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APPLIC...fION FOR CONSTRI.CTION <br /> PERMIT <br /> fM Ewrpreen <br /> CITY OF �'��'«�� <br /> everett e <br /> BUILDING DEPARTMENT <br /> 259-8870 TO BE COMPLETED IN INK-PLEASE PRINT <br /> q M�iL�pDRCSS CRY 1�P PHONC <br /> � / '[/(Y � <br /> ,• < .�� -[;��L ---�z��,f�c-l�G_�'-- r-�':l . <br /> N�NT MMI.�ODFC55 CILY - �ZIP PIION[ <br /> MIGHITECTOR�ESIONEH MMI.�DDRE55 LITY ZIP WIONE <br /> QENER�L CANTRACTOP M�II�ODRCSS GIiY Z�P PIION[ IICENS[� <br /> MECM�NICIILGONTRIiCTO � M�IL��Of1[55 G11Y ZiP PBONE ��O__�JfIC�� <br /> /� lr/, !.�/a-�C/' f�i� s//D fj<<�� 5�— ✓� �.5,% •• S 3j/ ,� '��— <br /> PLUMltNO CONTR�CTON MM1.�0[IN[55 GTY ZIP PIIONE LiCENSE• <br /> ClM!Oi VY0i1K <br /> ❑ NEW ❑ �DDITION I�ALTERATION ❑ REPAIR ❑ OEMOLITICN ❑ WJODSTOVE/FPPLINSERT ❑ BWLDINGRELOC�TION <br /> TEN�NT a�PROVEMENf OP INTERiON qEMOOEL ONtY CONI�CT°ERSON�NU PNONE NO <br /> COMTI111GT PRIGE OF WOfIK <br /> DElCIIIlE YVORK�ND 80U�RE nFOOT�OE�NVOI VEO �/ <br /> Yo rtS /1('N � �`Jn�r't----�'L �n--- � <br /> PIqv06E0u9EorBm�DiNO IHEREBVCENTIFVIHATIHAVEREADANDE%AMINEOTMISAPPLIC�TIONAND � <br /> ,��.����,���i��N /p _ KNOwT11F:SnMEiOBETRUEANDCORRECTALLPROVISION30FLAWSAND <br /> t¢a�� E li`TIONOf PROP[RTYIBHOWN BEIOW ener, FOURCOPIES� ORDINANCES GOVERNING TInS TYPE OF WOHK WILL BE fAMPLE7ED WITH <br /> WHETHER SPECIFIED HEREIN OR NOT.THE 6R�NTiNa OF APERMIT DOESHOT <br /> PRESUME TO GIVE AUTHORITY TO VIOL�TE OR CANCEL TME PROVISIONB OF <br /> ��T ��K � ANYOTHERS7ATEONLOCALLAWREOULATINOCANSTRUCTIONORTMEPEI4 <br /> FORMANCE OF CONSTRUCTION.THAT 1 AM AUTMORIZED BY TME OWNEN OF <br /> TNIS PROPERiV TO PERFORM THE WORK FOR WHICH APPLIC�TION IS M11DE <br /> AND 1 COMPLV WITH TME STATE CONTR�CTORS LAW 15.27 RCW AND <br /> 296200 WAC. `/� � <br /> SiGNATUREOFCONiR�GTORORnpiNOR12EC�0EN1 O�TE ! / G/ � I <br /> X I <br /> lIIDJECT11pDRESS �� � � . N <br /> (r�I ' 1 / I � � ' eA �MSCiiY M[SSLI�D�NO SINE65 E � <br /> ` <br /> /{,yN��►p MECHANICAL <br /> NO. TYrE OF FlKTUIIE 0111TEM FEE NO. TYPE OF EOUIPMENT FEE � <br /> WATER CLOSET(TOILEn _ A/C—A/l INDI.G UNITS—N F. <br /> BATHTUB FORCEDAIRSYSTEMS—BT.U. MEA <br /> LAWTIXiY(WASHBASIN) UNITHEATERS- B.T.U. M <br /> 9HOWER CL.OTHESDRVERS <br /> KITCHEN SINK 6 DI50. � VENTII A710N FAN � <br /> DISMWA9HER RANGE MO00 <br /> LAUNDRVTRAV --- __ -- � � �WATERNEATFR . .�-�._—__ _— _ — <br /> CLOTHES W�SHER WOOD S70VE <br /> URINAL � METAL FIF[PLACE 6 CHIMNEV <br /> DRINKINO FOUNTAIN FIRLPLACEINSERT- — � <br /> FLOOR DRAIN MEAT PUMP <br /> BACKFLOW PNEVENTEPS GAS PIPING <br /> ' ___�_ —_—_-- _— <br /> ROOF DRAINS—R�INLEADEFS E%HAUST FAN ! <br /> SINK�SERVIGE—BAR,ETG) ! <br /> SUB TOTAL 5 SUB TOTAL S <br /> __ _—__ _._-'_— .____ .... _ _ .__ ____ __—__ -_____._ .—____ _- — <br /> PERMIT S PERMIT 5 <br /> ___—__—_. ____— —. _._ _ ___—._________--_._.._..._.._—.— _ <br /> TOTRL FEE t TOTAL FEE t <br /> FpONT9ETB�CN PWRSEtB�GIc SIDESRB�CN PUNC11ELkNUMlER FEE I�ECEIRMO. <br /> U9EZONE IOT�RE� V�C�NTS17E FEEB VALUIITION FEE <br /> ❑Y85 fl NO <br /> _ ----- BUILDING <br /> 7YPEOFLONST OCCl1P�NLYUROUP NOOFDWELLINOIINITS .. __—'—" "_. _ . . ..__.. __.. . - .__- "__ -. "_ _---_-- _ <br /> �ttowee���ciun� PLUM5ING <br /> BIZE Of BLDO. NO OF 6TOHIES BSMi OCC 10�0 <br /> n r MECHANICAL <br /> I1N . —___ ""_ "_ _ __._ — ___—_— --. — <br /> NEIONiIIMIT�TION 0T11ER <br /> FIREBPRINkL[RS REOUINEO ❑rE5 u Ho _ _ STATE BUtLDING SURCHARGE <br /> SIATEENEf�YSIINCHAWGE <br /> --___ .. _ _ .._ _. ___ . __—.—. ____-___—_-__ —._—_ — <br /> •PPUL�TION�LCBY PUNS�PPRBY <br /> PUBLIC WORKS <br /> TOTAI <br />