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APPLICATION F1�Ft CONSTRUCTION <br /> PERMlT <br /> Ihe Evxrgreon <br /> CI7V OF <br /> everett `�°1C1 <br /> BUILDING DEPARTMENT � <br /> 259-8810 TO BE COMPLETED IN INK— PLEASE PRINT <br /> OpWNER n' ����� AIL�83/ l�ue��R �-VcY �y+ Z����O/ 1'1101252 —�I�� <br /> LL��� �� /vl , <br /> 1[NANT MPIL�DUIlE55 CIIY IIP <br /> PIIONE <br /> `Yl//Jl ��jdj�F1-GE <br /> nnCIUtF.QO�UE5IGNER MeILnpORE55 �ilY IIP PIIONE <br /> ���5�'�,���, ,;, PO, Soxn53�� LYn�Nwoop _ 9�oy�� ���0��'17�- ?5�3�. _ <br /> �o�IG' BcCi�pcRs i�t/� 75/w �Nl�"E1� /�R �V, 9��03 353-2331 —�� <br /> I.IECIIAKICnIGONIRnCIOfi AInI�pDD�E55 CIiV 21P PIIONE LL^ENSF <br /> NOitIE so� l� gZ �53os <br /> fLU61pINGCON111AC100 AIAll�OURESS �Ily T.IP 191pNE LiCENSE• <br /> NONC <br /> cinssorxonrc — — --- <br /> � NEW ❑ AODI7ION G ALIERATION ❑ fiEPAlfi ❑ DEMOIITION ❑ 1YOODSIOVE/FRPL INSERT ❑ BUILOING REIOCATION <br /> 'ENFNtIMPpOVEMEN10l11Ni[RIORPE�IOOELONLY R1C ' �� COVIACLPERSONTFD�IICNENO — <br /> WNIMGit'NCEOfWORK //�{' p��� <br /> U[SGRIBEWO�HnND50U�R[fOp1AGEINVOLVED �-��Ty-V,� '-- — <br /> /1��N.L �'ToR�4-5E �460 !�`� <br /> nR01'OSEO USE OF Blllll)ING -- <br /> I HEREBY CEI7TIFY THAi I 1 inVE READ AND E%AMINED THIS APPLICATION AND <br /> KNOW 7HE SAME TO BE TRUE AND CORRECT.ALL PROVISIONS OF LAWS AND <br /> LEOAI DESCRIP(ION OF PRO�ERiY�5�10WN BElO\YOR RTI�GII l'OUR GOPIE51 ORDINANCES GOVERNING THIS TVPE OF WORK WILL BE COMVLETED WITH <br /> WHETHERSPECIFIED HEREINOR NOi.711EGRANTING OFAPERMIiDOES NOT <br /> PRESUME TO GIVEAUiHORIIY TO VIOLAlE OR CANCEL THE PROVISIONS OF <br /> to* e�ocK or ANYOTHERSTATEOfiLOCALLAWREGULATINGCONSTRUCTIONOR7HEPER� <br /> JJ FORMANCE OF CONS7f7UCilON.THAT I AM AUTHORIZED BV THE OWNER OF <br /> __�.O�I2���� I� � I� _/1 I UE .��_�_� THIS PROPERTY 70 PERFORM TFiE WORK FOR WHICH APPLICAiION IS MADE <br /> - AND I COMPLV WITFI TnE STATE CONIRACTORS LAW 1827 RCW AND <br /> /� // `, 1 ^ zss.zoo wnc. <br /> ��Y TU �✓ �/{ E�vD� 1 Q O� p/�R SIGNANt1EOfCON1R�qOnO11nU11tO�IZED�GENt OAIf <br /> ��o��'� ��^J � sNc�ffonriSL{ eRzu,�LY— X ���� �� �'-/� - 8� <br /> ISOO F—�7ST /Y(lrR�/V� vIEW ��� �r��IGANiSCIIYBU'l! SSLIC[NSENOANDAUSII�jISNAME <br /> � <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTUNE ON ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> _ WATERCLOSET�TOILEn JUO�� A/C—q/HNOLGUNITS—H.P. Q��� <br /> BATHTUB N �j FORCED AIR 5'/STEMS—B.T.U. M EA <br /> LAVATORY�WASHBASIN� /�� UNITHEAiERS—B.T.U. M <br /> _ S���WER O CLOTHESDRYEtiS <br /> KITCHEN SINK d DISP. Q� VENTILATION FAN <br /> _ DISHWASHER � 7�� RANGEHOOD <br /> LAUNDRYTliAY /�/D�II WATERHEATER <br /> CLOTHESWASHER ^�jV_ WOODS70VE <br /> _ UFiINAL NONE METAL FIREPLACE 8 CIIIMNEY � <br /> DRINKING FOUNTAIN NUNE FIREPLACE INSERT <br /> FLOOR DRAIN D � HtAT PUTA� <br /> :Z �ACKFIOW PREVENTERS GI1S PIPING <br /> ROOF DRAINS—RAINLEAOERS E%HAUST FAN '�-y-�� <br /> SINK�SEfiVICE—BAR,ETC.) ON �y ` <br /> SUBTOTAL S SU�TOTAL $ <br /> PERMIT $ PERMIT S <br /> TOTAL FEE g TOTAL FEE 5 <br /> fnONi5Et0�GN PE41i5ElpACN SI�[SEIBAGK PUNCHEC NUMBEN fEE � RECEIPTNO. <br /> 8� a,�.s�� �l y � G� <br /> usFzor+e wranEn vncaH�sire FEES VALUATION FEE <br /> 111E5 O NO <br /> tYP[OfCpNSL OCCOPANCYCBOUP NOOfpIYELUNpUNRS BUILOING / Q a�_`_ _ <br /> ALlOWAOLE/ACiWL <br /> PLUMBING �y/oNE <br /> s¢E or oioo uo or sromes osnn. �cu iono I�D�E <br /> ❑v MECHANICAL _ _ _ _ _ <br /> o e� <br /> IIEiGMILIlAI�IiON OTHER <br /> ni�r srmNk�ens�eoumeo u res u e+o STATE BUILDING SURCHAt7GE <br /> STATE ENERGY SURCHARGE <br /> nnruc�noHncc.ov rinHsnrrn.ur —" — <br /> PUBLIC WORKS <br /> I�II, � TOTAL <br />