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� �, � <br /> ; APPLICA-1'ION FOR CONSTR4�:TION <br /> � PERMIT <br /> � 11�Ev�rpn�n - • <br /> CRV OF everett <br /> � everett e <br /> ; BUILDING DEPARTMENT <br /> ; 2b9-8810 TO BE COMPLETED IN INK— PLEASE PRINT <br /> 'i <br /> 2 / �^y <br /> g �jc�C ��J��c/ � aE55 6// ,�ld2r�� l�'ir-�'��S�� <br /> IENN/ MML�O�PE59 GILY iiP PNONE� <br /> i <br /> .� <br /> MGHRECTORDElqHER M�IL�DDRE9S C�TY ZIP PHONE <br /> y OENENLLL[1NT11�CTOR MAIL�UORE39 GITY ZIP PHONE �ICENBE• <br /> � MEpAMIC�LCONTRACTOR M�i��DOPE59 pTY ZIP qpHE 4CEHyE� <br /> � �� RUMNMOCONTRIICTOP MMI�UORESS QfY IIP PHONE LICFNSE� <br /> < - �=-�i� �,:s�-��-/��--� 3Yl/.f�d.�iza�.�.rJ.�S' �Y <br /> "°"" .�ss ibs �ZS <br /> ❑ NEW ❑ ADDITION ALTERATION ❑ REPAIR ❑ OEMOLITION ❑ WOODSTO�FJFRPLINSEPT ❑ BUIlU1NORELOCATION <br /> 7EIMMT IMPHOVEMEM OR IMTERIpq REMODEI ONLY CONIAGi VERSON�ND PMONE NO . <br /> �i CONTMCTMIICEOfW�11K' <br /> � D[ Nq11K�NDlOUMEFOOT INVOlVEO — <br /> co oreuaoiNa IMEREBVCEPTIFVTHATIHpVEREADANOE%AMINEDTHI9AFPUCATIONAND <br /> � � � KNOYVTHES�METOBETRUEANDCORRECT.ALLPROVI810N90FLAWSAND <br /> LEp11LDElCRIPTIONOFPROPERTY�9NOWNBEIINOR�R�CMFOUNCOPIES� ORDINANCESGOVERNINOtNI$lVPEOFWORKWILLBECOMPLEiEpWITH <br /> WHETHER SPECIFIED HEREIN OR NOT.iHE ORANTINQ OFA PERMIT DOES NOT <br /> PRESUME TOOIVE AUTHORITV TO VIOLRTE OF CANCEL THE PROV1910N9 OF <br /> } LOi e�ocu or ANYOTHERSTA'eORLOCALUWREODUTINOCONSTRUCTIONORTHEPER• <br /> � FORMANCE OF CONSTRUCTION.THAT I AM AUTHORIIED 8Y THE OWNER OF <br /> � :,1 TH19 PROPERTV TO PERFORM THE WORK FOR WMICM APPLICATION 19 MADE <br /> ; AND I COMPLV WIiH THE 9TAtE CONTFACTORB LMN 1B.Y7 RCW AND <br /> j 288.200 WAC. <br /> SION�TURE Of CONIR�CTOR OR�UT110PI2E0�OENI O�TE <br /> r , g� <br /> ; ������� s.�, <br /> � �� na.�ca�ooneea <br /> f M 1 � 1 �/�^ � �PI�[19R I9CIiYBU91 6SlICEN5EN0.�NpBU9MES3N�ME <br /> i Y` � v v <br /> � M.UMlINO MECHANICAL <br /> � ,'+� N0. T'K OF flXTU11E OII ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> �) / WATERCL09ET(TOILET) A/C—/VHN�LOUNITd—H.P. <br /> '1 B�TMNB FORCEDAIRSY57EMS—B.T.U. MEA <br /> �3 / UVATORV(WASMBA9IM UNITHEATERS—B.LU. M <br /> .f BHOWER CLOTHES DRYERS <br /> �� KI�CMEN91NK6DISP. VENTILATIONFAN <br /> �� DISMWA9HER RANOE HOOD <br /> LAUNDRVTRAV WA�ER HEA7ER <br /> � CLOTME9WA9HER W0009TOVE <br /> 1 URINAI METAL FIREPLACE 8 CHIMNEV <br /> ,j DRINNINOFOUNTAIN FIREPLACEINSER7 <br /> ; FLOOR DRAIN HEAT PUMP <br /> . BIICKFLOW PREVENTERS GAS PIPINO <br /> � ROOFDR�INB—RAINLEADERS E%HAUSTFRN <br /> ; 81NK�SERVICE—BAR,ETC.) <br /> i <br /> h <br /> 1 <br /> � <br /> •� SUBTOTAL S SUBTOTAL S <br /> � PERMIT S PERMIT S <br /> � TOTAL FEE S TOTAL FEE S <br /> � FRONTBETMCk pEAqBEfB�CK SIpEBETB�CN nANCNECI(NUMlER FEE pECE1Rpp. <br /> � I18E20NE LOT�RE� V�G�Ni51tE <br /> i� ❑ve5 ❑No FEES VALUATION FEE <br /> � <br /> '� IYPEOFCANBT. OCCUP�NCYOROUP NOAFpWEL4NpUNliB BUILDING <br /> ���J �������� PLUMBING <br /> J 012EOFSLO(3. NO.OFBTORIE9 BSMT. OCGLO�� <br /> ; ❑r MECHANICAL <br /> � ON <br /> } HEIOMTLIIAITAT�ON OTHER <br /> ! <br /> �� FlRE BPHINKLEq9 FEOUIRED O YE9 ❑NJ STATE BUI�DING SURCHARGE <br /> 1 <br /> j STATEENERGYSURCHAFGE <br /> � APPLIGeTIONACGBY p��NB�PPH.BY <br /> I PUBLIC WOFKS <br /> � TOTAL <br /> j <br /> � <br /> , _ ,..:� ,.. ..., .._. , ... <br /> ...� .__.._.. . ,n., -�..., - . _... <br /> .,. <br />