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APPLIC.-.flnN FOR COt�STRi,<oT10N <br /> PERMIT <br /> the Evor9rcon ���ri ru <br /> GTVOF <br /> everett <br /> BUILDING DEPARTMENT <br /> 259-8Bt0 TO BE COMPLETED IIJ INK— PLEASE rRINT <br /> Owr�tP n!�R�DonL55 � ,• )��, r'i�arv[ <br /> ` -vNrfe/� �JL��iC' 3717 UA�.eS l�Ya Eo'e.c.%tf 98 __ 3�J-%_s`� . - <br /> •J`JJ�._� PiY .'I� CIpNE <br /> (] ��.�..�J MA�L ApORE55 <br /> � � � _ .— — -- .—_-- <br /> �.] FUU��RCiOAOLSIGNLN MAIL�DORESS QfY TIP FNONE <br /> b � �. 9ef�� 93�- yu8—_ <br /> � y y ;�n,�,e! 6� u,t�ltt�G /catoy 3Y ifu�s�.J sFit.�/e <br /> � GENEP�LCONLFLCIOR M41LAJ�PE55 QiY 21P �'NONE IIGCYSC• <br /> K � n", �{� .�z�e � p(��.,�1£ve.car 1{c�v F13 f^�il G��zeK 9�i0/2 �>Y�'!�! /`re�c'..rH/uti�'. <br /> r�[1.��J1�� ��" -----'-� GiY ZIP P��ONE IICENS[• <br /> y ![Cr�>NIG�LGONLPACiOR MPILe..]IiC55 <br /> �q M �V <br /> y.� y ti �'C.11lI1MGCONLPACTOF MAILADOPES$ LITY Z�P �10NE UCENSE• <br /> C � � <br /> LNLASS Oi VruRrc <br /> � <br /> N , 1�. NE1Y ❑ ADDIiION ❑ A�TERATION ❑ REPAIR ❑ DEMOUTION ❑ WOODSIOVE/FRPLINSERT � B111L01NG�.ELOCAiION <br /> iCN4M IMPPOVEMENT OR INTEflIOF PEMDOEL ONLV CON1ALi PEHSON PNO PIIONE NO <br /> �-��^� � �� �r r� 77F���€"'2i.. 77'3_'a5/ ���3=1'��ac�- <br /> b H � LONiRAG1PR6EOfWOPN •- _ — <br /> �~ �� DESGPIBEWORNAHUSOUARCfOOiAGEINVOLV[D <br /> �r y <br /> Sj� N H �7p/ '� L'�U �yil$TlcJC7J� <br /> '" O N �RO�'OSCOWEOFBULLOING � � � �� � � � <br /> � ro r ^ IHE�1[�VCERTIFY?NATIHFVEREADAN�E%AMIN[DTNISAPPLICA710fJAND <br /> � L L � p _ .`�NL� KNO�N'l�ESAMETOBETRUEANDGOFRLQ.ALLPROVISIONSOFLAWSAtJ� <br /> � � i-Wn t`� ORDII�ANCLS GOVERNING THIS TYPL OF\'10RN WIL�dE C01dPLf.T[D WI�I1 <br /> y u.cn�oesCnivnoNofvnovEaniS�OwneELOWORnT*nGnFouaGoviEs y,�HHTHERSPEGFlEDHEREINORNOLT11EGi7ANTINGOFAPER1dIiDOE5N0T <br /> PRESUM[TO GNE AUTHORITV TO VIOLnT[OR CANCEL THE PROVISIONS OF <br /> �Gr� BLOGK Ov ANVOTHEPSTATEORLOCALLNWREGUTATRJGCONSTFUCTIONORTHEPER� <br /> FORN�ANCE OF CONSTRUGTICV.TNAT I AM AUTHORIZED�Y TNL OWNER OF <br /> TNIS PROPERTV TO PEa�CRId iH[WORK POR 14'HICH APPLICATION IS 61AD[ <br /> AND � COMPLY WITN THE STATE CONTRAQORS LACJ tr32% ��CV✓ AND <br /> 296 200 W 4G. <br /> s�c�+A�ur.co�cov*ancm�r��wu:��a4�zromcni �." <br /> X / �� � `'— • '��y <br /> / � <br /> 7f'_ �_ � ' <br /> PPpJCLiFO�P[$$ Lf+l'LI�4K1iC11Vf'L��IIIC_.`.1• ritL� PIipOUF`iCti'�l.:.�.� <br /> � �3��,��( ���� - <br /> PLUMBING MECMANICAL <br /> h7. TYPE OF FIXTURE OR ITEM FEE NO. TY7E OF EOUIPMENT FEE <br /> ��� �. � WATER CLOSET(TOILED _ _ _ _ A/C=NHNDLG UNiTS—HP._ _ _ <br /> BATHTUB _! FOFCEDANSYSiC1.1S—BTU. MEA � =_ <br /> I �� _� LAVATORY�WASHBASIN) = _ _UNITHEFTEHS_�TU M __,_ <br /> SHOWER CLOTHESDRYEHS �� <br /> � � KITCHEN SINK�B-BI9P. _�_ VENTILAiION fAN <br /> I 1��+ / DISHWASHER � RANGE HOOD _ � � _ <br /> �! I LAUN�RV TRAY _� _ WATER NEATER __�` <br /> / CLOTHESWASNER ' _ WOODSTOVE __ _ <br /> — URINAL METALFIFEPLACEdC""ANEY _ <br /> � DRINKING FOUNTAIN _ HREFLA^.E ItBERT __ ._ <br /> I ��� _ FLOOR DRAIN _ _H[AT PUMP _— <br /> � BACKFLOW PREVENTERS GAS PIPING — <br /> ROOF DRAINS—RAINLEADERS E%HAUST FAN _ . <br /> O�' i � SINK�SERVICE—BAR.ETC) _ — ---_—� -- _ <br /> r <br /> � �I� � —— ' — SUB TOTAL 5 �C— <br /> SUBTOTAL S � '— ___ _ <br /> PERMIT S __ PERMIT __ S. _ _ _ _ _ <br /> -- — �--'— --�- — — TOTALFCC S <br /> TOTAL FEL 5 � � <br /> fRONI5C1 �EARSQBRGR 9DCSR0<LM PIANCN£QHNUMBER fEC NECEIVTNO. .; / <br /> � ���� ���� � ` � � , .': _ / � �' � A- ./� �' I <br /> ��J l. �. ( 1 �.Y <br /> f�� � <br /> � usezoHe iotnaen v nnisrte ,FEES VAWATION FEE <br /> /� ��/J��� YES I1 NO �/C?^y <br /> 1T�� �7�"�-�Y _ �UILDING _/ �/7 S.S�. —_- _ 111-1 � <br /> ivCEOFGONST OCGUI'ANCYGROUP NOOFDWELIINGUNIiS ------- Y �� �� <br /> nuownBL[� � PLUMBING <br /> ��r R•� -- - _ -- )� <br /> 's�zEoroioc rvoorstoei�s nsrar. occia.o MECHANICAL ��_ ��J <br /> r,r <br /> D f Z. ym _ -- __ <br /> 8'� n[i�Niuurtn n _OTHER ________ _ "__— —_- <br /> �6�[SPFINNII�FFOUIPEO ❑YES YNO � � <br /> _ — STATE OUILDING SURCHARGE _ J"1 I ) <br /> S1ATE ENERGV SURCHARGE _ __ I�.�1 <br /> a�n�li,ni�ovaccer vuHsnooe.er � G � <br /> PUBLIC WORKS <br /> I,�'�.� �(� TOTAL � r <br />