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;.��.. <br /> ���� APPLIC �''� ION FOR CONSTR�TION <br /> PERMIT <br /> i fM Ewrynm everett <br /> � CITY OF � <br /> ; everett <br /> BUILDING DEPARTMENT <br /> ; 269�8810 TO BE COMPLETED IN INK— PLEASE PRINT <br /> ,S p p AUIL�DOPESS GITY IIP FNONE . <br /> � � ' C�� ��i�ii'%�w �'.��r, �,�� ���o � as;-s8.�r <br /> S �T MAILADDflESS GITY LIP PNONE <br /> � <br /> MCNITECfOR0E81aNEP MAILII�URE59 CITY ZIP PHONE � <br /> ' MAI��DOPE55 CITY 21P PHONE LICENBE• <br /> � OENEMLCONTRACiOX <br /> � x �i - A.. �Ll�E/ - — _ <br /> jMEGI�NIC�ICONiMCR/ MIIILAO�NES4 CITY ZIP PNONE LICENSE <br /> 1 <br /> ( PLUMNNOCONTR�CTOP MAIL�DORE54 GITY ZIP FNONE LICEMlE♦ <br /> CV18D OF YNPK <br /> ❑ NEW ❑ ADDITION ❑ ALTEMTION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPLINSERT ❑ 6UILOINORELOCATION <br /> 7[lUNi IMVROVEMENT OP INTERIOR REMO�EL ONLY CONi11Ct PERSON RN�1'NONE NO <br /> CON7q�GT VPICE OF N'OIIIC <br /> p[lCpllE WORK�NO BOUME FOOTAOE�NVOWEO <br /> � � <br /> ; r�o ousE�oreu n+ IHEREBVCERTIFVTHATIHAVEREADANDEXAMINEDTHI9APPLICATIONAND <br /> KNOW THE SAME TO BE TRI�E AND CORRECT.AlL PROVI910N9 OF LAWS AND <br /> � � � ORDINANCES QOVERNING THIS 7YPE OF WORK WIIL BE CAMPLETED WITH <br /> � [ RIPiION P ERT/1811 NBELOWOXATT/�CHfOURCO%E5� WHETHERSPECIFIEDHEREINORNOT.TMEORANTINQOFAPERMITOOEBNOT <br /> '� PRESUME TO OIVE AUTHORI7Y TO VIOLA7E OF CANCEL THE PROVISION9 OF <br /> �oi e�ocK or ANYOTHERS�ATEORLOCALLAWREOULATINGCONSTRUCTIONORTHEPEIF <br /> FURMANCE OF CON9TRUCTION.THAT 1 AM AU'MORI2ED BV THE OWNER OF <br /> ; TH19 PROPERTV TO PERfORM THE WORK FOR KNICM APPLICATION IS MADE <br /> i AND I COMPLY WITH THE STATE CONTRACTORS LNN 18.27 RCW AND <br /> ! 2A8.200 WAC. / pp <br /> j SION�TUREOFCONiR�C10ROR�UtMORIZEOAUENT O�TE /D ��"OO <br /> 1 ^ X%�l[lL' ' [`��r <br /> j rypJE6fMDRE89 11Pp�IC�NT9CITYBU91NE5SUCENSENO.�NDBU51NE89N�ME <br /> � <br /> � �ifn i !I rl �)KJ <br /> i rL{IM�INO MECNANICAL <br /> NQ. 7YrEORR11fTU11EO111TEM FEE NO. TYPEOFEOUIPMENT � �E <br /> i WATERCL08ETITOILET) NC—NHNDL6UNITS—H.P. <br /> i BATHTUB FOPCED AIR 8VSTEMS—&T.U. M EA <br /> UVATORY(WASHBASIM UNITHEATEHS—&T.U. M <br /> 8MOWER CLOTHESDRVERS <br /> j KITCHENSINK6019P. VENTILATIONFAN <br /> DIBHWABMER RANOE NOOD <br /> j LAUNDRVTRAY WATERHEATER <br /> � CLOTMESWASHER WOODSTOVE <br /> � URINAL METALFIREPLACEdCHIMNEY <br /> 5 DRINKINQ FOUNTAIN FIREPLACE INSERT <br /> FLOOR ORAIN HEAT PUMP <br /> � BACKFLOW PREVENTERS GAS PIPING <br /> � ROOFDRAIN9—RAINLEADER9 E%HAUSTFAN <br /> � <br /> � <br /> 91NK(SERVICE—BAR.ETG) <br /> i <br /> � <br /> ' SUBTOTAL S SUBTOTAL S <br /> �{ PERMIT S PERMIT S <br /> � TOTAL FEE E TOTAL FEE S <br /> � FIqNTlETMCK PEARSEf6�GN SIDESETBIIGK MANCMfCkNUM�EII F[E �«��R�� <br /> i UlEIONE LOTAREA V�CANTSITE FEE8 VALUATION FEE <br /> O YES o NO <br /> BUILDIN6 <br /> � TYPEpFGONlL OCGUPNICYOIIOUP NOOFUWELlIN0UN1T5 <br /> � KlW/�BLd�CiUIJ. PLUMBINQ <br /> ` 812EOFBLW. NQOF9TONIE9 BSMT. OGGLOAD <br /> � o v MECHANICAL <br /> ON <br /> HEIOMTLIMIT�TION OTI{ER <br /> I <br /> iIRESPPINN�ERSREOUIPEO O YES O NO STA�E BUILDING SURCHARGE <br /> � STATE ENEF3V SURCHA9GE <br /> ' �PPLICATIONAGGBY GLAN9�PP0.8Y PUBLICWORKS <br /> , TOTAL <br /> � r� .....,..-'_.. . ..... _. .. .._._...�. . . . ,,. . _ <br />