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pppLlt,.AT10N�FERR�C'T NSTAJCTION <br /> evcrelt <br /> fhe Ever9reen � <br /> CITY OF <br /> everett <br /> BUILDING�DEPARTMENT Tp dE COMPLETED IN INK— PLEASE PRINT <br /> 259•8810 <br /> cirr tir rrwr�c <br /> OWNEP n�nu eonness G(i��� <br /> A S 3 L - � � �l��.. li f/!" -�x- <br /> /V:ii,�� f dC e' e _-__. .___ - ruorve <br /> S r�� MARP��RE55 G1Y ZIP -- <br /> TEN�NT <br /> _____ __ __---__- __-___ —'___ -- <br /> APCNRECT OR DESIGNEN MML��10fi[SS <br /> --"----�-- QTY �-" 21P 1'l1ON[ <br /> GENEH�LCONTBACTON M�IVDOf1E55 <br /> CITY ---=1� PHONE IICENSE• <br /> ---- GIIY - ....-._-2��'---' �IIONE -"— IILENSE• <br /> MECM�NIC�LCONTR�CTOR MAILAOOBC55 �L I' J!�' !� � �R��•�f�l �4�r�Z�� /���� <br /> / 6 � <br /> �y'''�4��I' �dL ��, �1L.,J�D=1���6 :h.'C crtr nr — r�wr�e — uceNse. <br /> PLUMBINGCONiR�CTO M�IL�OOPE55 <br /> CLASS OF WORK <br /> ❑ NEW � AOOIT�ON ❑ PLTEFATION ❑ REPAIR ❑ DEIAOLITION coOACWORDOI�PNDPNONeNaSERT ❑ BUILDINGRELOCATION <br /> TEN�NTIMPflOVEMENTONINTERIOPPEM00ELONLY_/ <br /> pl! <br /> CANTR�GTPRIGEOFWORK ��v' — <br /> pESCR18E WORN 1ND SOU�RE FOOTAGE INVOLVE� <br /> n�.w-1 �"�e� �1wN f� C-n s _ — <br /> P09EDUSEOFBUIL iNo IHEREBYCERTIFVTHATIHAVEREADANDE%AMINEDTHISAPPLICATIONAND <br /> � KNOW THE SAME 1 O BE TRUE AND CORRECT.ALL PROVISIONS OF tAWS AND <br /> ORDINANCES GOVERNIhG THIS TVPE OF WORK WILL BE COMPLETED WITH <br /> lEOAL�ESCRIVTiONOFPROPEfltt15110WN9ElOWOPRIUGHFOUR60P1[51 WHETHERSPEGFI[DMEREINORNOT.7HEGRANTINGOFAPERMITDOESNOT <br /> PRESUME TO GIVE AUTHORIN TO VIOLATE OR CANCEL THE PROVISIONS OF <br /> iot e�ocK oF --------�----�-- ANYOINERSTATEORLOCALLAWREGULATINCCONSTRUCTIONORTHEPER- <br /> FORMANCE OF CONSTRUCTION.THAT I AM AUTMORIZED BY THE OWNER OF <br /> --- ANI�SPROOMP YTW THRTIOIEM TA EWCONTRAGTIORSML WL182T7�RCW AND <br /> 2�Jfi200 WAC. <br /> S�GNelUREO IBeGI:)uONAUIiIORIZLD�GENi D�IE <br /> XI{�� 14.L. -r �� 5 c� <br /> pR0.1EGT�ODRE55 <br /> . APPIICANLSCItYBU5MES5110ENSE �NDBUSINESSN�ME <br /> sa � � <br /> MECHANICAL <br /> Pl.UM81N0 FEE <br /> NO. T'PE OF FI%TURE OR ITEM FEE NO. TYPF_OF EOUIPMENT - — <br /> A/C-W�iNOLGUNITS-H.P. _ <br /> WATERCLOSETITOILEn __ __ -- - ---'— _ <br /> FORCED AIR SYSTEMS-B.T.U. M EA _ _ _ <br /> BATHTUB - ------�-� -'--- <br /> —-"-- �---- -�'�--- ---� -�- UNITHEATERS-BT.U. M <br /> LAVATORY(WASH BASIN) — CLOTHES DRYERS <br /> SMOWER - — VENTILATION E4N <br /> f KITCHENSINK6015P. — ppNGEHOOD <br /> �� OISHWASHER — - '--- _ <br /> WATER HEATER <br /> LAUNDRYTRAY � WOODSTOVE <br /> CLOTHES WASHER — METAL FIREPLACE 8 CHIMNEY — <br /> URINAL — FIREPLACEINSER7 <br /> DRINKING FOUNTAW ___- --- — — �1EAT PUMP — <br /> FLOOR ORAIN _ —_� GAS PIPING_ — <br /> BACKFLOW PREVENTERS _ --- — E%HAUST FAN - — <br /> ROOFDRAINS-RAINLEADERS __ — --- ---- <br /> SINFI�ERVICE-BAR.ETC) - ---- --�--�-"-�----�— ' — <br /> --- — SUB TOTAL s � <br /> -- SUBTOTAL $ __.-- — -- -----�-- PERMIT 5 �— <br /> PERMIT ___ $ __-- — "— --"--� TOTAL FEE E �^� <br /> TOTALFEE $ FEE PECEIPfNO. <br /> FRONTSETB�CK <br /> REARSEfO�CN SII1E5[TO�GN PUNCHECKNUMBER <br /> �--� VAGANi51T[ FEES VALUATION FEE <br /> USE 20NE LOT AREA ❑VES �l NO <br /> BUILDING _ — <br /> 7YPEOFCONST. OCCUPANCYGROUP NOOFOWELIINGUNITS — <br /> ALLOWABLE/AQWI PLUMBING <br /> SIZEOFBl00. NO.OFSTORIE9 BSMt. OCCtOAD MECHANICAL `���, — <br /> nv <br /> ❑ N <br /> HEiGMTLIM1TAilON OTHER -- <br /> FIRE SPRINNLENS REOIlINEO (1 YES O NO STATE BUILDING SURCHARGC' _� <br /> STATE ENERGY SURCHARGE <br /> ♦PPLIUt10NACCBY PIANS�PPROY PUBLICWORKS <br /> J _.- <br /> TOTAL �� <br />