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APPLICA. �ON FOR CONSTRU�. fil)N <br /> PERMIT <br /> I�o Evorpreen °'�� <br /> CITV OF <br /> ' everett e a <br /> BUILDING DEPARTMENT � <br /> 259-e8t0 TO BE COMPLETED IN INK— PLEASE PRINT � <br /> � <br /> owi�E rnni�Aooatss cn z�r vnav� I ' <br /> " �/ u,f ��3'/�,� J4,�, - zi� -/7�i % � <br /> /�r {��lr���,YF I J.2 7 /C t< c kC.t � e �_ - <br /> I.•ciLtiDDF65 CI1V 21P PIIONL I <br /> iCN1N1 I <br /> I <br /> �RLNRECT OR�LS�GNER <br /> MAiL�0�RE55 UIV 2iP PHONE � <br /> HOH I <br /> w r� -- Uiv ZiP Pn N[„ t�cEN$E• <br /> [iJ[f] GEN ALCANiR/�GTOF n MPIL/�DPE55 � �J ? ���/�(fN ; <br /> aN N W �7/Jscu..� �>� ' /5/dad S.a�•oll4., � 6Ld0 -/UR��.itup ���a :3c,�N <br /> C��"'� MCLM�NCALCONLPAQOR MMl�0�RE55 C1 ZIP FMON[ LICCNS[• <br /> a H cn <br /> ~ �'� PLUMBINOCONIRRLLOR MAllAODF[$5 C�LV ZIP PNONE lIC[NSE• i <br /> H ��H <br /> K y� -- <br /> cUSs oF wORrc <br /> �' ~� ❑ NEW ❑ ADDITION ❑ ALTERATION REPAIR C OEMOlIT10N ❑ WOODSTOVFJFRPL INSENi ❑ �UILDING PELOCATION <br /> �H ENSON ANO f MONE NO <br /> f3 C iEN4N11MPRWCIAENiORINiERIORREMODELONLY ��TA�'T� <br /> � x a f�/,5—e-o <br /> O� CONiRACiPR�LEOFWORN � <br /> yd ocscaiecwo���*ncEiNvoivco .( <br /> � �g __ ��,,���-no,v _�� �r,.�' �� /� — <br /> n„ n ,�rnorosEoyeooiemloirvG , iH[REBYCERTIFVTHATIHAVEREADANDE%AMINE�THISAPPLICATIONAND <br /> H C�' � KNOK'THE SAAtE i0 BE TFUE AND CORRECT.AlL PROOISIONS OF LFWS AND <br /> x H 3 _�LG�'�� �'�"'t�� ORDINANCES GOVERNING THIS TVPE OF VlORK`.VIIL BE COMPLETED WITH , <br /> y y[i1 �[c«cESCaiatoNOFvaoaEairlSNOWNBEIowon>T*ncr�GOVacowE51 yyHETHERSPEC�FlEDHEREINORNOTTH[GRANTINGOFAPERMITDOESNOT <br /> /j J' PPESUMETOGNEAU1i�ORITYTOVIOLATEORCANCELTMEPROV1510NSOF <br /> r ~'� ioi ! � B�OCrc/, OF ANVOTHERSTAIEOPLOCALLAWREGULFTINGCONSTRUCTIONORTNEPER� � <br /> � y FOH�dANCE OF CONSTV:UGTION THAT I PM AUTHOFIZED BV THE OWNER OF ` <br /> �~ /+—/ y�' � THIS PROPEflTV TO PERFOFM THE WORK fOF\NMICN APPUCATION IS MADE <br /> n �N L�'U��I1Ge ���� � l�r �J� AND � CO�dPLV WITH TNE STATE CONTPACTORS LAW 1827 RCN' AND I <br /> � �r - 296.200 WAC. . <br /> � ;IHt� . 'O�CONIRACIDROFAUL�ORI2[OAGLNI D4E <br /> H o�n -Of,� tbz� � �` � <br /> 7��,���,� 5 J's���� - �— � %C,,t�� � <br /> FPCVFCiADDnE55 �PnJCNisC��veU^u[sslirk.s[rvO�Noflu5i4E.>�!'�� ��� <br /> �� � 3 �, �k�����-� . — <br /> PLUMBING � ECMANICAL ; <br /> NO. TVPE OF FIXTUAE Ofl IiEM FEE N0. TVPE OF EOUIPMENT FEE I ' <br /> WATERCLOSET�TO�LEq A/C—WMNDLGUNITS-HP. _ � � <br /> '.�� BATHTUB _ _ FORGED AIR S�S1EId5—B.T.U. M EA _ = I . <br /> � I LAVATORV(WASMBASIN) _ UNITHEATERS—BTU. M <br /> SHOIYER __ CLOTHESOflVERS _ — <br /> KITCHEN SV.KB DISP. VENTILATION FAN — i <br /> '� � _ DISHWASNER _ RANGE HOOD — ��. <br /> "^` ! LAUNDRVTRFV _ K'nT[RHEATER ,I <br /> CLOTHES WASMER __ WOOD STOVE — �� <br /> — METAL FlREPLAC[8 CHIMYEV <br /> �.r � _ URINPL — — ' <br /> � � DRIhKING POUNTAIN _ FlREPLACE INS[Rl <br /> FLOOR DFAIN _ HEAT PUfdP _ — <br /> BACKFLOW PPEV[NTERS GAS PIPING __ _ — <br /> '�'`""' _ ROOFDRAINS—RAINLEADER$ E%HAUSTFAN _— <br /> � SINK�SERVICE—BAR,ETCJ <br /> `. .I..; __ __ — _ <br /> �.. w — <br /> {� SUBTOTAL 5 SUBTOTnL __ 5 ___ <br /> �.`� PERMIT S — — __.� .— __�PERMIT .__ __ _5 __ — <br /> _ • <br /> TOiAL FEE E TOTAL FEC 5 <br /> fPONiSEIB�C� RLePS[t13ACN S�OESEiBPGx PIANCNECNNUMBEN <br /> fEF AECEIOTND. <br /> usezorve �otna[n vnc�rvtsnc FEES VALUAiION FEE <br /> C YES '.'NO <br /> BUILDING __ _ —_ _ <br /> iY�FOFCANSi. OCCUPANGYGHOIIP NOOFpWLLLINGUN1i5 — ---- —-- -" <br /> <i i owee�Ei�ttu�� pLl1td81NG — <br /> ';¢COfBLD6. NOOFSiOPiE3 BSMi. OCClOnO MECHANICAI <br /> ❑Y — <br /> CN <br /> -- uewH�urniranorv OiHER <br /> nn�sramKieasneowaeo ❑res n no ___ STATE BUILDING SURCNARGE <br /> STATEENERGYSURCHARGE <br /> nrrucnncrvnccor-- rur+saJ}�n �;v--- � PUBLICWORKS—' _ _ — .__— � <br /> TOTAL <br /> � <br />