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„„,. �.� <br />APPLIG.�+►TION FOR CONSTRJGTION <br />PERMIT <br />Ihe Everp�een i•��'u'll <br />CITY OF � <br />everett <br />BUII.DIN:a GcPARTMENT <br />259�8810 TC BE COMPLETED IN INK — PLEASE PRINT <br />UWNfR MMI�L`DRLiS O�Y J�P �NONF <br />��_tiSL�'7U � -Jr�;lori[1 .54-rJ-(t Pr�ii'f��;lrJ�: l;.� P1iJ�l'rSui�c/- �7��(. (r'�_`/� �r�n���_ <br />iCH�M M�ILADOPE�S C�IY I�P � 4v�ONC <br />�HCIIRECTOPOCSIGN[N MAIL�ODPE55 GIiY ZIV PNONE <br />•�ij Il'�l 7>�sic,� ���17— n9�1% <br />GENERALCANiF1GT00 MAllA0�RE55 GItY ZIP P��NE3pf�5/-(`/j�'���(��l <br />1i!/���r7H ('U TOrI P/�v�1F.S VvaG I�R2,r5/i7F.JIZ. /7N��YSVicu,= iQir�c �v.�"!— lc�nS� <br />___ ��.. vie PNONC UGENSC• <br />ti�,�� <br />hUMBIN�CONiRRCiOP MAILADORE53 CILY ZIP PNONE UCENS[� <br />1�'� 7�_q(�i lJ��r�( r� <br />CUS501'NtlPN <br />[� NE\Y ❑ ADDITION ❑ ALTERPTION ❑ REPAIR ❑ OEMOLITION ❑ WODDSiOVE/FRPLINSERT ❑ BUII.OINGRELOCATION <br />T[4�NiIMPPWEMENi09iNiEBiONREM00ELDNl, r� CANT�LTFERSOtIANOPHONENO. <br />r L <br />LOMMGTFFICEOFWORk �Y �.I � <br />PESCRIBEIVOPRANDSOU�REFIXJIAGEWVOWEO � <br />. . �_.. .. .- -�._ � . <br />� `� <br />C- <br />LOi `� BLOGN '� Of <br />/ i� o_� G. L l- <br />. j . . ��✓ � <br />N GF <br />.�--�. - s-!'t'E�� ��-'' __5 <br />OROICCiPDDR[SS <br />5330 �, �'nd A,rQ <br />PLUMBING <br />Np TYPEOFFI%TUfiEORITEM FEE <br />:/ WATERCLOSETITOILET) _. <br />O <br />% <br />KITCH[N SINK 8 DISP. <br />LAUNDRYTRAV <br />URINAL <br />FLOOR ORAIN <br />BACKPLOW PREVENTERS <br />ROOF DRAINS - RAINLEP <br />CIu V ICFO\II(`F — FGO FTI <br />SUBTOTAL 5 <br />PERMIT 5 <br />TOTALFEE 5 <br />fOaGM / flEFRSEiBAGN � SIOESElOALN <br />' /O y�- L o :; p�-/ <br />LOLAPE.� VACANLSIIE <br />M1 YCS :1 N0 <br />I� �l t �� <br />ONSL OCCUPANCYGROUP NOAf�WEtUt <br />.EIAGiU�� � � <br />.DG ��O O� SiOFIE OSML. �CG 1U�0 <br />ov <br />� Z.�� . . W H —' <br />NEiGNt LI1dItAi <br />VNLEPSPEOU�qED ❑YES �y.n0 <br />ONACLtlY PIANSNPPP.OY <br />�, <,._ ) <br />I HEREBV CERTffY?HAT I HAVE READ ANO EXAMINED THIS APPLICATION AND <br />KNO W THE SAME TO BE iRU E �NO COARECT. ALL PROVISIONS OF LAW 5 AND <br />ORDINANCES 60VERNING TNIS TVPF.OF WORK WILL BE COMPLETED WIiH <br />WHETHLRSPEQFlEDHEREINORNOT.TMEGRANTINGOFAPERMITDOESNOT <br />PRESUME TO GIVE AUTHOPIN TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTH[fl STATE CR LOC�L LAW REGULATING CONSTRUCTION OR 1HE PER- <br />FORMANCE OF CONSTRUCTION. TMAi I AM AUTHORIZEO BY THE OWNER OF <br />THIS PPOPERTY TO PE(7FOFM TME WOPK FOR W HICH APPLICATION IS b1ADE <br />AND 1 COMPLV WIT4 THE STATE CONTRACTORS LAW 1827 RCW AND <br />2D6200 WAC. <br />siGNPiuRtO�QovIIWciCrn::aUP�oPREOACENi oAiE /�' � L� <br />(� � C ( .' <br />Xp ,�,. , J <br />�'1������di.o r`�-,�c-t`�� <br />ppv�IC>NIS GI Y pU>�Nf55 U:.[NCE NO FYO OUS NE55 NAMF <br />MECHANILAL <br />TYPE OF EOUIPMEh <br />NC- A/HNDLG UNITS- H.P. <br />FORCED AIR SYSTEMS- B.T.U. M EA <br />UNITMEATERS-BTU. M <br />CLOTHESDRVERS <br />VENTILATION FAN <br />RA�GENOOD <br />WATER HEATER <br />WOODSTOVE <br />h/EiAL PIREPLACE 8 CMIMNEV <br />FlFEPLACEINSCRT <br />MEATPUMP <br />GAS PIPING <br />E%HAUST F/ <br />PERAIIT <br />TOTAI FEE <br />;NNUMBEN !EE ' <br />1 �• <br />. I.'�"� ;�� _ <br />FEES VALUATION <br />BUILDING <br />PLUMBING <br />MECMANICAL <br />OTHER <br />STATE BUILDING SURCHARGE <br />STATEENERGYSURCHARGE <br />PUBLIC WORKS <br />rora� <br />r �- <br />FEE <br />� V �.U- <br />— . (u5S 7l <br />� <br />