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;�;;'. ,t-1 F•7 <br /> APPLIC:�:iT10N FOR CONSTI�CTION f <br /> PERMIT � <br /> fM EnryrNn ' <br /> GTYOF <br /> e�erett <br /> everett e .� <br /> BUILDING DEPARTMENT <br /> 269�8810 TO BE Ct7MPLETED IN INK— PLEASE PRINT <br /> EF IMILADDRE55 CITY ilP PHONE ` <br /> �i�ur �� EC/_�oiT iZ�5S /1�.r�Sr. ��� 9�au/ 2��- �"��2 � � <br /> TENNIT MAII�D�RE59 GITY LIP PHONE � <br /> ARGNITE+ORDEBqNER MAILAOORF55 CITY ZIP - PMONE � <br /> OENE TRACTOP MML�ODFE55 CITY ZIP PMONE LICENSE• � <br /> ���r�-,i�ccr �l�sz/ !/,���� �i� �, �t��cu�o� `1 F�7-3i�1 ��3-�ss�P�az i�, <br /> MEC/NNM.�LCONTMCTOR MAILADDRE99 � CIT'.' ZIP FHONE �ICENBE• � <br /> PLUMMNOCANTMCTOP 1MIL�O�RE59 GITY 21P PNONE �IGENSE� <br /> •--• � <br /> QAM OF NOqK - <br /> 1 <br /> I <br /> NEW ❑ ADDITION ❑ ALTER�TION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPLINSERT ❑ BUILDINORELOC�TION <br /> N�Ni1M►IqVEMEHTOpINTEPIORREMODELONLY C /�I�, � CO�/j�)CiPER90N�NDPHO ENO � <br /> ODNTMCTMICl�O1FWMI( • �G ✓ �(/cNN15 I�' er�Kt 3�� r <br /> t�CG� �N / �t E�T(�OEINVOIVED � ^ <br /> L �� <br /> � f <br /> rM�WtDUlEOFMI�LDINO IHEREBYCERTIFVTHATIHAVEREADANDEKIIM�NEDTHISAPPLIGITIONAND �� <br /> �/rQ�G^(� KNOWTHESAMETOBETRUEANDCORRECT.ALLPROV1910N90fLAWSAND I� <br /> LEOAIDElCRIPfIJNO'PROPEpfY�eHOWNBEIOWOP R�CNFOUPCOPoE3� ORDINANCESOOVERNINOTHISTYPEOFWORKWILLBECAMPLETEDWIiH ;ry <br /> w'�y WMETHER SPECIFIED HEREIN OR NOT.THE GRANTINOOFA PERMITDOEB NOT <br /> �pTGl�Z7µp�K_ 23 ! oF PRESUMETOGIVEAUiHORIiVTOVIOLATEORCANCELTHEPROVISION90F �� <br /> ANY OTHER 9TATE OR LOCAL�AW REOULATINQ CqN9TRUCTiON OR TNE PER• r <br /> t,����I I/I S IO� � �� �j F FORMANCE OF CONSTRUCTION.THAT 1 AM AUTHORIZED BY THE OWNER OF I <br /> TH19 PpOPERiYTO PERFORM THE WORK FOR WHICH APPLICATION 19 MADE � <br /> AND I COMPLV WITM 7HE STATE CANTpACTOR3 WY 1827 RCW AND (: <br /> w �^ Q �U 2�p �1.�� K 288.200 WAC. <br /> Z I �y 61ON�TUREOFCONTMC70ROR�UiHCRREDAdENi OME 1'� <br /> `., <br /> -zt�'� 3 2�vo � X �____�_,�1�.-1�-,� �- t7-q� ,. <br /> �f���� �PPIIC�NT9 G7Y BUSINESS 4CEN9E NO.ANO BUSINESS NAME � <br /> �zl $ /til E_'ST �+.�t, `r �6Z[1 �; <br /> �LUM/INO MECHANICAI kt <br /> t <br /> N0. 7YPE OF FIXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE (+�� <br /> WATER CL09ET(TOILEn IVC-A/HNDLG UNITS-H.P. ;}� <br /> BATMnB FORCEDAIRSVSTEMS-&T.U. MEA �� <br /> LAVATORV�VYA9M8ASIN) UNITHEATEFiS-&T.U. M <br /> SHOWER CLOTHES DRYERS � <br /> KITCHEN 81NK 8 DISP. VEH�ILATION FAN �'. <br /> DI3HWABHER RANOE HOOD <br /> LAUNf RYTRAY WATERHEATER � <br /> CLOTHES WABHER WOOU STOVE G <br /> _ URINAL METALFIREPLACEBCHIMNEY � <br /> DRINKINO FOUNTAIN FIREPLACE INSERT �: <br /> FLOOR DRAIN HEAT PUMP �' <br /> 1� <br /> BACKFLOW PREVENTERB ppS PIPING �' <br /> ROOF DRAIN3-RAINLEADERB �XHAUSi FAN r� <br /> SINK(SERVICE-BAR ETC.) �;� <br /> I <br /> i <br /> - � ' <br /> SUBTOTAL S SUBTOTAL S r� <br /> PERMIT S PERMIT S �� <br /> � TOTAL FEE S TOTAL FEE S i� <br /> F�T�T�K PEAR6ETB�CK SI�ESETB/�CK PUNCMECK MBER FEE IIECFIRNO. �� <br /> � <br /> Zo z0� S ' d , � � 3S. ;, <br /> VSE20NE ��T�p� O YESTg�HO FEE9 VALUATION FEE {i, <br /> �`Z ��� � BUILD�NG �� <br /> TYVEOFCANBT. OGGURWGYOPOUP NO.OFDWEL4NOUNIT9 I O � <br /> KLOW�BLEIACiUA l� �l <br /> _��� ��I '� �T PLUMBING E,. <br /> &IEOFBLOQ NO.OFSTORIEB BSMf, OGQIO�D <br />. G7Z sF � �N N� MECHAN�CAL <br /> NEIQHiLIMIT�TION OTHER <br /> /s/ �. <br /> FIPEBPRItIKLERSPEOUIREO ❑YES NO STATEBUILDINCaSURCHARGE <br /> �, <br /> STATE ENEFGY SURCHARGE �� <br /> AiPLICATION ACG BY PLANS APPR BY � ��� <br /> I � PUBLIC WORKS _ � � <br /> �), <br /> TOTAL �� � '�' <br /> i: �I <br /> t' I <br /> �� � <br /> + " � o -- _ ' -ci �rr.�:�^r�..- - - -.•-�:---rw+- - - -n'--'+,+- - ` <br />