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� ('''� �-�). <br /> APPLICATION FOR CONSTRULTION <br /> PERMIT <br /> 1��Erorpnen <br /> CITY OF everett <br /> ev�;rett e <br /> BUILDING DEPARTMENT <br /> 269-BBto r I_ TO BE C MP ET D IN INKr— PLEA�/SE PRINT (� <br /> �`��_" .l�r e I�1� Ic .2� `.ZQi �e���.��� �Fl�"��f� ?9.2C�iI z� � 1 ��� <br /> p � M�ILAOORE55 GifY 21P PHONE <br /> iEN�N1 M�'��ODR[55 CItY ZIP Al10NE <br /> 11pLMITECiOR0E510NEN M�ILAODRE53 C�IY IiP PIIONE <br /> �Rc� s�Rv�cc� �030 �o�fw p,� sc �uF�Q�- 4szr.� 3s�S-4pG <br /> dEHEMLCONTR�CTOA MAILAO�nf55 CIIY 21n PMONE LILENSE• <br /> pQ�O 5� � 12 I C� <br /> MEGN�NIG�LGONiH�L10R M�ILROpRE55 Cliv ZIP PHONE IiGENSEG— <br /> �IUM&NOGONiR�GtOP M�IL�DORE55 CItY 21P P110NE I�LENSE• <br /> bu�93OF N JNN <br /> � NEW ❑ ADDITION �' A�TERATION �FEPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL INSERi ❑ BUILDING RELOCATION <br /> TENANTIMPIqVEMENIOPMTEN1pqRRE ODELONLY (�� CONI�GiPER50N�NpPNONENO <br /> CONTIUCT WIiCEOi WORK ��/�'��Z�!`LY ��OOO r O� <br /> pElCRIlE WONI(�ND 90U�RE fOOTAOE(��NVOIVED <br /> S hCe,'{-ro�� R �1i v�<x � �'�o r✓1S�V�� I _ <br /> waroa[o�ee or waon+o I HEREBY CERTIFY THAT I HAVE REAO AND E%AMINED THI$APPLICATI()N AND <br /> S���Ie -��� `v � KNOWTHESAMETOBETRUEANDCORRECT.ALLPROVISION90FLAV�SAND <br /> LEMLDEBCA�P FIUJPERTVISNpWNBEOWORATT�CNfOU�GOfaES� ORDINANCESGOVERNINQTMIS7VPEOFWORKWILLBECOMPLETEGWITH <br /> W HETHER SPECIFIED HEREIN OP NOT.THE aRANTIN60FA PERMITDOES�r0? <br /> PRESUME TO GWE AUTHORITV TO VIOLATE OR CANOEL THE PROVISIONS OP <br /> LOT B�ocn or -- ANYOTHERStATEORLOCALIAWREGULATINOCON3TRUCTIONOPiHEPER� <br /> FORMANCE OF CONSTRUCTIOII.THAT 1 AM AUTMORIZED BY 7HE OWNER OF <br /> THIS PROPER7V TO PERFORM 7HE WOPK FOR WHICH APPLICATION IB MADE <br /> AND 1 COMPLV W�TH THE STATE CONTRACTORS LNN 1827 RCW AND <br /> 298.20�WAC. <br /> 510N�ilIREOFCONIR�C�Of101a�U���OR12ED�aENT D�TE <br /> ►IqJEGT�'JDRE93 �pp��pfY USIH.59�NSENOA 0 USINESSN�ME � <br /> `�� 2� e r , uP . a �C v �. - <br /> M.UMSINO MECM�NICAL <br /> Np. TYPE OF FIXTURE OR ITEM FEE NO. 7YPE O�EOUIPMENT FEE <br /> WATER CLOSET(TOILEn A/C-A/HNDLG UNITS-H.P. <br /> BATHTUB FORCED AIR SYSTEMS-&T.U. M EA <br /> LAVATORYIWASH BASIN� UNIT HEATERS-&T.U. M <br /> SHOWcR CLOTHES�RVERS <br /> KITCMEN SINK6 DISP. VENTILATION FAN � <br /> DISMWA9MER RANGE HOOD <br /> UUNDRY TRAY WATER HEATER <br /> CL.'1THES WASHER WO00 SiOVE <br /> UPINAL METAL FIpEPLACE 8 CHIMNEV <br /> DRINKING FOUNTAIN FIREPLACE INSERT <br /> FLOOR DRAIN HEAT PUMP <br /> BACKfLOW PREVENTERS GAS PIPING <br /> ROOF DRAINS-RAINLEADERS EXHAUST FAN <br /> SINK�SERVICE-BAFy ETC.) <br /> SUBTOTAL 5 SUBTOTAL S <br /> PERMIT S PER!.11T S <br /> TOTAL FEE E TOTAL FEE S <br /> FIqNTBET&1CK f1EAqSETB�CR SIOESEtBALY. P�ANCNECI(NUMpEH FEE RECEIFTNO. <br /> U6EzoHE ioi�n� V�G�NTSIiE FEES VALUATION FEE <br /> ❑ YES l]NO <br /> TYPEOFCANST. OGCUPANGYOflOUP NOOfDWELLINGUNIIS BUILDING _ <br /> ALLOWABLF1ACTueL PLUMBING <br /> &ZEOFBLDO. NO.OF&LORIES BSMC OCCLO�D <br /> ❑r MECHANICAL <br /> an — <br /> MEIG111LIMIlAiION OiHER <br /> FIRE9PPINNLERSREOUIRE� ❑YES O NO STATF BUIIDING SURCHARGE <br /> SiATE ENE(iGY SURCIIARGE <br /> �PPLIG�TION�CGBY PLAN9�PPRBV <br /> PUBLIC WOPKS <br /> TOTAL <br />