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the Erorpreen <br />CITV OF <br />everett <br />BUILDING DEPARTMENT <br />259-8810 <br />APPLICATIOPI FOR CONSTRI�.�TION <br />PERMIT <br />TO BE COMPLETED IN INK— PLEASE PRINT <br />1M1IlPFCC �i1LY ZIP <br />tLL w,9LKc��'� 2�oi rJ�.uu z- <br />NT M�IL RODRE55 <br />� <br />everett <br />e <br />7�- ����o� <br />PLUM&NOCANTP�CTOR M�IL�OONE55 GITY ZIP PHONE LICENSE• <br />CLA9S WJPK <br />NEW ❑ ADD�TION ❑ ALTERATION ❑ REPAIR ❑ OEMOLITION ❑��VOODSTOVc/FRPL INSERT ❑ BUILOING RELOCATION <br />IENIJITIMPROVEMENTORIN I RRE��,,�\/pOEIONLV CONi�LiPENairvnNDPHONENO /�j� � <br />CANTMCTPRICEOFWOP'< Lf��A../ Il% C''�}� �U���I S ���(� <br />DESCRIBEWORK�NO�i 19 FOOT� INYOIVE� / <br />�`��T /�cC�rc'- � G„ii ," Et L �j- / S S �� — <br />�seo eeor uaoir+o� IHEREBVCERTIFYTHATIHAVEREADANDE%AMINEDTHISAPPLICATIONAND <br />t ,,,� KNOWTHCSAMETOBETRUEANDCORRECT.ALLPROVISIONSOFLAWSAND <br />LEIULDESCNiPTiONOFPHOPEP ISMO'NNOELOWORRTt�CHFOURCOPIES� ORDINANCESGOVFRNINGTHISNPEOFWORKWILLBECOMPLETEDWITH <br />W HETHER SPECIFIED HEREIN OR NOT.THE GRANTING OF q PERMIT DOES NOT <br />PRESUME TO GIVE AUTHORITV TO VIOLATE OR CANCEL THE PROVISIONS Oi <br />�oT B�ocK or ANVOTHERSTATEORLOCALLAWREGULATINGCONSTRUCTIONORTHEPER- <br />I'� FORMANCE OF CONSTRUCTION. THAT I AM AUiHORIZE� BV THE OWNER OF <br />� 1 R'rCI^i- ��i C-.% 12 S I 5T �`�� •�� THIS PROPERTYTO PERFORM THE WORK FOR WHICH APPLICATION IS MADE <br />�/ AND I COMPLY WITH THE STATE CONTRACTORS LAW 18.27 CW ANU <br />�VtJ�-� { w�C_dCJ� I.�-QQ /�J�� 0 296200WAG �� <br />` SIGNPiUREOFCONTRAGTORORRVLNOR123DRGENTan Dl�if ^ � <br />/I <br />�- �L'.�� /� � -- � � <br />Ad/ <br />PR0.1ECf�UDRE55 <br />z����/fil,��� �. <br />xuMeiNa <br />-Np, � TVPE OF FUITURE OR ITEM FEE <br />I WATERCLOSET?^ILET) � <br />SINK 6 DISP. <br />DRINKINO <br />FLOOR DR <br />BACKFLOV <br />ROOF DRP <br />FIRE SPRINNLERS HEOUIPED <br />G <br />/ <br />- RAINLEADERS <br />TOTAL FEE <br />R SEfBACK <br />O� <br />�RE� 7 <br />��,/��L=� �� <br />:UP�NCYGROOP <br />OFSTORiES BSM <br />� iCr <br />N <br />5 �li NO <br />S <br />�,� �-�� ���.�, <br />MECMANICAL <br />NO. TVPEOFEOUIPI <br />A/C - A/HNDLG UNITS - H.F <br />FORCED AIR SYSTEMB - 0.T <br />IINITHEATERS-�T.11. A1 <br />WATER HEATER <br />WOOD STOVE <br />METAL FIREPLACE 8 <br />FIREFLACEINSER7 <br />HEAT PUMP <br />GAS PIPING <br />E%HAUSTFAN <br />SUB <br />,j �e%/(�� 25r� .� %L= %.� <br />vnc�nrsrt FEES <br />� ❑ YES � NO <br />BUILDING <br />NO. Of DWELLING UNI15 <br />,�'� PLUMBING <br />OCG LOAD <br />A MECHhNICAL <br />MEIGNTLMI iION OTHER <br />? STATE BUILDING SURCHARGE <br />STATEENERGVSURCHARGE <br />�PUBLIC WORKS _ <br />3 TOTAL <br />V. <br />FEE <br />M EA <br />S <br />S <br />5 <br />nccr�� No. <br />/.� .� ���a/ <br />