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- APPLIC�f1dN FOR CONSTRI..�.:T10I�! <br />PERMIT <br />' IA� Ewrpreen <br />CI7Y OF <br />�, everett <br />BUILDING DEPARTM[NT <br />i 259•881� <br />i <br />c <br />TO BE COMPLETED IN INK— PLEASE PRINT <br />�coa[ss r ' crtr z�r <br />�n-�f /%�% 1/1/'4����9 �%L _ <br />cve�ett <br />� <br />MICHRECTORDE3�ONER APIL�DDHESS ���Y Z�P P����� <br />OkNEMIGONiR�CTOR MAILADDRESS G1Y . ZIP PNONE LIGGN5E• <br />r <br />❑ NEW V^O AODITION ❑ ALTERAiION ❑ PEPAIR ❑ OEMOUiION co0^cWOHDONaNu/rroH� OSERT ❑ BUILDINORELOG4TION <br />TENNIT IMPPWEMEKI OR INi[RIOR PEMOOEL ONIY <br />�ONTPI�LT PPILE Oi WORK _ — <br />pElCpIKMORFI.NDBOU�AEF001�0EIHVOIVED � � � <br />aS' PF G�s R ae <br />PROVOSED USE OF OUiLD�NO 1 HEREBV CERT�FY THAT I HAVE READ AND E%AMINED TMIS APPLICA710N AND <br />�1 � /7 /+ / KNOWTMESAMETOBEIRUEANDCORREC7.ALLPROVISION90�WNSAND <br />LOT BIOGK—_ OF <br />i — <br />I — <br />i <br />� maee* �ooness <br />� � �-�a� � <br />; <br />� ►WM�INO � <br />ryp, TVPE Of <br />WATER CLOSET (TI <br />j &1THTUB <br />;I LAVATONY(WA3M1 <br />9HOWER <br />KITCMEN SINK 6 0 <br />CLOTHES <br />URINAL <br />DRAINS — <br />ccavir.c — <br />ORD�NANCES GOVERNING THIS NPE OF WORK WILL BE COMPLETEO W�TF� <br />N'HETH[R SPECIFIED NEREIN OR NOT. THEGFANTING OF A PERMIT DOES NCT <br />PRESUME i0 GNE AU7HORI7V TO VIULATE OR CANCEL fHE Pf10N$IONS OF <br />ANYOTHER STAT40R I.00AL LAW REGULA7INCGONSTRUC110N OR THE PER� <br />FORMANCE OF CGNSTRUCTION. TMAT 1 FM 4UTHORIZED BYTHE OWNER OF <br />THIS PROPERTV TO PERFORM THE WORK FOR W IiICH AVPLIGATION 19 MADE <br />AND I COMPLY WRH iHE STATE CONTRACTORS LAW 1B27 RCW ANO <br />296200 WAC <br />SIGN�ruR[orcONiRAC10110neutMon�EEOAGENr oAtE <br />� �ch _1ccC'�1_l l.vu !�Y^ !.1 �� P� I�� C <br />•PPUCANIO CItY BUSINE55 LICCNSE NO. �NO OlI51N[99 NGME <br />MECHANICAL <br />ITEM FEE NO. TYPEOFEOUIPMENT <br />NC—NHNDLO UNITS—N.P. <br />FORCED AIR SYSTEMS— B.T.U. M EA <br />UNIiHEATERS—B.T.U. M <br />CLOiHES DPYER:� <br />VENTILATION FAN <br />RANGEHOO� <br />= WATER NEATER <br />WOO� STOVE <br />ME fAL FIREPLACE 8 CHIMNEV <br />FIREPLACLINSERT <br />HEAT PUMP <br />FIPI <br />EhHAUSTFAN ____ <br />SUBTOTAL E <br />PERMIT 5 <br />TOTAL FEE � <br />❑r <br />❑ N <br />nED ❑ YE9 O ND <br />FEE <br />veceHisit� FEES VALUATIGN <br />❑ vE6 ❑ NO <br />BUILDING <br />�'OOFDWFI�INOUk118 �- --- <br />PLUMBING <br />occ.w�o MECHAtJICAL <br />��— T` L <br />NE�OMiLIMITAIION OTHER •1�-� �A\ <br />STATE BUILOING SURCHARGE <br />STATE ENERGY SURCIiAr�GE <br />PUBLIC WOFKS <br />, TOTAL <br />