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:i��,� i .. . <br /> ��. APP�LICATIONP O�RUC'T NSTRUCTION <br /> the Erorgrcen r��•i�'ti <br /> CITY OF � <br /> everett <br /> BUILDING DEPARTMENT <br /> 259-8870 TO BE COMPLETED IN �NK— PLEASE PRINT <br /> owr+[n �.wi�nooa[ss �� — /�c_"z I /� ��� <br /> �4� F-�x - I�5�,8 f� - �, , ,��_ • , <br /> � � � �,�� �a <br /> � i[N RIAILA E55 CITY ZIP PIION[ <br /> � ,��,n`o. <br /> Y � V1 Af1C1 ECTOPOESIGNEP AIAI�AODPE55 CItY ZIP IONE <br /> M � <br /> � y � G{I�NERAL ONiRACTO MAIL R DRE55 CIiV ZIP PIION� � LICENSE• <br /> ° � ° 1yI �C�—;�-� �S C�0 2�h1 � �`_�1- <br /> N M �[ �A IC LG RA�TOR MA LR OPE55 CILY���'���/�����E I � � `I�ENSE• <br /> � � � ! �' L �-��' <br /> VlUM61NGCONiRAGIOR MAILAWRE55 CIIY 2P P ONE UCENSG+ <br /> � M <br /> L1 `p � GLASSOiWORK ' <br /> � y � ❑ NEW ❑ AD�ITIOY TERATION ❑ REPAIR ❑ DEh10LIT10N ❑ WOODSTOVFJFRPL INSERi ❑ BUILDING RELOCATION <br /> r L[NANi IMPRW EMENT OR INf FIIIOP REMODEI ONLY� CONTPGL PEPSON AND PNONE NO <br /> n�y N /T/` <br /> JC y �y CONiRFLTFRIGEOFWORK ���V <br /> Y � Vl O[SCPIBEN'OANANp50U AEF lAG NVOLVED � e , � <br /> � � � -`'- � � � � / � Q� i-u:� _ <br /> H y va seo �oram�oirvo � IHEREBYCERTIFYTHATIHAVEPEADANDE%AMINEDTHISAPPLICATIONAND <br /> � KNOW THE SAME TO BE TRU E AND CORRECT.AlL PROVISIONS OF LAW S AND <br /> �� ORDINANCES GOVERNING THIS TVPE OF�VORK WILI 9E COMPLETED WITM <br /> IEGALOESCRIPT10NOFPROPERIY�SMOWNBELOWORATiACHFOURCOM[51 WHETNERSPEGFIEDNEFEINORNOT.THEGRANTINGOFAPERMITDOESNOT <br /> PRESUME TO GIVE AUTHORI7Y TO VIOLATE OF CANCEL THE PROVISIONS OF <br /> tOi B�ocK or ANYOTHERSTATEORLOCALLAWREGULATINGCONSTRUCTIO�ORTHEPER� <br /> FORAIANCE OF CONSTRUCTION.THAT I AM AUTHORI2[D BYTHE OWNER OF <br /> TH IS PROPERTY i0 PE(iFOflM THE WORI:FOR W HICH APPLICATION IS MADE <br /> AND I COMPLY WITH THE STATE CONTRACTORS LAW 1827 FCW AND <br /> 296200WAG <br /> � SIGNAiUREOFCONiii4CiORORAUt110RIZEDAGENi OAiE <br /> PNOJECiA00RE55 % AP ��SCI���ESSI�CLN -T�OAM��OSMESSNAM�� <br /> �� t� I! � � _ <br /> � <br /> PLUMBING MECHANICAL <br /> �' , NO. TYPE OF FI%TURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> ( �� _ WFTERCLOSET�TOILEf) _ A/C—A/HNDLGUNIiS—H.P. — _ <br /> � � BATHTUB FORCED AIR SVSTEMS—aT. . 1 EA _ <br /> 1 LAVATORY�WASNBASIN) _ UNITHEATERS—BT.U, M — , <br /> '�_ SHOWEfl CLOTHES�RVERS — <br /> ��_' KITCFIEN SINK 8 DISP. VENTI LATION FAN <br /> DISHWASHER RANGE HOOD <br /> LAUNDRYTRAV WATERHEATER _ _ <br /> �_ CLOTHES WASHER __ �y00D STWL <br /> I I 1 URINAL _ METAL FIREPLACE 8 CHIMNEY __ � <br /> � fIREPLACEINSERT I <br /> DRINKING FOUNTAiN _ i <br /> FLOOR DRAIN HEAT PUMP _ , <br /> BNCKFLOW PREVENiERS GAS PIPING _ <br /> � '_I ROOF DRAINS—RAINLEADERS __ E%HAUST FAN _ I� <br /> �. SINK(SERVICE—BAR,E7C.) I, <br /> � '��1 ' _ <br /> �► <br /> L. � <br /> SUBTOTAL 5 $UBTOTAL S U , <br /> f�� PERMIT 5 _ PERMIT S / I __ <br /> ��r' TOT.1L FEE 5 TOTAL FEE 5 �. <br /> FRONTSETUACK R[PRS[lOACN SIpE5El0ACN PUNCNECRNUMBEN FEE flECE1pTN0. I <br /> u5e2oHE �ot�aen wcnnrsi*[ FEES VALUATION FEE ', <br /> ❑YES ❑ NO <br /> — BUILOING <br /> TYPEOFGONSi. WGUP�NCYGNOUP NOOFOWELlIN011N115 --- - — '--- � <br /> ALLOWABLElAGTUAI PI UMBING <br /> SREOFBLDa. NOOFSTORIES BSMi. OG4LO�D MECHANIGAL S.]� <br /> ❑Y <br /> ❑N II <br /> MEIGNiUM1TAl10N OTHER <br /> , FIPESPRiNNLEP5PE0UIRED ❑rEs ❑No STATE BUILDIN±SURCHARGE _ I <br /> STATE ENERGV SURCHARGE I <br /> �PVIIC�TIONACC.BY PLANSAFPR9V PUUUCWORK$ I <br /> TOTAL � `� <br />