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- - <br /> APPLICwT10N FOR CONSTRI�.CTION <br /> PERMIT <br /> rne Emry�een iwciett <br /> CITV OF � <br /> everett <br /> BUILDING DEPARTMENT • <br /> 259•88t0 TO BE COMPLETED IN INK— PLEASE PRINT <br /> OWNCR M11L��UPC55 CIIY ZI{� PNOHC <br /> ML L� S!l�/�/'�QD �a� Y W��Z�F�,. EK�RfT � 252-6 0cj <br /> �H�.�T M�IL�DDRC55 LItY ZI PNONE <br /> �Nrr — � <br /> �RCNRECT09D[SIGNER M�ILADDHE55 GIV 2P �MO E I <br /> /�ACQqci� (�i..Sr 71 3 7- N�GHL.M�v i1t� E`�'ri,['�'r� y er-+� I 2Si- 7Y5� N^�49�d`th'°h � <br /> pENER�I GOHTR�CTOR M�4�DONE55 GtY 2 P P ONE l GE SE 5 <br /> i <br /> MECM�NIGILCOHTR�LfOR M�IL�D�RE59 CIiY ZIP FMONE ULENSE• <br /> 'LWNN6CONTRACTOR M�IL�DDAk55 GII� 21P VNONE LIGENSC• <br /> DI+4F d�A•,ff 3Ylr k�?orrE/t Etii`RE(T 2S`1tqBo - <br /> lX�b50iNOR1l <br /> ❑ NEW ❑ ADDITION ❑ AITERATION � REPAtR ❑ DEMOLITION ❑ WOODSTOVUFRPL�NSERT ❑ BUILDING REIOCATION t <br /> IEMIJIT M1�ROVEMENT OR IMTERqR REMODEI ONLY CONI�CT PERSON�HO PMONE NO <br /> cw.n,cira�orwoaK �13oeu — <br /> �p[p�p10[NpIM�ND SOV�aE fOOT/�GE INVOL'�/L 0 <br /> Rpef tiv.�N�, QN�•a.(SN�'fii'-c<K w�ro���AC�e'n!.-f <br /> ¢ouseo/waoiwo �4�n*'YN «•.Ff IHEREBYCERTIFY?HATIHAVEREADANDE%AMINEDTHiSAPPI�CATIONAND <br /> /`�SfO r�-E KNOWTHESAME7UBETPUEANOCARRE�T.ALLPROVISIONSOFLAWSAND <br /> LEMl0E9GRIotIONtBPROPERIVISNOWHBEIOWORQT/�GNiOUAGOWEA ORDINANCESGOVERNINC'iTH�STYPEOFWORKWILLBECOMPIEiEDWITM <br /> IYHETHER SPECIFIED HEREIN OR NOT.THE GRANTING OF A PERMIT DOES NOT <br /> PRESUME TO CIVE AUTHORIT!TO NOLATE OR C�NCEL TME PROVISIONS OF <br /> �p7__ 9,ot� o� ANYOTHERSTATEORLOCRLLAWREGULATINGCONSLRUCTIONOAIMEPER� + <br /> FORMANCE OF CONSTRUC710N.THAT 1 AM AUTMOR12E0 BV THE OWNER OF <br /> S � �„�„n��� THIS PROPEFTV 70 PFRFORM THE WORK FOR WHICH�PPL�CATION IS MADE <br /> ANO I COMPl1' WITH THE STATE CUNTRACTORS LNN 1827 RCW AND <br /> 298.200 WAC. <br /> S�ONRUAEOFCONTRI�CTORON�VIMORIZED�GEHT DATE <br /> -- X� , - /�( 91.,�1� l l- 9-Y t <br /> ryqJER MDRESS �FiLiG�rvTS GrtY PUS�HE55 UGENSE NO�N�BUSiHE55 N�ME <br /> (�oY I�nRRE <br /> ►LUMlINO MECMANICAL <br /> qp, TYVE pP fl1ITURE 0111TEM FEE NO. 7YPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILEn IVC—NHNDLG UNITS—H.P. <br /> BATHNB FORCED AIR SVSTEMS—B.T.U. M EA <br /> LAVATORYryVASHBASIM UNITHFATERS—B.T.U. M <br /> gMOWEq — CLOTHES DNiERS <br /> KITCHEN SINK 6 DISP. VENTILATION FAN _ <br /> D�SNWASHER .7ANGE MOOD <br /> UUNDRYTRAY WATER HEATEF <br /> CLOTHES WASMER WOOD STOVE <br /> URINAL METAL FIREPLACE 6 CHIMNEY . <br /> ORINKING FOUNTAIN FIPEPLACE INSERT � <br /> FIOOR DRAIN HEAT PUMP <br /> BI1CKFlOW PREVENTERS GAS PIPING <br /> ROOF DRAINS—M�NLEADERS EXMAUST FAN <br /> SINK(SERVICE—BAR ETC) —. <br /> 1 l <br /> SUBTOTAL 5 � I��� SUBTOTAL 5 <br /> PEfiMIT s PtR�A�T 5 <br /> TOTAI FEE E � _ � TOTAL FEE S <br /> iRONT5Ef8�Glt HE/.RSETB�CK SIDESEiB�LN VIANtNECKHUMBEP <br /> FEE �EGEIPfMO. <br /> VSEZONE ior�nu veceHtsrte FEES WLUATION FEE <br /> ❑YES ❑ NO f <br /> BUILDING <br /> TYPEOFGONST. OGLUPPNGYGRCUP NOOipWELI�NQUNITS � <br /> •LLow�etEieCiu�t PLUMBINfi <br /> sReosa�oe HO.OFSTOPIES BSMT. OCGLO�� MECMANICAL <br /> ❑v <br /> ❑N <br /> MEIGHTLIMITATION OTHER <br /> FIRESPRiNelEP5RE0UIRE0 ❑vE5 ❑Ho STATE BUILDING SURCMARGE � r,�''� <br /> STATE ENEFGV SUACHPRGE <br /> AFRIC�TIONILC BY PL�NSAPPR BV PUBLIC WORKS l <br /> � � 1 <br /> rora� J�� <br />