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� Y�w <br /> APPLICS�.-lION FOR CONSTR�TION <br /> PERMIT <br /> m.e»�vr..� �,� . <br /> � everett � e <br /> � BUILDING DEPARTMENT <br /> � 2b9-8870 TO BE COMPLETED IN INK— PLEASE PRINT <br /> , <br /> 1 p�ryEp M�IL�DDRE95 CItY ZIP PNONE <br /> � flsrini��C>F�E/� � 53��/h'�-i�R�'�!d`'e�9YJ�'rf ', <br /> j ��T MML�UDRESS CILY iIP PNONE <br /> '� ��� <br /> MCNRE TORDElqNER MML�UDRESS CILY IIP FNONE <br /> �'� ��pp� M;{ ����IL�DDRE69 q�Y 21P MONE UGENOE• <br /> ' �7��L /.g!//L�i}-� <br /> ,� MEC�I�IC�LCONTMGTOR � M�IL�WRES8 CIIY ZIP PNONE IICENBE• <br /> ; /�? u.9L..r °� /���rx�� 19� 7 �'(�,���- ,��nv�—p'd'm`lr �,� �Z-�� <br /> rIUMMNGCONTMGTOR M�ILADDHEBS IiY i tl M!E• <br /> ` 1� f� ���..�..trr 1a�G�-7—�h,�.�, ca�v ,����<2-�— <br /> �1 ❑ NEW ADDITION ❑ ALTERATION ❑ REPAIq ❑ DEMOLITION ❑ WOODSTOVE/FRPLINSEPT ❑ BUILDINORELOCATION <br /> 't IMNTIMMqVEMENTq11MERqRREM00ELONlr CANi�CTPERBONl1NpVMONENO <br /> � <br /> '� OONiMCTM1ICEOFNVIIK <br /> ,� ppC11hFNO1M(MIpqUM1EF00T/�OEINri7lVED <br /> ', nqro6 eco�waoiHa ::{EREBYCERTIFVTHATIHRVEREADANDE%AMINEDTHIBAPPLICATIONAND <br /> �i '��iL��i1 r 1•(^�— M.NOW THE SRME TO BE TFUE AN�CORRECT.ALL PROVISION9 OF LAWS AND <br /> �[—io �o[ ivrwr+�vnovennenOWNBEIOWON�TT�CMiOURCOPIE81 ORO�NANCESOOVERNINGTF11S7VPEOFWORKWILLBECOMPLETEDWITH <br /> WHETHEA SPECIFIED HEREIN OH NOT.Ti1E GHANTINOOFIIPERMIT DOE$NOT <br /> � PRESUME TO GIVE AUTHORITV TO VIOL�TE OR C�NCEL TNE PROV1910N9 OF <br /> � �m 9taK oF ANVOTHERSTATEORLOCALLAWRE6ULATINOCANSTRUCTIONOR7HEPER� <br /> J FORMRNCE OF CONSTRUCiION.iH�T 1 AM AUTHORIZED BY THE OWNER OF <br /> THIS PROPERTY TO PEFFORM THE WORK FOR WHICM APPLICATION IB MADE <br /> ,:j AND I COMPLV WITM THE ST�TE CONTRACTORS LNN 1827 RCW AND <br /> �1 288200 WAC. <br /> S��N�TUNEOfCONTRACTOP tH ZED/�OENT D�TE <br /> � � ♦ <br /> <t �� <br /> f <br /> �j �x�T��N �PCLIC BCI 8 N 84GENb HO NDlUBME89N�ME <br /> ! <br /> V <br /> � ' <br /> '� NLM�INO MECMANICAL <br /> ;� 1q. TY►[Of FlIITUIIE OII ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CL09ET(TOILET) NC—NHNDLG UNITS—M.P. <br /> BATHNB FORCED AIR SYSTEMS—B.T.U. M EA <br /> LAVATORV(WA9HBASIM UNITHEATERS—&T.U. M <br /> gMpyyEp CLOTHESDRYERS <br /> KITCMEN SINK6 D18P. VENTILATION FAN <br /> DIBMWASHEq RAN6EMOOD <br /> � UUNDNY 7RAV WATER HEATER <br /> CLOTMEB WASHER WOOD STOVE <br /> URINIIL METAL FIREPLACE 8 CHIMNEY <br /> �� DRINKINO FOUNTAIN FIREPLACEINSERT <br /> fLOOR DRAIN NEl1T PUMP <br /> �j BACKFLOW PREVENTERS OAS PIP;NG <br /> � HOOFDPAINS—PAINLEADEqS E%HAUSTFAN <br /> 1� SINK�SERVICE—BI�R,ETC.) <br /> � <br /> SUBTOTAL S SUBTOTA� S <br /> PERMIT ' S PERMIT S C� <br /> TOTAL FEE S iOTAIFEE S <br /> f110NTlEfMCK pEAHSETB�CN 61DE6ET&1CR ILAMCMFLI(MUMlEII 1'EE 11F EIRNO. d 'Jv <br /> '7 •W <br /> UlEZONE tounu V�C�NTSITE FEES VALUATION FEE <br /> ❑YEB O NO <br /> BUILDINCa <br /> TYPEOFCONBT. OCCUP�NLYpROUP NOOFDWELUNOUNITB <br /> ,���,�.� � a <br /> PLUMBING <br /> lIZEOFBL�Q NOOF6i0PlE8 BSMT. OLGLO�O � <br /> ❑r M[::HANICAL <br /> ON — <br /> HEtOMiLIMIiRION O�NER <br /> FME LPRINNLEPBREOUIqED ❑rEe o no STATL FiUfLDINO SURCHARGE <br /> ST.4TEENEROVSURCHARGE <br /> �rruc�non�cc ar PUN9��BY <br /> PUBLIC WORKS <br /> TOTAL <br /> I g4,�d <br /> wY.fT1T ^' ) .',.^'1= (.1 �\/ .� �{. ..'. �+'�r!{.�'�T..^ <br /> � � S <br />