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APPLI�►TION FOR CONSTfi.�CTION <br />PERMIT <br />IhaEveryreen L°����� ` <br />; CITY OF � <br />; everett <br />� BUILUING DEPARTMENT TO BF COINPLETED IN INK- PLEASE PRINT <br />i 259•8810 <br />OWNEfl �/ MAIL�O�RE55 G1Y ZIP PIION[ <br />� �ECE R��%7.Qr �M t9 N � 0� l�Jo�(pra Z M��� ��4 (/JA -�S-9-L�ZZ <br />� IEN�NT M�IL�DDf1E5S CIIY L� PNONE <br />L°fFAft��� GDG�NDG��� �,7/9 L���-��Z��I��I��k.�67-M51lL_=Y�.�7a_�3-/6: <br />' ARGNIIEGTOROESIGNER AI�IL�DDRE55 � LItY ZIP P110NE <br />.�.-.��o � �.,��..nw� 7✓a/1_-/„/�T�'�_o ALIFAlF 1�0_-L�4k/,.[,Z.,—M51!L�o�MPP137n1� <br />, <br />'!M�ILAODBE55 CIIY 21P PNONE 4CENSE• <br />� MEGNI,NIULGONiMGi011 <br />'� ,,,. �1�.-�.i (�Luti�Rl�� L9Kc=.��L-�I�DJS <br />��� GIIY Zlv PMONE LIGENSE • <br />\ <br />PW—M�INOCONTR�GIOR M�ILAOURE55 <br />{ <br />�I CUSSOFV�ORN <br />QQ NEW ❑ ADOITION ❑ ALiERATION ❑ R[PAIR ❑ DEMOLITION ❑ WOODSiOVE/FRPL.INSeRT ❑ BUiLDINGRELOCATION <br />� iENANi1MPROVEMENiOBIMERIOyRREAIO�EGLONI• � LON1eGiPER50NANOP��ONENO. <br />' CONtR�CT PRICE OF 1VORK yf� � `_ �O � �� � ��� _ �, " —� � � <br />DE9CR19EWORN�Np50UAPEF001A0EINVOLVd� � <br />t,. . _ . _ n_ ..i <br />' ,i��IPk <br />� L O DESG^ 1'il0 P OPEHtVI5110WN�ELOWO0AT1 <br />, IOT� BLOCN_� OF Tl�t" <br />'. '� 1 l�� IV. <br />�. � � ���!- <br />PROJECT�DORE59 <br />�103 �� i� �-'� <br />�� PLUMBING <br />NO. TYPEOFFIxNREORITEM <br />WAiER CLOSET (TOILET) <br />� BATHTUB <br />LAVATORY (WASH BASIN) <br />� SHOWER <br />� Z KITCHENSINK8015P. <br />ORAIN <br />,23 ` 20' <br />USEZON^E <br />1 `�P� <br />, ttPEOF WNSi. . � 1 <br />♦��pW�BL ACTURL N <br />512EOF ;'�V� . <br />' FIRE4PRINNLER9AEOUIREO <br />SUBTOTAL <br />PERMIT <br />TOTAL FEE <br />ISETBP�K � <br />�,'o � 2.d <br />1NEA � �� <br />K �� [ <br />�,1PAN�GROU� <br />c2 <br />ON <br />FEE <br />C„ � S�i� <br />:nr�tsire <br />VES ❑ NO <br />I OF 01YELlINO UNI15 <br />� � <br />G LOA� <br />�� <br />� HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICFTION AND <br />KNOW tli E SAME TO 6E T17UE AND CORRECT. ALL PROVISIONS OF I.AWS ANO <br />ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLETED W�711 <br />\VMETHER SPECIFIED HEREIN OR NOT.THE GRANTING OF A PERMIT DOES NOT <br />PRESUME TO GIVE AUTHORITV 70 VIOLA7E OR CANCEL iHE PROVISIONS OF <br />ANY OTHER 57ATE OR LOCAL LnW REGULATING CONSTRUCTION OR THE PEP• <br />FORMANCE OF CONSTFUCTION. THAT I AM AUTHORIZED BY THE OWNER OF <br />AND PROOMPIYTW iHR7�E STATE GONTRAC�ORSHLAWL182T7ORCWMAND <br />296200 W4C. ^ (7 fj <br />SIGNANAEOFCONIDnC10ROen11t1�OnIZEOPGENi O�TE � py �� p / <br />X dz -.'r 7-�->-,-,-..J oa / oQs <br />�P CRNi5CI1V0USINES ICR�SEM1OANDBUSMCSSNnME <br />EaEr_s-ct.- e;�-� �;��v�C �-7 <br />MECHANICAL <br />�NO. — <br />I N(:—i <br />VENiILATION <br />RANGEHOO[ <br />WOOU STOVE <br />METAL FIHEPL <br />FIREPLACEIN <br />HEAT PUMP <br />GAS PIPINIi <br />F%HAlIST FAN <br />i Urvl��— n.r. <br />f5TEM5— B.T.U. M EA <br />— &T.U. M <br />SUB TOTAL � lC lL <br />PLFih11T $ <br />TOTAL FEE S <br />FENE,I � PECEPTN . � <br />/D� � <br />vei uennN FEE <br />BUILDING <br />PI.UMBIIJG <br />MECHANICAL <br />O7HER `/��' I/1 V � <br />f. CL.l.� <br />STA7E BUILDING SURCHARGE <br />STATE ENERGY SURCIiARGE <br />PUBUC WORKS <br />TOTAL <br />r <br />