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APPLIC�.fION FOR CONSTRI+�:TION <br /> PERMIT <br /> fhe Fveryreen �q�prcll <br /> CITY OF <br /> everett � <br /> BUILDIN3 DEP�.aTMENT . <br /> 259-BB�O TO BE COMPLETED IN INK— PLEASE PRINT <br /> pµryEq Auil�Don[55 c�1Y bP vNO��E • <br /> ( �1' .�i, �. i1 � � '4' � c�l�l< _ #.�� ( � I `( �_it� �� °. ,�,} �—;l �'�'( <br /> '�( '��1�, L lll1L� — <br /> TEN�NT AUI�ADD�E55 CIIY Z�> PNONE <br /> ♦RCNiIEGTOR0E5�GHFA M�RAppn[55 C�tY 2�P PNONE <br /> YATL'�Sf..SLl�-.'��;'_:_.�YLS�1.�11C <br /> GENEP�LCONiNACiON �Wl Of1N[55 C11V ZIP PMONE LIGENSE• <br /> 1G'.'.� c.�,a,me Vic:; Dr. <br /> Fvnrey�!.�l�l ^ �.�'� <br /> ME�M�NIGLCONiR4CTOR M�I �D RES CIiY 21P VPONE UCENSE� <br /> �5�.r:�:, ��,?rc��;�.:�:- ;;,,r� r��(r <br /> RVMBINGLONTR�CIOP MAllA0�AE55 GITY , ZIP PNON! I�CENSE• <br /> �`,r <br /> 1Lr� � �ll,i��_ (�;r1�� �—� 1` 1� � I�CrY� � �� !L( 11�( �l( it} f��l . �( �� �J '-��—�` c�l <br /> a�ss or wonn ' <br /> ❑ NEW ❑ AODITION `�' � ALTERA710N ❑ AEPAIR ❑ OEMOLITION ❑ WOODSTOVE/FRPL INSEfiT G BUILDING RELOCATION <br /> 1[N�Ni IMPPW EMENI OA��'TER'OR REMO�EI ONLY CONiFLT PERSpN�NO PIIONE NO <br /> ' V " J /� <br /> CONiR�CTFRICEOFN'pRK ���I��I7 I L\.l ` , ��'-� !!/I• )l� �l�!` _ <br /> DESCRIBE YIORN�Hp 50 W RE f001AGC INVOlVEO <br /> __J' lly�v(!i t `� �� l��t�'. ����.��-l.'•'L � 1'll� ��i Cl� ` � — <br /> cnovos[ouSEOFBwiou+G - IHEREBYCERTIFVTHAiIHAVEREADANDE%AMWEDTHISPPPLICATIONAND <br /> ;�..11�i1! `, '`i `�+ �ll� '�ll� � KNOWTMESAMET00ETRl1EANDCORRECT.ALLPROVISION50PLAWSAND <br /> � � " OR�INANCES GOVERNING THI$TVPE OF WORN WILL B.`COMPLETED W�TH <br /> IEG�L0�5LFiP1iOHU�PROVENiVISNOWNBELOWORRiRCMfOURCORE51 WHETHERSPEGFlEDHEREINORNOTTHEGRAN7INGOFpPERMITDOESNOT <br /> PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br /> lot B�OCK oF qNVOTHERSTATEORLOCALLAWPEGULATINGCONSTRUCTIONORTHEPER� <br /> FOA��PNCE OF C0�'S7RUCTION.THAT I AM AUTMOR12ED BV TME OWNER OF <br /> THIS PROPERTV TO f'E�FORM THE WORK FOR WHICH APPLICATION IS MADE <br /> AND I COMPLV W1T4 iHE STATE CONTRAC70RS LAW 1827 FiCW AND <br /> 296�00 WAC. <br /> S�cNA1uPEoiCOHrRAclOfi�.�u<uinonREOAG[Vi o�iE <br /> �� 1 ( <br /> �( { � l�. 1 ) . /. / <br /> FROJEGT ADORF55 pppLIGANiS O1Y BUSINE55 LICEHSE ND AND DUSINE55 NAME <br /> • 1!"—fl�� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR I?EM fEE NO. TYPE OF EOUIPMENT FEE <br /> IYATER CLOSETQOILET) WC—A/HNDLG UNITS—H.P. <br /> BATHTUB FORCED AIR$VSTEMS—B.T U.�,��rA EA <br /> LAVATOFV IW�H BASIN� UNIT HEATER$—B.T.U. M _ _ <br /> SHOWER CLOTHESDRYERS _ <br /> KITCHEN SINKB DISP. VENTILATION FAN _ _ <br /> DISHWASHER RANGE HOOD __ <br /> IAUNDRYTRAV I WATERHEATER ___. <br /> CLOTHES WASHER WOOD STOVE __ <br /> URINAL METAI FIREPLA(:E 8 CHIMNEY <br /> OFINKING FOUNTAIN � FIREPLACE INSERT _ <br /> FLOOR ORAIN HEA7 PUMP <br /> BA:.KFLOW PREVENTERS � GAS PIPING <br /> ROOF DRAINS—FAINLEADERS EXHAUST FAN _ <br /> SINK�SERVICE—BAR,ETC� . <br /> SUBTOTAL 5 SUBTOTAL 5 <br /> PE�.IAIT S PEFMIT 3 __ <br /> fOTALFEE 5 70TAlFEE 5 <br /> fRONISETdACN PEANSEf9AGK SIOESEIBALR PLANCNECKNUMBER FEE NECEIPiNO. <br /> usezo�r. IOT�P[A VAL�NTSITE FEES VALUATION FEE <br /> ❑YES ❑NO <br /> BUIIDING _ <br /> iVFEOfCqH51. OCCOPANCYGROUP NOOFOWELLINOUNITS <br /> eLLOweStEi�GTuet P�UMBING <br /> SIZEOFBLD6. NOAFSiORiES BSAIL OGGLO�O ` <br /> ❑� MECHANICAL <br /> G N <br /> HE�c�ruutt�non OTHER <br /> �iae srniH.�EAsn[ownEo ❑vEs a No STATE BUILDING SURCHARGE _ <br /> STATE ENEFGV SURGHARGE <br /> pP�l'C�'�ON�CC BY PLPNS�PPR BY PUBLIC WOflKS <br /> rora� <br />