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APF�LICr.T10N FOR CONSTRUCTION <br /> PERMIT <br /> �.��«<� <br /> I��E�srOreen � <br /> CITY OF <br /> everett <br /> BUILDING DEPARTMEM <br /> 259-8810 TO BE COMPLETED IN INK— PLEASE PRINT <br /> r,nr zir, ruom 3 3 5' �yl y5� <br /> �Ep ra�u Aomrtss N , <br /> �1 � �p,. , J '�I (,'D /6�" U i� T ` A'�DL� [J - 3'f 7 •/�Lk-- <br /> KAY /•I I)�! �.I � L M�II �OP�55 � -��������GIC �11 - ���-�� ` PIIONL <br /> TCN�NT <br /> . .._ _ _. _..__--—_.-'PIIONE <br /> ___—__ _eiui��oon�.-ss_. . . -___-_-cnr-.__ zm <br /> •aa�r.ca oa o[sicn�a <br /> CitV-- - ZIP ----��IOH[ �� IIGEN9E• <br /> OENER�LCONTF�CLOR ---- -� MuIMORLtiS . ...-�-� --� �� -- �!�4O},�lZj ' <br /> A9r}L,.�y �FIqoDLUn.C,-- !`f3.1L_. .�i,./_�-Ce i�JS�r_. --`l_k17�_G5f-7�— G✓y � <br /> r���H� L�GENSE• I <br /> MECM�NIGLCONiR�GTOR MMI �D��I:55 <br /> --MGLa���C55 "�-- —-"����-�f.11Y--"-- IIP ----�NJNC LILEHSE• <br /> AU1.�NNOGONTR�CLOR � � � �� , /��'�� � <br /> IJSLL. <br /> 1�11N3drJ /�c U.�l�'i•�'4-- -- - <br /> U�SS Oi NOAN <br /> ❑ NEW ❑ ADDITION�'I ALTERATIDN �EPp�A ❑ DEMOLITION cCO�C'OO�NONE/PROtEHOERt � BUILDINGNELOCATION � <br /> 1EM�MTIARRMEMENTORIN1fR10RREMODELOHIY `v <br /> {� � Q��C% _ <br /> COMTMGTPRICEOiVIORK N� I I /��—----- -------- I <br /> p[lCR�lE V/ORR�NO SOl1�RE i00t�0E t�i-�� <br /> Fc�uN4qTia'n1 ,f h�qM��c ��EI h�/.LS ?��9c�c-r✓��r�� — <br /> qqcosEouseo�emio�Na (/ � IHEREBYCERTIFVTHAlIHAVEREADAN�E%AMINEDTHISAPPLIC�TIONAND <br /> /�[ nL/J4 `LrN�� ( ���Y� KNOW TNE SAME TO BE TRUE AND CORRECT ALL PROVISION90F IAVYS�ND <br /> u�j /q FP.J/y�-r�J - pRDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLETED WIM <br /> LE04DCSGNi0T10NOfPR01'ERIVISMOWNBEIOWORAIIG roiucor�s WNEINEHSP[CIFlEDHEREINJRNOi.TNECRANTINGOFAPERMITDOESNOT <br /> ( �aK F'LqI l� EG:� PRESUME TO GIVE AUTHORITV 10 VIOI.�TE OR C�NGEL THE PROV�SIONB OF <br /> ��T,Z/� IL Y,Jl ov �/---- ANYOTHERSTATEORIOCALLRWREGULATINGCONSTRUCTIONORTHEPEN� i <br /> FOfiMANCE OF CONSIRUCTION.THAT I AM AUiNORIZED BV THE OWNER OF <br /> TIIIS PROPERiV TO PERFURM TIiE WORK FOR WNICH�PPLIC�TION 19 M11DE <br /> I�OL Z OF rGA� �,� �t ---- AND I COMPLV W�TN THE STATE LONTRACTORS LAW 1827 fiCW AND <br /> � 296 200 WAC. <br /> SIf.N�111REOfCONiR�LIONOliAU1MOP12[O�GENI �QE I <br /> SN(Ncr+�i�/ ��° — -- <br /> 7 ,� �� �f-/7-b / <br /> X �c t`�y�L,L�j <br /> ppDJELT��D�n )) AP�LICANiSCIiYPU5ME55LIC[NSE ��N�B�SMESSN�ME <br /> K�� G. /` U���� <br /> MECMIINICAL <br /> PLUMlINO FEE <br /> �p. TYPE OF FIKTURE OR ITEM <br /> FEE NO. TVPE OF EOUIPMENT <br /> WIITER CLOSET ITOILET) A/C-A/MNDLG UNI7S-M.P. <br /> � BATHTUB _� _ _ FOF7CE0 AIR SVSTEMS-HT.U. M EA <br /> UVATORVIWASHB�SINI ___� __ UNITNEATERS-B7.U. M �� <br /> CLOTHES DRYERS I <br /> SHOWER —� -- _ <br /> / VENTILAiION FAN <br /> KITCHEN SINK 6 DISP. RANGE 11000 __ <br /> DISHWASHER -- — -- yypTER HEA7ER � <br /> IAUNDRVTRAV — WOODSTOVG <br /> CIOTHES WASHER ---- -----'- <br /> METAL FIREPLACE S CI�IIMNEV <br /> URIN�L FlREPLACEINSERT __ ____ - <br /> DRINKINGFOUNTAIN --'� - ' --"���� � � <br /> ,- _ _ __. IIEA7PUMP ._.___'_.-'_.____. <br /> FLOOR DRAIN -�-� -"-� ---- - �-- <br /> ------- --'�-- — '� GAS PIPING - — <br /> BACKFLOW PPEVENiEfiS --- -- — -'- �EXIIAUST FAN _ — <br /> ROOFDRAINS-RAiNLEA0ER5 — -- ---�------- _ <br /> SINN ISERVICE-BAR.ETC) __ — — -----��--- <br /> ___ <br /> _. - —- <br /> _ _ -'_-"_- <br /> --�-- ---- -- ---' SUB TOIAI. E <br /> _ � — — <br /> SUOTOTAL E � -- <br /> ___. ._-_'._'_ <br /> -_� _ __._._ ___- _ - -- PEfiM1T § -_ <br /> _— �S .-_-___- <br /> PERMIT __ - --- ----""-� -- TOTALFEE S <br /> -- TO7ALFEE 5 Z'�� � FEE�� Q; AECEIPfNO. <br /> PEARSEiB�CN SIOPStlOACN PUNCNG�iO�� 1�`� /1o�"Y) <br /> FRONTSEtB�GK / O[.. !—i <br /> /�� ��+ / � FEE <br /> �orenea �^�^�+r�1Tj FEES VALUATION <br /> USEIONE i�y�5 �LNO � <br /> �_ � BUILDING � <br /> OCCUPANCYGROUP HOOFDWELlIN6UNIT5 ----'- <br /> ___-__ —___— — <br /> TVPEOFCQNST '1 ZO � <br /> �LLOw�BtE/eGiu�� �' I - yL- �--- PWMBING _ _ ___._ _ <br /> SREOFBLDG NOOFSTORILS BSIAL OCClOAO MECHANICAL __ __ _— — <br /> � f I V NIC� __ ____ -._ <br /> � - Z rJ �7EmntuMrtnl�or+ OTHER — <br /> pipESPRiNKiFnS AeomaFo u vEs ��o _ _ _ . STATE BUILDING SURCHARGE � � <br /> STATEFNERGYSURCII�f7GE _ _ _ <br /> ��M�c�i���r rieHserrnev pUBLICWORNS <br /> �\� j�./r� Z 3 G 5 <br /> �� TOTA� <br />