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APPLIC�ON FOR CONSTR�TION <br /> PERMIT <br /> fM Ewryrs�n <br /> CITV OF everett <br /> everett e <br /> BUILDING DEPAPTMENT <br /> 259-8810 TO BE COMPLETED IN INK— PLEASE PRINT <br /> OWNEN/� / / MAILADDRE/SS � '/ GIiY ZIP PHONE <br /> Y1��le� /:�f/CJ ZJG�di4.�T� /9�-0 �LoiJl�a..oii �oa[a.'7`� 1�S�Z - 8090 <br /> IENiVIT � MPILADURE55 GITY ZIP PHONE <br /> / �, <br /> I14CHREC ORUESI(iNER M�ILAD^�E55 CI V 21P PHONE <br /> OENEMLCON ACTOR M�ILAODRE55 CRY 21P PHONE LICENSE• <br /> ME�'H�/���� A��D��� ��ITY�IP ��� - ��Ol�NSE• <br /> �1L �N/�I/S9�il�, <br /> PLUM&NOCONTRACTOR MMLADORESS GTY ZIP PIqNE LICENSE• <br /> �„�-/� �L�.,,�,;,� �D, BoX S29 �1iL'�-rs�.%�� 99270 653-2�0 <br /> OFVqRN � <br /> �NEW ❑ ADDITION ❑ ALTEMTION ❑ REPMR ❑ DEMOLI710N ❑ WOODSTOVE/FRP�INSERT ❑ BUILDINQ RELOCATION <br /> TENNIT IMPR(N�MENT Ofl INTERION PEMODEL ONLY CONT�CT PERSON AND PR9NE N0. <br /> � �" � � n ^ <br /> CONTMCTPRICEOFWORK / . �a/Ch �{„J <br /> DEBCRIlE WORK MIU 90WRF FOOLWE INVOWED <br /> vnoroseo uSE or eu��allo I HEREBV CERT�FY THAT 1 HAVE READ AND EXAMINED Tk IS APPLICATION AND <br /> KNOW THE 9AME TO BE TflUE AND CORRECT.ALL PROVISIONS OF LAWS AND <br /> � LEMLDE9GRIPTIONUFPROPERfY�SNOWNBELOY/OR�TTIICHFOURCOPIE3� ORDINANCE3GOVERNINGTHISiYPEOFWORKWILLBECAMPIETEDWITH <br /> � WHETHER9PECIFIED HEREIN ORNOT.THE ORANTINOOFA PEqMITDOE9 NOT <br /> PRESUME TO GIVE AUTHORITV TO NOUTE OH CANCEL THE PROVISIONS OF <br /> � ��T ��K � ANVOTHERSThTEORLOCALLAWREODUTINOCAN3TRUCTIONORTHEPER• <br /> . FORMANCE OF CONSTRUCTION.iHAT I AM AUTMORIZED BY THE OWNER OF <br /> THIS PROPERTYTO PERFORM THE WORK FOR WHICH APPLICATION IS MADE <br /> ' AND I COMPLY WITH THE SiATE CANTRACTORS LPW 1827 fiCW AND <br /> 298200 WAC. p <br /> � SIQNATUREOFCONTR�QORORPUT10RI2EDAGENT D�TE S'Z�J - / O <br /> � J F►� O�oiC. L.vaJ X . <br /> � Pip.lECf MDRESS � <br /> 2 9 2 9 �� d ��� TS QT E NO BU 55 N�ME <br /> 4 PLUM/INO AECMANICAL <br /> � Np. TYrE Of FlI(TUIIE OII REM FEE NO. TYPE OF EOUIPMENT FEE <br /> . WATERCL0.4ET�TOILEI) A/C—AIHNDLGUNITS—H.P. <br /> BATMTUB FORCED AIR SVSTEMS—flT.U. M EA <br /> UVA?ORV(WASH BASIM UNIT HEATERS—9�.'.U. M <br /> SHOWER CLOTHESDRYERS <br /> . + KITCHEN91NK6DISP. VENTIUTIONFAN <br /> J <br /> DISHWA9HER RANGEHOOD <br /> UUNDRY TFiAY WATER HEATEH <br /> � CLOTHESWA9HER WOODSTOVE <br /> � URINAL METAL FIREPLACE 8 CHI��!:cY <br /> . DRINKIN6 FOUNTAIN FIREPIACE INSERT <br /> � FLOOR DRAIN HEAT PUMP <br /> BACKFLOW PREVENTERS GAS PIPING <br /> ROOF DMINS—RAINLEADERS E%HAUST FAN <br /> `� aINK(9ERVICE—BARETG) <br /> i <br /> F ` <br /> i SUBTOTAL S �� SUBTOTAL S <br /> . PERMIT _ S �L` PERMIT S <br /> ` TOTAL FEE S O TOTAL FEE E <br /> � FRONTSEfB�CK REARSEf61CK SIDESETB�GK RAMCHECKNUMlER FEE 11ECEIPfNO. <br /> USE20NE LOTAREA VACANTSITE FEES VALUATION FEE <br /> ❑YES ❑NO <br /> � 7YPEOFSN3T. OLCUP�NCYOROUP NO.OFDWELLINOUNITS BUILDING <br /> ���8������ PLUMBING W <br /> &ZEOFBLD0. NO.OFSTORIES &4MT. OCGLOAD <br /> ❑v MECHANICAL <br /> ❑ N <br /> ME�OHTLIMIT�TION OTHER <br /> FlRESPRINKLER9REWIRED ❑YES ❑ NO STATEBUILDINGSURCHARGE <br /> STATE ENERGY SURCHARGE <br /> APPL;G�TIONIICCBY PLANSAPPRBY <br /> PUBLIC WORKS <br /> I TOTAL <br />