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APPLIC.+�ION FOR CONSTRI.CTION <br /> PERMIT <br /> MsEwryrosn <br /> CITY OF C°� <br /> everett <br /> BUILDING DEPARTMENT <br /> 25?•8810 TO BE COMPIETED IN INK—PLEASE PRINT <br /> qyqEq I 1 M�IL�DDRC55n p CIiV 21P GHONE <br /> D1bV��. �log�:-Ia/ 9/6 !'ar�f�c fir�. Ei�.�e� ���0 � <br /> TENANT M4ILRDDRE55 GiY ZIP PMONE <br /> ARGNITEGf OR DESM.NER M�IL�DDRESS CiTY 21P PNONE <br /> B�-'t<s.�, U..l, }l�,v va�� N��-� c�•�1! qs:�o3 <br /> 6ENERI�L CONTR�CTOB � MAII�O�RE55 CITY ZIP �MONE LiGENSE• <br /> /�f<.✓�.�..,,� G'.,y�: P.o.Bax 95Y E�e.e� 9�doC• <br /> MEGNIINIG�LCANTHAGTOR I MAIL�DDHE55 C�TY 2iP VHONE IICENSE• <br /> G��nlf s1,-<�w,.?•.� 1_ P.0_ 6,X ass � G.u<t� 9sao3 %�s.2-�v=.l �Uc,����6�0�� <br /> pLL1MBINGCONTR,�GTOH MMLADORESS CITY ZIP PMONE LIGENSE• <br /> CIASS OF YI�RR <br /> � NEW ❑ ADDITION ❑ AITEPATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVFJFFPL INSERT ❑ BUILDING RELOCATION <br /> TEN�NT t'IPROVEMENT Oq INTERIOR REMODEI ONLY CONiACT PERSON AND PNONE NO <br /> CpN1qAGT PIiICE OF WORIt <br /> DE9Gp1lE YnVOPR AN�SOU�RE FOOT�GE INVOLVED <br /> NUnG �o nPt(/ MRZ BN II^'7M.� <br /> PROGOSEDUSEOFBU�I ia lHEREBYCEFTIFYTHATIHAVEREADANDEaAMINEDTH15APPLICATIONAND <br /> L �_ KNOWTHESAMETOBETRUEANDCARRECTALLPROVISIONSOFLAWSAND <br /> LEG�LDE9RIPfIONOFPROPERTYISMOWNBELOWOR�R�CHFOURGOPiES� ORDINANCESGOVERNINGTHISTVPEOFWORKWILLBECOMPLETEDWITH <br /> W HETMER SPECIFIED HEREIN OR NOT.THE GRANTING OFA PERMIT DOES NOT <br /> PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br /> �oT BtoGc oF ANYOTHERSTATEOALOCALLAWREGULATINGCONSTRUCTIONORTHEPER- <br /> FORMANCE OF CONSTRUCTION.THAT I AM RUTHORIZED BY TME OWNER OF <br /> THIS PROPERTV TO PERFORM THE WORK FCR WMICH APPLICATION I�MADE <br /> AND I COMPLY WITH THE STATE CONTRACTORS LAW iB.27 RCW ANO <br /> 296200 WAC. <br /> SIGN�iUREOFCONTR�CTORONAUIMORI2EDRGENT DATE <br /> x � �.uq� i--ii-y�y <br /> PXOJECi ADD �PPLICANTS GiTY BIISiNE55l IGENSE NO RN�BUSME55 N�ME <br /> "�i� Pn �;�, � A�� . E��,� <br /> KUM�INO MECM�NICAL <br /> 11p, Tr�E Of FlIfTU11E OII ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILEI) PJC–A/HNDLG UNITS–H.P. � <br /> BATHTUB FORCED AIR SVS7EMS–B.T.U. M EA _ <br /> LAVATORV ryYASM BASIN) UNIT HEATERS–B.T.U. M _ <br /> SMOWER CLOTHESDRYERS <br /> KITCHEN SINK{DISP. VENTILATION FAN <br /> DISHWA9HER RANGEHOOD <br /> LAUNDRVTRAY WATER HEATER <br /> CLOTHES WASHER WOOD STOVE _ <br /> URINAL META�FIREPLACE 8 CNIMNEV <br /> DRINKINO FOUNTAIN FIRE?LACEINSERi <br /> FLOOR DRAIN HEAT PUMP <br /> BACKFLOW PREVENTERS GAS PIPING <br /> ROOFDRAINS–o.AINLEADERS S EXHAUSTFAN DD <br /> SINK�SEFVICE–BAR,ETG) — <br /> SUBTOTAL S SUBTOTAI S ' <br /> PEPMIT S PERMIT 5 <br /> TOTALFEE E TOTAL FEE S <br /> FRONt SETB�GN PE�R SETB�CN SIDE SETB4CK PIAM CMECK NOMlEII FEE �ECEIPf NO. <br /> usE ZowE �oT�nee v�enr�t sire FEES VALUATION FEE <br /> ❑ves ❑ r+o <br /> BUILDING <br /> ttPEOFCqNST. OCCUPANCYGROVP NO-0FDWELLINGUNITS — -- <br /> �uoweeiEi�ctw� PLUMBING <br /> S12EOfBlDG NO.OFSTORIES BSMT. OCGL0�0 <br /> ❑y MECHANICAL 7 O� <br /> ❑ N <br /> ME�pHiLIMIThTION OTHER <br /> iIRE SPPINKLERS REOUIRED ❑VES ❑NO STATE BUILDING SURCHARGE <br /> STF?EENERGYSURCHARGE <br /> RP^LIWTIONRCG.BV PUNS�PPRBY � <br /> PUBLIC WORKS <br /> TOTAL <br />