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� - , •- <br /> � APPLICi+�ION FOR CONS'�Rl.�T10N <br /> PERMIT <br /> � fM Er�rprnn everett • <br /> ' GTY OF <br /> � everett e <br /> � BUILDINO DEPARTMENT <br /> 269-BB10 TO BE COMPLETED IN INK- PLEASE PRINT <br /> MML�DDRE5w5� CITx 21P PHONE <br /> /P�r.�.E� CO�P�� ,a�.s.3Jr /lohl'DF sf .G�l2'�� f�.703 ��.3�5'.� <br /> . �n�T M�ILIDDRESS GTY LIV PNONE <br /> MCHRECfORpE610HER MML�D�RE9S GitY 21P PNONE <br /> � OEMEMLCANTMGTOR MML�DDNESS CITY LIP PMONE LIGENBE• <br /> _ ./ 7!_ <br /> �3 <br /> M[d1�NIC�LfANTMCiOP ���DD ESS CiTY IiP PNON� LICENSE• <br /> ' PLVMAMOfANTMCTOR MML�DDRE55 CITY 2iP PHONE UGEHSE• <br /> { <br /> CW!Of NVRK <br /> ; � ❑ NEW ❑ �DDITION ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WUOOSTOVE/FRPLINSERT ❑ BUILDINOPELOCATION <br /> � ; 1E/NNTIMPROVEMENTORINTER EMODELONLY . CANTACTFERSON�NDPMONENO � <br /> � � o,,,rn�crvm�orwonK / OD-P .� . � Sc�n� C� S /�l�/hf`' <br /> , : pUeC111�EWp111tM�10,80UMEFO1OTA0E1 WIVED , / � <br /> ` i /��f�I'4//O�i/-.�ffE lY 2 �..7.� <br /> t ■IIDPWm U6E Of WILDINO � I HEREBV CE9TIFV THAT I HRVE��EAD AND EXAMINED THIS APPLIC�TION AND <br /> F S KNOW TNE 9AME TO BE TRUE ANIi CORRECT.AlL PROVISIONS OF UWS AND <br /> i � L.'�-e � � � ORD�NANCES GOVERNING THIS iVPE OF WORK WILL BE COMPLETED WITH <br /> � � L[UKDElCIIIPiIONOiFPOPERTYISMOWNBELOWOR�TT�CMfOURCOF�E41 WHETHERSPECIFIEDHEREINOFNOT.THEORANTINOOFAPERMITDOESNOT <br /> � � PRESUMETOOIVEl.:1THORITVTOVIOLATEORCANCELTNEPROVISION90F <br /> 1 �m.�'�� ��� or ANVOTHERSiATEORIOCALLAWREpULATINOCANBTRUCTIONORiHEPFR- <br /> ! � �a � TH 9 PROPERN ONPE FORM THE WORK FOR WHICH APPLICAT ONNIS MADE <br /> � ��� �,h �O ����a«Or" "h � qND I COMPLV WITH 7HE STATE CONTRACTORS LAW 18.27 ACW AND <br /> � � / I {'/1. JI I/ 2B82J0 WAC. � <br /> : �/l�,r/� /(��Afleur/C I I� e SION�TUREOFCONiRAC10ROF�UtHORIZED�0EN7 D�TESQ� <br /> � �I1 (/ <br /> , � �����0 <br /> I i .���nS �}, <br /> � �� �-�C�NT9CITYBU51 LICE S NO.�NOBUBIHEBSN�ME <br /> � j ��� � .S_ <br /> ' � M.UM�INO MECHANICIIL <br /> i i <br /> l � ' NO. T'P[OF Fl1IT1J11[OII ITEM FEE NO. TYPE OF EOU�PMENT FEE <br /> i WATERCL09ET1TOILE7) NC—NNNDL6UNITS—H.P. _ <br /> !� g��ryN9 FORCED AIR SVSTE�IS—6T.U. M EA <br /> 0 � LAVATORV�INABHBASIM UNITHEATERS—flT.U. M <br /> � � 9HOWER CLOTHESDRYERS <br /> � KITCHENSINK6DI9P. VENTILATIONFAN <br /> i OIBHWASHER RRNOEHOOD <br /> { � UUNDRYTRAV WATER HEATER <br /> : � CLOTHES WA9HSR WO00 STOVE <br /> � URINAL METAL FIREPLACE 8 CHIMNEV <br /> DRINKINO FOUNTAIN FIREPLACEINSEFi <br /> . 3 FLOORORAIN HEATPUMP <br /> ± BACKFLOW PREVENTEHS aA5 PIPING <br /> ; � RGOF DRAIN9—RAINLEADER3 E%HAUST FAN <br /> i I 91NK�SERVICE—BAR,ETC.) � <br /> i <br /> 1 <br /> i <br /> � SUB TOTAL E SUB TOTAL S <br /> � ', PERMIT S PERMIT S <br /> � TOTAL F�E S TOiAL FEE S <br /> 1 FppNiBE1MCN PFi�R8EtB11CK SIDF.9EtB�Ck PLANCNECN UM9Ft1 FEE IIECEIifMO. <br /> � 2.r� � � aa �a3 � 2S �93 <br /> � ueezo LOTAR61 v�c��+t5�j� FEES V�LUATION FEE <br /> � f' ❑YE9 }�NO <br /> ' �� euaoiNc � <br /> � T'PEOFCONBT. OCCUP�NnCYOROUP NOAFDWEtLINOUNlTB <br /> � µ�������� /C ' � � PLUMBIt10 <br /> I <br /> lIZEOFBLOA NO-0FSTORIES BB . OCGLO�D <br /> I � A 1 N ./L MECHANICAL <br /> T /rT <br /> � HEIOHtUMITRION OTHER <br /> FIREBPRINI(LEPBREOUIPED a r¢n o � STATE BUILDINO SURCHARGE <br /> i <br /> STATE ENER�V SURCHARGE <br /> I �PPLIC�TON�c[BY PL�NBAPPR EY <br /> �w /J PUBLIC WORKS <br /> �„ <br /> �!�`� TOTAL a <br /> ._ . . ..._ .,_ _ . , .... -- - ,: <br /> .. <br /> , . . .-...._.,. . . . ..r.�. . ..: . . ..Jb:i\�. � :.� r' :. � '.. . .� ��. ' � , �, t".. . . .r. •u'Ilrl .i:4L:!� <br />