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the ErBrawn <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />259.8810 <br />APPLIC'MriON FOR CONSTR TION <br />PERMIT <br />TO BE COMPLETED IN INK — PLEASE PRINT <br />DvereU <br />e <br />OWNER MAIL WDRESS CITY ZIP 'NONE <br />9-✓VEST pe, /3E>k 7-r s- FyFlZFl7 9 g'1or y5-a —3gay <br />TENANT <br />MAIL ADDRESS Cllx ZIr PHONE <br />AIICMITECT OR DESIGNER M IL ADDRESS <br />GENERAL CONTRACTOR MAIL ADDRESS CITY zlr ••� <br />L NA,QrrA/ 7-klk�f<1 6- Po $ry 7ic L dtiveacl 993e6 77S-3iob �7 ,ce(,- <br />_.? i n/. <br />cnr ZIP PMDNF LiGEM�ET— <br />KUMMNGCONTRACIOR MAIL ADDRESS CnY HIP rNONE LICENBEE <br />Vr....^^ ❑ ❑ REPAIR DEMOLITION ❑ WOODSTOVE/FRPL. INSERT ❑ BUILDING RELOCATION <br />❑ NEW ❑ ADDITION ALTERATION <br />_ <br />CONIACI PRBON AND PHONE NO <br />NAMT IMPROVEMENT OP INTERIOR REMODEL ONLY <br />CONTACT MICE OF WORN---- <br />DEBCMIBE WORK AND BOUARE FOOTAGE INVOLVED <br />1J <br />w c LL/A <br />MDo SIuSLr F'f A'i <br />4- <br />— <br />MOPOBEUBE OF BUILDING <br />I HEREBY CER IIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND <br />`A/ Ff A4,L <br />/''rV L� � <br />KNOWTHE SAME TO BETRUE AND CORRECT.ALL PROVISIONS OF LAWS AND <br />ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLETED WITH <br />WHETHER SPECIFIED HEREIN OR NOT. THEGRANTING OF APERMIT DOESNOT <br />IPTION� PRGPERTY IF VOV.M BELOW OR AITACNFOURCOME& <br />TL_ <br />PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />OR LOCAL LAW REGULATING CONSTRUCTION OR THE PER <br />LOT BLOCK OF <br />ANY OTHER STATE <br />FORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE OWNER OF <br />THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE <br />AND I COMPLY WITH THE STATE CONTRACTORS LAW 1827 RCW AND <br />2R6.200 WAC. DATE 3/2-7/� f? <br />SIGNATURE OF CONTRACTOR OR AUIIIOWZED AGENI <br />�r <br />AnPICANIS Crtx RUBPESS IJCENSE NO AND BUSINESS NAME <br />PAOJECf ADDRESS <br />PLUMBINQ <br />MECHANICAL <br />No, <br />TYPE OF FIXTURE OR ITEM <br />fEE <br />NO. TYPE OF EQUIPMENT <br />FEE <br />CLOSET (TOILET) <br />- A/HNDLO UNITS - H.P. <br />WATER <br />_NC <br />FORCED AIR SYSTEMS- B.T.U. M EA <br />BATHTUB <br />LAVATORY(WASH BASIN) <br />UNIT HEATERS-B.T.U. M <br />_ <br />CLOTHES DRYERS _ <br />.— <br />SHOWER <br />KITCHEN S.NKA DISP. <br />VENTILATION FAN <br />_ <br />DISHWASHER <br />_ _ <br />RANGE HOOD <br />LAUNDRY TRA% <br />WATER HEATER <br />CLOTHESWASHEP <br />WOOD STOVE <br />METAL FIREPLACES 'IMNEY <br />URINAL <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />_ <br />ROOF DRAINS- RAINLEADERS <br />EXHAUST FAN <br />SINK (SERVICE - BAR, ETC.) <br />SUBTOTAL $ <br />PERMIT <br />"E.,E <br />$ <br />TOTAL FEE S __ <br />PONT BETBALK <br />SEIOAGK <br />PLAN CHECK NUMBER /EE RECEIPT NO. <br />USEZONEIHTSRE <br />FEES <br />VALUATION <br />FEE <br />S D NO <br />-UNITS <br />BUILDING <br />TYPEOFCONST. <br />OCCUPANCYGROUP <br />NO OF DWELLING <br />uLGWABLEJACTUAL <br />PLUMBING <br />SIZE OF BLOC <br />NO OF STORIES <br />OCC. LOAD <br />MECHANICAL <br />_ <br />ITY <br />❑ <br />OTHER <br />nN <br />NEIGIIi IIM:UiION <br />STATE BUILDING SURCHARGE <br />FIRE SPRINKLERS REOUIRED ❑ YES ❑ NO <br />STATE ENERGY SURCHARGE <br />PUBLICWORKS <br />AMUCATIUNACC. BY PLANS APPR BY <br />TOTAL <br />