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�4. <br /> gl� <br /> APPLICf:�ION FOR CONSTR�.`�TION <br /> PERMIT . <br /> the Eve�Oreen <br /> CITY OF eVerett <br /> everett - � � e <br /> BUILDING DEPARTMENT <br /> 259•eelo TO BE COMPLETED IN INK—PLEASE PRINT <br /> �EH MAILAOORE55 CI1Y ZIP PHOHE <br /> bbie� LaYS�n 141CQ �� IvlaV��,o,�lrcwor $,.�e�.f� �c tD�f2 86�(.c� <br /> TEN�NT MAIIADORESS CIIY 21P PNON! <br /> 11RCMITECTOROESI�NEP M�II�DDRE55 pTY 21P PNONE <br /> GENERALCONTRAGIOR MRILRD�HE59 CITY 21P PHONE LICENSE• <br /> M CM�NICALCONTR�CiON M�ILADDRE55 CIiY 21P PNONE UCENSE• <br /> ����� f�l�}-. C-�,� 2�Q1� M�_t�a.�� A� �Co�t( ��'l1� 2�9-�f-92 ur�U�A,b15�a <br /> PLUMBINOCON CIOR M�II�DDPE55 CITY 21P PNONE UCENSEi— <br /> CLASS OF WORK <br /> ❑ NEW ❑ AD`u:TION ALTERATiON ❑ REPAIR ❑ OEMOLIiION ❑ WOODSTOVE/FRPLINSERT ❑ BUILDINOREIOCATION <br /> TEN�NT IMPROVEMENT OR INTk910R PEMDOEL ONIY CONT�C7 PERSON�ND PHONE NO <br /> CONTH�CTPNICEOFWOhY.� ' <br /> DESCRI�CPK�SOUAREFOOI�GEI�eo �CP ( ��� � <br /> .�1 � <br /> raOroSEo �� o ' IHEREBYCERTIFYTHATIHAVEREADANOEIfAMINEOTNiSAPPIICqTIONAND <br /> KNOW THE SAME TO BE TRUE AND CORNc�.T.ALL PROVISIONS OF LAW9 AND <br /> LEMLDESCPIPTIONOFPROPEIilY15110WNBELOWORAT1�C11fOUPCOPIES� ORDINANCESGOVERNINGTH�57VPEOFWORKWILLBECOMPLETEDWITH <br /> WHETHER SPECIFIED HEiiEIN OR NOT.THE ORANTINO OFA PERMITDOE9 NOT <br /> �oT eipcK or PRESUMETOaIVEAUTHORITYTOVIOLATEORCANCELTHEPROVI510N30F <br /> ANY OTHER STATE OR IOCAI LAW REGULATINO CONSTRUCTION OR THE PER- <br /> FORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE OWNER OF <br /> THIS PROPERNTO PERFORM THE WORK FOR WHICH APPLICATION IS MADE <br /> AND I COMPLY WITH THE STATE CONTRACTORS LAW 1827 RCW AND <br /> 298.200 WAC. <br /> SIGNATUREOFCONTR�GTORORRUTNORI2EDAGENT D�TE <br /> X ,�.c�� ��J �-aa-�9 <br /> FR1OJECiADDRE55 �P INTSpTYBUSINE35lICENSENO.ANDBUSINE59N�ME <br /> lG��� �.L> �i -mc�1�l �I'�(� <br /> PLUMBINO MECHANICAL <br /> NO. 7YPEOF FIXTURE OR ITEM FEE NO. TYPE OF EQUIPMENT FEE <br /> WATER CIOSET(TOILEn A/C—A/HNDLG UNITS—H.P. <br /> BATHTUB FORCED AIR SYSTEMS—BT.0 EA <br /> 4AVATORV�WASHBASIM UNITH�ATERS—&T.U. M <br /> . SHOWER CLOTHESORYERS <br /> KIiCHEN SINK 6 DISP. VENTILATION FAN <br /> DISHWASHER RANGEHOOD <br /> LAUNDRYTRAY WATERHEATER <br /> CLOTHES WASHER WOOD STOVE <br /> UHINAL METAL FIREPLACE 8 CHIMNEY <br /> DRINKINO FOUNTAIN FIREPLACEINSERT <br /> FLOOR DRAIN HEAT PUMP <br /> BACKFLOW PHEVENTERS 6A5 PIPING <br /> ROOF DRAINS—RAINIEADERS EXHAUST FAN <br /> SINK�SERVICE—BAR,ETCJ <br /> SUBTOTAL S SUBTOTAL S <br /> PERMIT E PERMIT S <br /> TOTAL FEE S TOTAL FEE S <br /> FRONi SEtB�CK RFJ1115EI9�CN SIpE SE104CN PUN CHECY,NUMBEII FEE RECFIPf N0. <br /> uSeioNe LOTARE� WGINTSIIE FEES VALUATION FEE � <br /> ❑YES Il NO <br /> 7YPEOFCANST, pGCUPFNCYOROIIP ND.OFDWELIINUVNIIS BUILDING <br /> ALLOWABIE/AGTUAI <br /> PLUMBING <br /> SREOFOLDO. NO.OFSI0RIE5 0.5MT. OCGLOAD <br /> ❑v MECHANICAL <br /> O N <br /> IIEIGIITLIMITAiION QTHER <br /> FIPE51'RINNLERSREOUIRED o vEs ❑No �TATE BUILDING SURCHARGE <br /> SfATE ENERGYSURCHARGE � <br /> AP('LIC�LION�CGBY MANSAPPR.BV <br /> PUBLIC WORNS <br /> TOTAL <br />