVERNINOTHISTYPEOFWORKWILLBECOMPLETEDWITH <br /> WHETHER SPECIFIED HEREIN OR NOT.THEORANTINOOFA PERMITDOES NOT <br /> � �pT� �p� �' � 6365� 78 PRESUMETOOIVEAUTHORI7YTOVIOUTEORCANCELTNEPROV1910N90F <br /> ANYOTHER STATE OR LOCAL LAW REQULATINO CONSTRUCTION OR TME PER- <br /> .�►y� FORMANCE OF CONSTRUCTION.THAT I AM AUTHORI2ED BV THE OWNER OF <br /> � .S�'J�� `�I�IO �Y I�/��r. THISPROPERNTOPERFORMTHEWORKFORWHICHAPPLICATONI9MADE <br /> AND I COMPLV WITH THE STAlE CONTHACTORS LAW 1827 RC.YY AND <br /> � 288.200 WAC. <br /> SION�TUFEOFCO R� ONO UTIqp12ED�0ENT OA O' �_�p <br /> �• <br /> X �Vi ST ULC �i�12 I R G Gt7F� <br /> � �E���� �PPLICANTSCITYBUSINESSUCEN ENO.ANDBU91NE99N11ME <br /> � Q2/2 PlNE STR.E�1' <br /> IRIIM�ING MECHANICAI <br /> NO. TYr[OFFUITUIIlOIIIT[M FEE NO. TYPEOFEOUIPMENT FE[ <br /> WATERCL0.4ET1TOILEn — A/C-NHNOI�UNIfS-H.P. <br /> � BATMTUB � FORCED AIR SYSTEMS-flT.U. M EA <br /> UVATORY�VYA9MBA91M UNITHEATERS-&T.U. M <br /> � � SMOWER CIOTMESDRVERS � <br /> I KITCFiEN91NK8DI3P. � VENTILATIONFAN <br /> ' D19HWASHER � RANGEHOOD <br /> � LAUNDRYTRAY �� WATERHEATER <br /> � CLOTHEBWA9HEH WOODSTOVE <br /> URINAI METAL FIREPLACE 8 CHIMNEY <br /> DRINKINO FOUNTAIN FIREPLACEINSEFT <br /> � FLOORDMIN HEATPUMP <br /> � BACKFLOWPREVENTEF9 OASPIPING <br /> ROOF DRAIN9-RAINLEAOERS E%HAUST FAN <br /> SINK�SERVICE-BAR ETC.I <br /> � <br /> � <br /> 3UBTOTAL S SUBTOTAL S <br /> PERMIT S PERMIT S <br /> � TOTAL FEE S � TOTAL FEE S <br /> fIqNTlE7d1Cl( , pE�RBE�K � SIOESETBI�CN MA�LCNNUM�l11 u L IL! `� 11[ClIA1q.� <br /> S a <br /> �r�.. �r.. — <br /> ueEzoH �oi � � Tsire FEES VALUATION FEE <br /> �l �`6O ES O NO <br /> tt►EOFCON9T. OGCUY�NGYOBOUP NO-0FOWELIIHOUNl19 BUILDINO <br /> ������'N ��3 I PLUMBING <br /> 7REOPBLOQ NO.OFSTORIEB BSMT. OCGLO�D <br /> �O ` t o N 'r A MECHANICAL <br /> �i � IU T <br /> NEIGNTLIMIUTION OTHER <br /> flREBPRINNIERSREWIRED O YES NO �� ! STATEBU�LDINGSURCHARGE <br /> STATEENERGYSURCHARGE <br /> APPLIGTION:�CGBY PWISMPR�BY <br /> \ �/ PUBLICWORKS <br /> 'r"i� ;d� ; ��. <br /> ���•�- TOTAL <br /> '�; .. _ . .. . . _ . <br />