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fha EverO�een <br />rITY OF <br />everett <br />BUILDING DEPARTMENT <br />259-8d10 <br />APPLICwiION FOR CONSTRI..:TION <br />PERMIT <br />TO BE COMPLETED IN INK- PLEASE PRINT <br />ovrrcu <br />e <br />�(�,�_l�i�,.,���r _�-�j�._��Z Posr--S�r..�.�_W.e. 99zo¢--so9 G�z474?-3 <br />T N�NT AIMIApp QIY ... .- lIP. . . 1'llf]NG <br />� <br />--__ —_'__ ___— _._._ _ __ _. — <br />AHCHITEGTOPOESIGNER A141LAODRESS f.11Y ZIP PIIONE <br />GENERALCONTPACIOP h1PIL�0UP[SS CIIY ZiP PIION[ lIC[NSE• <br />_?�'Q� •.��s-c_ . P.o.bo�c Sa�'3_�S'�u�-_�a[Lt 99u�S�9 3Z8i8y i' o�J-b <br />MECH�NIC�LCONTRAGTOR M1UIlA00fV[SS CILV 21P PIIONE LICENS[• <br />____.___—'____—'—_ _. __.__-__—_'.__.____.___'.__-__._... _."___—_ <br />PIUMBINGLONTR�LiOR 1.IRILAppq[55 C�1Y IIP VI�ONE LICENSE• <br />_— —_—_' - ___. __"___. ___ . . _ _ . .. .. __ _ . .. . . . _— _.___'"___""___"_ _ <br />CLASS OF WORK <br />❑ NEW ❑ ADUITION ❑ ALTERATION �I REPAIR ❑ OEMOLITION ❑ WOODSIOVE/FRPL INSERT ❑ BlII�01NG RELOCATION <br />fANTH�CTPRICEOF WORk <br />DESCRIBE WOPN �ND 50 WRE fOOGGE MVOIV[0 <br />3� fl�t �� _r I�IZ�t1 — <br />PflOPO5E0 USE Of 9 W LOING <br />lEcel oEscBlriioN uF rflorEntt (5�1owN eELow on nnecu FaUR cOPIEs� <br />LOT BLOGN OF <br />PROJEGtA0�RE55 <br />PLUMBING <br />VO. TYPE OF FI%TUiiE ON <br />WATER CLOSET ITOILEn <br />BATHTUB <br />LAVATORY�WASH BASIN� <br />SHOWER <br />KITCHEN SINKB DISP. <br />DISHWASHEF <br />LAUNORVTRAY <br />CIOTHES WASHER <br />URINAL <br />'G��i� �T. _f�u._ Zo�_747_8S6$ <br />I I IEflL�Y CEHTIFY THAT I 1{qVE READ AND E%AMINED TI IIS APPLICATION AND <br />KNOW TI IE SAM1tE TO BE Tr7UE ANn CORRECT. ALL PROVISIONS OF LAWS AN D <br />ORDINANCES GOVERNING THI� 7VPE OF WORK WILL BE COMPLETE� WITH <br />WHETHER SPECIFIEDIIEREIN OR NO7.7HEGRANTING OFAPERMITDOES NOT <br />PRESUME TO GIVE AULhIORITV TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTI IER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PER� <br />FORMANCE OF CONSTRUCTION THAT I AM AUTHORI2ED BY THE OWNER OF <br />THIS PROPERNTO PLRFORM THE WOFK FOR WHICH APPLICATION IS MA�E <br />AND I COMPLY Wllll iHE STATE CONTRACTORS LAW 1827 RCW AND <br />296200 WAC. <br />$IGNAi11RL ONIRACIUHOI�' � IJN1ILOAGFN� O41E <br />X ////l LD/ _���� � <br />PI'PUGNISCII USW[.�IICCHS[1lOA1lODUSMESSN4x�E <br />MECHANICAL <br />NO. TYPE OF EOUIPMENT FEE <br />__ .I'�_��_ ___ A/C-A/HNDLGUNITS-=H.P _' <br />� FOI±CED AN SYSTGt.1S-- 6T.U. A1 GA <br />--�-- �� ���---� �-� -� -�- UNITHEATE(iS--�TU M <br />-_- ---'�� ---� ��_'- CLOTHESDRYERS <br />VENTILATION FAN <br />__ -____ � . _fl .— _ _'-".- - _-__ __ <br />u_ <br />RANGEHOOD <br />— --- --�- WATERf1EATER �-- �-�----_--� <br />'-__ _-_- _- _-__. �WOODSTOV[ ._-___._- <br />__'_ -.. _____ ___________ __. _ ___ _____.._ <br />IdETAL FIREPIACE 8 CI IIIdNEY <br />_-__ _.-.-_ -_. _ - __ ......._._. __— <br />FIREPI.ACEINSERT ___ <br />_._._" '__._'_'_"_ ._"'_..__ ____ .. . <br />.___.._. ... <br />IIEAT PUMP ___ <br />__ "__ ___ ... __. __'- ___ . -_ ._-____. . <br />BACKFLOW PREVENTERS GAS PIPING _ _ <br />-_—'_-'__-_-'_..___.__._.. ..__.___.. _ _ <br />ROOFDRAINS-RAWLEAOERS B%HAUSTFAN _ __ ___ _ <br />____..._ ___'___ _.___- _ - -_ ._' __ - . <br />SINK �SERVIGE - BAR. ETG I <br />SUBTOTAL 5 _ _�� _ ___________ SUBTOTAL___ <br />PERMI7 __ S ___C�. L. . --__ __ __-_-_- - PERMI! __ <br />TOTAL FEE S LL' iOTAI FEE <br />.._.. �.�...�.....r.. mneevn.rv oleNf.NECNNIIMBEN FEE <br />ALLOWABLE/ACiWt <br />I I Y <br />❑N <br />fiRESPRiNNLENSRWUIRED ❑ YES ❑ NO <br />_. _ ._ _..._. . <br />VAGNT 511 c <br />�11E5 il NU <br />NO OF DWEILING UNi15 <br />FEES <br />�ui�oiNc <br />PLUh181NG <br />IdECHANICAL <br />OTl1ER <br />STA7E BUILDING SURCIinRGE <br />STATE ENERGY SUFiC11ANGE <br />PUBLIC WOPKS <br />TOTAL <br />� <br />__' -�___- <br />