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L'1 � � <br />ay <br />io�x <br />C H <br />9H[n <br />y <br />K n <br />H� <br />"�9 H'il <br />U1 N <br />H <br />� � <br />OH� <br />��g <br />G] r CCJ <br />9HL�1 <br />� <br />Hy <br />g�' <br />H <br />('� C7 U� <br />��� <br />H O �n <br />� <br />s� <br />��1 <br />,.,, <<�..�,�,,,, <br />a.v ov <br />everett <br />BUILDING DEPARTMENT <br />zss sa�o <br />,APPLICAiION FOR CONSTRI,..:7'ION <br />PERMI'� <br />TO 8E COMPLETED IN �NK — PLEASE PRINT <br />«�� <br />e <br />cra�i � rrn�� coou�ss �� � • . <br />ti(,da.��ur�'D �.,H�r,�.oui,� a� i4 U! 2G ��cli�,_G:.UEi2E�7 �8201�_�=5��9� _ <br />MFIL �ODRE55 ��� � VI O4f <br />ii�wvi <br />NUIV E. �,�� i�� vHONe <br />n�+.C��nELiOF0E51GNEA M�IL�ODflE55 <br />1110N E ucEr+s� -. - <br />dt'dnALGONTRAGiOR MNLAPDNC55 GITY ZIP PNONE <br />NO� � LIiY ZIP VNONE LICENS! . . <br />MlO1nN�G�IGONIP�.C10A MM�ADOPE55 <br />�C� GIIY ZIP PMONE UCCNSf. <br />vwMBINOLONiR�LtOR M4LAD�NES$ <br />�G�F _ <br />❑ NEW ❑ RDUIiION ❑ A�TERATION <br />1CNqN1 IMCROVEMENI OR M1ER�OF cFEMOOEI ONIY <br />iP LTPRCEOFWOPK '..�7JO0� �� <br />oesca�ee woen n�uo sau•ne roo*Aer: mooivro <br />RL'PLPGE L`XiSc�NG7D'�EHm <br />r��i5i1LLG � � ADD <br />l•soroseo use or euaoinn <br />l E G4L�CmiION OF PROPERtV ISNOWN BCLOW OF <br />LGi BLOCe OF � <br />❑ DEMOLITION ❑ WOOOSTOVE/FRPL.INSERT ❑ BUILDINGRELOCPTION _ <br />u:�NEc.%. iU.oVE � � ,�J .-.-___. <br />,sJf.12 �S6.L.L— Y <br />I H EREBY CEPTffV?HAT I HAVE READ AND EXAMINED THIS APPLICFTION ldJD <br />KN01Y'HE SAME TO BE TRUE AND CORRECT. ALL P(iOVISIONS OF lAVlS PN D <br />ORDINANCES GOVERNING THIS TYPL OF WOFK WILL BE COMPLETED WITH <br />An�cHfoUr+coc�[s WNETHHRSPLCIFlECHEPEINOPNO?.THLGRnNTINGOFAPERtdITDOE5N0T <br />PRESUME TO GNE AUTHORITY TO VIOLPIE OR C/ NCEL TH[ PRO'JISIONS OF <br />ANV OTHER STP.TE OR LOCAL LAW f7EGULATING CONSTRl1GTION OR TH E PER- <br />FORMANC[ Of CONSTRUCTION. iHAT I AM AUiHORIZEO �Y TME OWNER OF <br />iNIS PROPERTV TO PE�FORid THE WORK fOR 1YHILH AVP�ICATION IS MADE <br />— AND I COMPLY \VIT'� THE STAT[ CONTFACTORS l<Yd 1�2] RCW AND <br />Y9fi200 W4C. <br />s�cNaiuneorcorv*rmaor��,�.n�u�r,n¢ro>ccr�i � n<ii �_ <br />��`�II�I l �'It"rrl�ll(i <br />PLUMBING '- <br />JO. TYPE OF FI%TURE OR ITEM <br />� WATERCLOSET�TOILEn <br />BATHTUB _ <br />� LAVAIORVIWASHBASINI <br />SHOWER <br />KITCNEN SINKB DISP, <br />DISNWASHER <br />LAUNDR�TRAY <br />CLOTHES WASHER <br />URINAL <br />ORINKING FOUNTAIN <br />FLOOR DRAIN <br />84CKFLOW PREVENTERS <br />ROOF DRAINS— RNiNLEADERS <br />SINK ISERViCE — BAR. ETC I <br />SUBTOTAL 5 <br />PEFMIT 5 <br />- TnTAL FEE 5 <br />er <br />❑ YES <br />� <br />MECHANICAL <br />FEE N9. iYPEOFEOUIPMENT <br />NC— NHNOLG UNITS — HP. <br />fppCEO AIR SVSTEMS— BLU. �d EA <br />UNITHEATEPS—BTL. M <br />RANGEHOOD <br />WOOOSTOVE <br />METAL FIREPLACE 8 <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />E%HAUSTFAN <br />SUBTOTnL S <br />PERMIT 5 <br />TOTAL FEL `� <br />ves n eo <br />BUILDING <br />NOOFOWELLINOUNIiS -- —'— <br />PLUMBING <br />esMr. occ ioeo MECNANICAL <br />or <br />❑N <br />ee�GHiuMrt�nON OTHER <br />STATE BUILDING SURCHARGE <br />STATE ENERGY SURCH0.i�GE <br />� PUBLIC WORKS <br />TOTA� <br />FEE <br />