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I <br /> �1PPLIC�.�ION FOR CONSTRI,�.TION <br /> PERMIT <br /> I�e Crnrqrnon rvru�il <br /> QTV OF � <br /> everett <br /> BI�ILDING DEPARTMENT • <br /> 259�eAt0 TO BE COMPLETED IN INK— PLEASE PRINT <br /> ow/Nca n Man�ooecss cnr zu� r�our. <br /> c�� �y' ---/'�'t/Snn Z/I- L: U�e.,i /1�!r vi C✓i�t�9 —2'Y+~�4• 8"G <br /> TI'H�Ni� <br /> MMl�00AE55 LIIY ZiP PIIONI <br /> ♦RGMrtEGI OR DES�GNER M�R e0pRE55 CrtY ZiP PMOHE <br /> GENEF�LWViR�GTOA M�II�ODR[54 CiIY ZIP P�ONE L�CENSE• <br /> MECN�NIGLCONjR�GTOR M�RApORE55 GIIY ZIV CHOH[ ULFNSE• <br /> ,V,,n,l��t � liu,E-L��,G� 3//0-f�l s Sr 6✓.���'f 4l S�l�/ 1c�-i3f/ N�-71��,4 /i•�C/ <br /> PIUMBINGCONiN�QCR MALADORCSS CIiY 2P V ONE L�CENSE� <br /> Ll/SSOF WORn <br /> ❑ NEW ❑ AODITION � ALTERATION ❑ FEPAIR ❑ DEMOIITION ❑ WOODSTOVEr'FRPL INSERT ❑ BUIIDING RELOCATION <br /> T[N W i IM�POJEMENT OR INIERiOP pEMOOCL ONLY CONL�LL PEASON 1N0 PNONE N0. <br /> CONTR�f.T VRICE OF WOAK . <br /> DESCPiOE WOA��H��WRE�OO��GE INVOI+ED <br /> � �r � r F��,, ' ��lt <br /> �.���,.� �, - <br /> �vrroaoaEDus[o�Hu�� wG iHEREBYCERTIFYTHATIHAVEiiEADANDE%AIdINEDTMISAPPUCATIONAIJD <br /> S �? KNOWTHESAMETOD[TFUEANDCOFF7ECT.ALLPROVISION� )FIAW$AND <br /> �/< OR�INANCES GOVERNING THIS TVPE OF WORH wlLl BE COMP�ETED WITH <br /> LEG�LOESCFIFIIOHO��OPEAn'ISNOWNBELOWOR�TfACN.`OI1RC0%E57 WHETNERSPECiFlEDHEREINOANOT.THEGRANTINGOFAPEFMITDOE5N0T <br /> PRESUME 10GIVE AUTHORIN TO VIOIATE OR CANCCL THE PROVISIONS OF <br /> �pr g.pCK OF ANYOTHERSTATEORLOC�LLAWFEGULATINGCDNSTRUCTIONORTHEPEA� <br /> FOAMANC[OF CONSTfiUCTION.TMAT I AM AUTHOR'2ED DV THE OWNER OF <br /> TMIS PNOP[RTY TO PERFORM THE WORK FOR WMICM APPLICATION IS MADE <br /> AND I COMFLY WITN THE STA7E CONTRACTOP.S LAW 1027 RCW �ND <br /> 296200 WAC. <br /> StGNaNREOf iRACiJ40FAViNOAR[O�GENi OATE <br /> X I �u,�.�.w �= �Y�S _ <br /> �PROJEGT�DDRE55 A�'FLICANiSCItYBUSiNESSLILENSEN AN( OUSINESSN�ME oY <br /> z r, � �;� ai �-4., �� u.,t�. w� 1 wa .�, o2d/ <br /> PLUMBING MFCHANICAL <br /> NO. TYPE OF FiXNRE OR ITEM FEG NO. TYPE OF EOUIPMENT FEE <br /> WATER ClOSET ITOILE� A/C—lVNtlDL(i U NITS—H.P. _ <br /> BATMTUB FORC.D AIR SYSTEM$—B.T.U. M EA _ <br /> LAWTORY 0'�'ASH BASIM UNI7 HEATERS�—B.T.U. M <br /> SHO�'✓ER CLO7HES ORVEPS -- <br /> KITCHEN SINK 8 DISP. VENTILATiON(AN _ <br /> DISHWASHER RANGE HOOD <br /> LAUND�+YTRAV �-- WATE:iHEATER <br /> CLOTHES WASHEF _ _ WOOD STOVE <br /> UHINAL METAL FIRCPLACE 6 CHIMNEV <br /> ORINKING FOUNTAIN FIREPLACE INSERT _ <br /> FLOOR DRAIN HEAT PUM17P — <br /> BAGKFLOW PREVENTERS I GAS PIPING — <br /> ROOF DRAINS—�AINLEADERS EXHAUST FAN <br /> 51 NK(SERVICE—BAR.ETC� <br /> SUBTOTAL S SUBTOTAL S <br /> PERM17 S PERMIT g � <br /> TOTAL FEE 5 TOTAL FEE 5 <br /> fRONTSETB�CN RGRSEiB�IX SIOESETB�CK VIANCNEL6HUM9EN FEE <br /> PECEIPT N0. <br /> u5E2onE loreeEe VAGANTSITE FEES VALUATION FEE <br /> ❑YES ❑NO <br /> BUILDING <br /> iYFEOFfqN4T. GCCUP�MGYGROUP NOOFOWELLINOUNITS <br /> ALLOM�ABIE/�CTU�L P�UMBING <br /> sieEo�e�oa. �o.ovsroaies eSMr. oce�o�o MECHANICAL <br /> ❑Y - <br /> ❑N <br /> — neienruuir.nor+ OTHER <br /> nr�[5vert+��ERs P[OuiREo ❑vE9 C No STATE BUILDING SURCHARGE _ <br /> SiATE ENERGY SURCHARGE _ � <br /> nvviiG�nov�GC nr v�nr„Ecrq Bv P�BUC WORKS <br /> � <br /> � MTAL I <br />