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APPLICA rION FOR CONSTRI,.:T10N <br />PERMIT <br />me evx�0�een <br />CIl l' OF rvrrrtl <br />everett e <br />BUILDING DEPARiMENI <br />259�d810 TO BE CUMPLETED IN INK— PLEASE PRINT <br />UVNfR A411 �IA�PfYS fi1V 111' 1'tlONC <br />Mn�i � so� _�o•,�-�,_� is� �. U,�¢.� t,� l nfn,� Cw �,.�.�a ZS 9�zf i 6s.z o�_� y— <br />tEN+Nt - - �.un-<iim�is5 - r.nr� . . -tii' r�irni[ - — <br />�OCNIiECTORD[SIGN[R M�II�DOp[55 . . . . .... . ..... �Clh' .. .-_.. - tIP ""-'- <br />"______.___—_--_-__ _ __ ._ "__ __"".__" <br />GENEN�lCOM9�C10R M��I�D�BCSS/ CIIY IIP � - PIION[ tICENSE• <br />/YIN�1? ��2K�'_� /S G � UiSF�a_�c(i±qF4_'L---�u�N+�o ,ZS- - �J�Lf �— /y1N LC /7_' <br />MECnAMC�tCONiReCtOR M�il�[)On[Ss Cil�' ziP PIIONE IIGENSE• <br />RUMpINGGONtR�CLOR M�ILAOpPf55 _--- - --- �f.pY ��� ���----- �-IIP ------�PIIONC <br />C1459 OF NORn ------'-- <br />❑ NEW ❑ ADDITION ❑ AITER�TION ❑ PCPAIR � DEAtOLIT10N ❑ WOODSIOVG/PNPL.INSERi _❑ OUILDINGRELOCRTION <br />TEN�NT IMPROVEMEMT ON INiERIOR RCMOU(L ONl Y CONIACI PU150N ANO PIION[ NO <br />CONIR�W PPICE OF WOPK <br />pESCPIBEWORN�NO5/0W�FEfOOT�GEINVOIVCD --/----'— - -'� -- -- -- - -- ----�------- <br />�ih6� C.u.. - �D...nl.i�l�r�nu � <br />lE LDE 1� OfVROPERttI ��mYNB!'SIOWURAt1nCL1110111iCUPiC/5�1 . _. <br />toT n`J 1._ e�ocn� Ur �ll�L��l.�-L- \�A�� _ . <br />�L- _._ .__-_.____- <br />v�ureiwa <br />T'PE OF fl%TURE OR ITEM FEE <br />WATER CLOSET�TOILEI) <br />e�rHrue <br />UVATORV (WASH BASINI <br />_ ' _' _. ... _- ____'__' <br />SHOWER <br />KITCMEN SINK6 DISP. � <br />DISHWASHER <br />_'___.._..__". .. __.. <br />LAUNDPYTFAV <br />fLOOR DR�IN <br />BACKFLOW PHEVENTEPS <br />ROOF DRAINS- RAINLEA <br />SINK 1SEPVIGF - 9AR. ET( <br />SUBTOTAL 5 _ <br />PERMIT S <br />TOTALFEE $ <br />as�te.cn sm[serencK <br />PR[A-" — V�GANi511C <br />I I YES � t NO <br />❑PAYCYGROUP NO OfOWEIUt <br />)FSTOPIES BSMf OLGlO�� <br />nr <br />n r� <br />FlNESPPINNIERSP[OUIRED ❑ YES U NO <br />♦PPI IUT1011 �CL OT... - -- - <br />111 EREBV CENI IFY iHAT I HAVE REFD AND EXAMINED TMIS APPLIC�TION AND <br />NNOW T HE SAME TO BE TNUE AND CORRECT. ALL PROVISION9 OF LAW9 ANU <br />OROINANCES GOVEHNING 7NI5 iVPE OF WORK WILL BE COMPLETED WITH <br />WHE111FH5PECIFIEDHEHEINOR NOT. TNEGRANTINGOFAPERMITDOE9N0T <br />PRESUME TO GIVE AUTFIORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANV Ol11ER S�AT E OR LOCAL LAW HEGUI.ATING CONSTRUCTION OR THE PEIi <br />FUqMANGE OF CONSIHUCiION THAi I AM AUTIIORI2ED BV THh OWNEROF <br />11115 PROPEfi1V 10 PtqFOHM IHE WORK FOR WIIICH APPL�CATION IS MADE <br />AND I COMPLV WI7H 1HE STATE CONTRACTOHS LAW 1827 RCW AND <br />2�36200 WAC. <br />SiGN�111RE Of CONIIUQOB ON IUIIIOIUZLO �Gf NI OME <br />��,��.�_ 4 ���_ <br />NO. TYPEOFEOl11PMENT <br />A/C - A/HNDLG UNITS - H P. <br />FORCEDAIRSYSTEMS-BT.U. MEA <br />UNITHEATERS--BTU. M <br />_"...._ __ ' '-_-___'______'_'_' _ _ . . _ ._ <br />CLOTIIES DRYERS <br />VLNTILATION FAN <br />NANGE IIOOD <br />WAIER IIEA7FN <br />WOOD SIOVE <br />— '_. . .'__'. ._ -___._..___ <br />METAL FIREFLACE 8 GHIMNEV <br />FlREPLACEINSERT <br />'___ '._ ___ _ _'_' __ _______. _ . <br />HEATPUMP � "���'�_ <br />-' . _.__ "____"_- _ - ' '_ _. ..____ __ <br />GAS PIPING <br />..- ---'E7(HAUSTFAN �'-'-'� -- <br />SUBTOTAL S <br />PERMIT 5 <br />TOTALfEE S <br />___ dUILDING <br />IS_ _.. ._._'_-_ ._ .-___. _- __- —. <br />I'LUMBING <br />tdr_HANICAL <br />OTIIER <br />__- FTATE BUILOING SURCHARGE <br />STATEENERGYSURCMARGE <br />PUI3LIC WOflKS <br />TOTAL <br />_. . . _ __I..- <br />FEE <br />