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..r ..w <br /> APPLICA�'ION FOR CONSTRV.:TION .� L� j fi,.�,� <br /> PERM�T - <br /> f�e Evnrpreen � `✓' <br /> �(y � CITY OF nl�5 -���/+ �`�'rri•tl <br /> ,�� x everett " e <br /> BUILDING DEPARTMENT <br /> �H v� 259-8870 TO BE COMPLETED IN INK—PLEASE PRINT <br /> � OWNLR IdnRA00RE55 61v Z�P PNONE <br /> l <br /> � y� � !�fn,n✓�„t� �.,��i9L� 2 Zo \ ac� �G�,�'�ZTf 5Y�uG: zS%- 9ZS�/_ <br /> O LC O iCNANT MFII pTJRES;I ? GiYC�' —�uv � vrorvc <br /> �fA N �9o'a.IL /7O. I/U�Y.�18 I ti.-_..____......_ . <br /> � �� �NCHItELiOF0E5�GN MML�ODRE55 LIIY ZIP PNONE <br /> �A�,� �ar��C�.�,cn� Z��z CvL�3� G'v�-ts'1t 9�JZv1 252- Z��3 <br /> OH � ccrvEa��cou �croA rnu�noonEss � zia �Hpti� iicENSE• <br /> Q <br /> ��8 � �" �.���a�3_ ���,, g�r �__c�Qy�ri= �b=�r�' s�Os� <br /> L1J�_ <br /> (�r (] M[y`M�NIp�LLpNTpKT00 M�ILRD�RL55 d � CITY ZI Y IIE —LIL[NSE• <br /> Y H� PLUMBINOLONTRACiOH MAIIRD�PE55 G1LY 21P PNONE LIf.ENSE• <br /> r� z <br /> HH <br /> g�� CLnS60fNORNJ ' <br /> n�y ❑ NEW l ADDITION ALTEPATION ❑ REPAIq ❑ DEMOIITION ❑ WOODSTOVE/FRPLINSERT ❑ BUILDINGREIOCATION <br /> IEN�NIIMP E ENTORIM[{PORR[MODELONLY � CqNT11CTPEP50N�NUGNOHENO <br /> CONTFALTPRICEOFwORK- J����U � � � <br /> H�CA OE RIBEWORNPNDSOU4REi00iAGEINVOWEO C <br /> ��1✓dK�(l�2 F/ S�T �7� �l/� 7 __ <br /> Pa0 SEDUSEOFBWLDIN9 � a,y..{ IHEREBYCERTIFVTHATIHAVEREADANDE%AMINEDTHISAPPUCFTIONPkD <br /> � LSQ {� S� ��IG:.'S � / KNOWTHGSAMETOBETRUEANDCORRECT.ALLPROVISIONSOFLAWSAND <br /> teeaic nioriOrvUrrnoPeetv�sHorvr�ectc��o n CNrouacoams ORDINaNCLSGOVERNINGTHIS7VPEOFWORKWILLBECOMPLETEDWIiH <br /> �/ �' �S WHETHERSPECIFlEDNEREINOPNOiTHEGRANTINGOFAPERMITDOESNOT <br /> LOT�(L�J�_ BIOGK� or I PPLSUMEIOGNBAUTNORITVTOVIOV.TEORCANC[LTH[VPOVISIONSOF <br /> ANV OTHEF STATE OF LOC�L LFW FEG�LATING CONSTRUCTION OR THE PER� <br /> ���'�� FORMANCEOFCONS1Fl1CTION TMATIAMAUTHORIZEDBVTHEOWNEROF <br /> 12,J�f��q THI$PPOPERTV TO P[RFORM THE WORK FOR W NILH APPLICATION IS MADE <br /> —I;i�--e� AND I COMPLV K'li4 TME STATE CANTFACTORS LAW 1827 RCW AND <br /> 296200 WAG .<� Gy <br /> SiGN/.tURCOICONiRnCiOfy.�Nf�U1NL;'�lCL4G(Vt� OAiE /Z/z�f/pV <br /> l � / ///, \ __� <br /> PROJEGTADORE55 �� ��-�` ��N <br /> AP =_A CII USM65LILENSENO�NDBU M[SSNAIAL <br /> zz.0 �4C. � (�• oFGG n` /�l!/�Z <br /> '�' PLUMBING MECHRNICAL <br /> NO. TVPEOFFI%TUREORITEM FEE NO. TYPEOFEOUIPMENT FEE <br /> 1�' WATEFCLOSET�TOILEn A/C-A/MNDLGUNITS-H.P. <br /> '�' BATIiTUB __ PORCEO AIR SV57E�d5-B.T.U. M EA _— <br /> LAVATORY�WASHBASIN) UNITHEATERS-BT.U. M <br /> ' ' SMOWER CLOTNESDRYERS _ <br /> � KITCHEN SINKB DISP. VENTILATION FAN <br /> 1 DISHWFSMEfi RANGENOOD _ <br /> LAUNDRVTRAV WATERH[ATER <br /> fCIOTHESWASHER __ WOODSTOVE <br /> URINAL METAL FlREPLACE 8 CHIMNEY <br /> f� ORINKING FOUNTAIN FIREPLA(;E INS[RT <br /> FLOOR DRAIN HEAT PUMP <br /> ' ' BACKFLOW PREVENTERS GAS PIPING _ <br /> � ROOFDRAINS-RAINLEADEFS E%HAUSTFpN <br /> •�1 SINK�SERVICE-BAR,ETC.) _ <br /> � <br /> 1�1 — — <br /> �' _ <br /> � SUBTOTAL 5 _ _ SUBTOTAL 5 _ <br /> PEFMIT 5 PERMIT 5 <br /> TOTAL FEE S TOTAL FE[ 5 <br /> fNONT5Ei8PCN RENRSETBl�C1t SiDESRBACM PUNCH (�OM6�� � iEi���� AE�EI��� <br /> �� � <br /> usc�zqyE /� LOTFRU wcnHrsirF FEES �AIUATION FEE <br /> Gl '�/ ❑YES 1(NO <br /> .�-�� ,�_, ���: :,,,,r <br /> BUILDINO �''' ���' <br /> iVPFOFCANST. ��/ OCGUPRNGVGROUP NOOfOWRL�NGUNITS ILOJ�__.�_� _�� � ��� . <br /> PLLOW�BLEPGTUAL � <br /> � �2- � PLUTABING <br /> sizE oG B�DG �+o oF SiomES esnrt. OCG.LORo <br /> 89�2 $� � r�r iy 'Q MECHANICAL _ <br /> G <br /> NEiGHiLIMiT�TION OTHER <br /> �iRESPRHKLERSPEOWPEO ❑vE5 NO I <br /> _ STATE BU LDING SURCHARGE _j S(� <br /> STATEENERGVSURCMARGE <br /> �PPUCniiONnCCBv PL�N9�PPR.BV <br /> ��' / � �UBLIC WORK$ <br /> /� � <br /> TOTAL <br />