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�im� <br />A��x <br />p H <br />9H[n <br />r� <br />�H� <br />"�fJ H '�tl <br />V1 H <br />�O� <br />OH� <br />Hr g <br />(�]Y �i <br />9H�4 <br />t HH <br />g�' <br />H <br />C] C7 N <br />��M <br />H O V� <br />.��, �,,.,,,,.,,,, <br />OTY O� <br />everett <br />BUILDING DEPARTMENT <br />259�8810 <br />AF�PLIC�4ilON FOF� COPISTRI,.oil�ly <br />PERMli' <br />TO 8E COMPLETED IN INK— PLEASE PRINT <br />'. ' I�.r'!i♦ "_ _. _ "— _--'. Pr�OGE __.___ . <br />-� � "����� MAllA0DRE55 ... _ � C:iv �I� <br />ri::;n <br />AqC�uiEGIORDES�GN[R MALLPO�RESS CItV ZiP PRONE <br />�� ci.v ziP rnon[ ucer�sc . <br />GENERALCONiRNGiOR AIAILPODPE55 <br />� _ •.' � / '1 F- ^ cirr Z�� PHONE LICENSG • <br />n�EG1iA iLPLGONinPG*OG— MA�LADOPE55 <br />1'LUM�iNGCONiF�GTOR '.IPIIADDNE55 <br />, <br />.-. . , ^.i _ %�1� / .Ii.IN�II� ' ♦ U ��'1�7 i[�-�� <br />��yt! � � � 41�-- <br />PIIONE UCENSE. <br />, y. ...,.... _ , _ <br />NEW ❑ ADCITION ❑ ALTCPATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVElFRPLINSERT ❑ OUILDIN6RELOCATION <br />W NTPAGT PR:CE �F WORK <br />l0i BLOGe OF <br />- 11=�1� 1- <br />PPOJ[GiADORE55 <br />I �,-�`� c�) I�'��,�r�rlr I/��Zt„� !J,� <br />PLUMBING <br />Np, TYPE OF FIXTURE OH ITEM <br />/ " WATERCLOSET�TOILETI _ __. __ <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DFAIN <br />BPCKFLOW PREVENTERS <br />ROOF DRAINS- �A�NLEADI <br />SINN ISERVICE - BAR. ETC I <br />SUBTOIAL S <br />PERMIT 3 <br />TOTAL FEE 5 <br />iY <br />❑N <br />IiqE4pRiNnLFR5RE0UIRE0 I]YES IJNO <br />F��„l'.:.PiION ACC O\ �I {'L�NS AI`ffl qY —� <br />I HEREBY CERiIFV THAT I HAVE READ AND E%AtdINEDTHIS APPUCATION tiND <br />KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAW S AND <br />ORDINANC[5 GOVERVING THIS TVPE OF WORK WILL BE COMFLETED W�TH <br />\NNETHER SPECIFIED HEREIN OR NOT.1H E GRnNT ING OF A PERMIi DOES NOi <br />PRESUWE TO GIVE AUTHORIN TO VIOLA7 E OR CANCEL TH[ PROVISIONS OF <br />— ANYOTNERSTATEORLOCALLAWREfiU�ATINGCONSTRUCTIONORTHEPER� <br />FOF1dANCE OF CONSTFUC110N. TMAT I AM AUTHORIZED BY Ti�E OWNER OP <br />THIS PROPERN TO FERFORtd 1HE WORK POR W MICtI APPUC�1T10N IS MADE <br />— AND I COMPLY V✓ITH THE STATE GONTqAGTORS LAV✓ 1827 RCW AND <br />296200 WAC. <br />SiGNAiUPEOfCONiR�LiO���V���T�ORIZEDAGENi D>iL <br />T , <br />X �, , _ , , .,��.,}�- � <br />- �w�. ��_L_ _: - -- <br />A['Cl'C� .�~��I V':'JS NLSS LIGCN:aL NO ANO �llciNESti NAl.1_ <br />MECMANICAI <br />FEE NO. TYAE OFEOUIPMENT <br />_i� �:�� _ A/C-A/HNJLGUNITS_ HP_ _ <br />- �J.' FOPCEO AIH SYSTE�dS - B T U. M flA <br />1.I'_ __ — _ <br />� (`j`i UNITHEATERS-BT.U_M <br />� �/ CL0IHES �RYERS <br />VENTILATION FAN <br />--� '� RANGEHOnO _' ____ <br />WATER HEATER _ <br />;. YLS '; NO <br />METAL FIREPLACE 8 <br />FIREPLACEINSERT <br />HEAT PUMP <br />GAS PIPING <br />FXNAlISi FAN <br />FEE <br />-- -- SUBTOTAL S __ __ <br />_..__ —.-_'— _—_ PERMIT _ -.___ 5 _ _. <br />"-- - ---- �- — ���TOTAIFEE �- 5 ---- �� <br />PLFNCNEL1lNUM0E11 FEE REC[IPTNO. <br />FEES <br />oui�owc <br />PLUMBING <br />MECHANICAL <br />OTMEF <br />STATE BUILOING SURCHARGE <br />STATE ENERGV SURCh1ARG[ <br />PUdLIC WORKS <br />rora� <br />� �, r I; ,_ <br />