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Ihe Eve�9ro�^n <br />CIiY 0�= <br />ev�;rett <br />EUILDII�G D[PARTMENT <br />259-8810 <br />I <br />i,�; �,. <br />APPLIC�►'f10N FOR CONSTRIii:T10N <br />PERMIT <br />TO BE COMPLETEp IN INK—�PLEASE PRINT <br />everett <br />e <br />_�f`/E ff5 A�✓E <br />�qCNRECTORDES�ONER M�R�D�RE55 C�iY ZiP PHONE � <br />. � <br />6ENEH�LLONiN�GTOt1 MniL�DOR[SS GTv lIP RIOIiC LILEN9E• <br />MECHIINILALGONTR�CIOR M�II�DDRE55 QTY 2^P �MOlE— . 41GENHE��, <br />{�L1�J3 V� m/nn . � <br />�� 1 <br />❑ NEW C� AODITION 0 ALTERA710N ❑ REPAIR ❑ O�MOLITION ❑ WOODSTOVE/FFPLINSENT ❑ BUILDINORELOCATION � <br />p1110E OF WO{IK <br />LOT BIUCN__ OF <br />PROlECTADORE95 <br />7v1� �vErrrraeE <br />PIUMSINO <br />pp, TYPE OF FIXTUIIE OII ITEM <br />WATER CLOSET (iOILET) <br />BIITHNB <br />LAVATORV(WASH BASIM <br />SHOWER <br />KITCHEN SINK 8 UISP. <br />OISHWA3HER <br />UUNDRV TMV <br />CLOTHES WASHER <br />URINAL <br />ORINKINp FOUNTIIIN <br />�ILOWABLEI�CTUAI <br />RNE <br />SUBTOTAL S <br />PERMIT S <br />TOTAL FEE E <br />RE�H SE18�CM SIpE SELBAGN <br />LOT�RE� MCnNi50f <br />❑ YES ft NO <br />OCCUP�NfYGROUP NOAFpWELI.n <br />rvO.OFston�es esMi. occio�o � <br />❑v <br />❑N <br />HEIGNi �I1dItRi <br />❑ YES ❑ HO <br />1 HEREBV CERTIFV THAT I HAVE READ AND FIUMINED THi3 APPLIC�TON AND <br />KNOW THE SAME TO BF. TRUE AND CORRECT. ALL PNOVISIONS OF LAWS AND <br />ORDINANCES GOVEt7NING THIS TYPE OF WORK WILL BE COMPLE7ED NA7H <br />WHETHER SPECIFIED HEREIN OR NOT. THEOF�NTINOOFAPERMRDOE9 NOT <br />PRESUME TO OIVE AVTHORI7V TO NOUITE OR CANCEL THE PROVI&ONS OF <br />ANV OTHER STATE OR LOCAL LAW RE6UUTIHO CANSTRUCTION OR THE PER- <br />FORMAN �E OF CONSTRUCTION. THAT I AM AUTHORIZEO BV ME OWNER Of <br />THI9 PROPERTV TO PERFORM THE WORK FOR WHICH /1PPLICAt10N 19 MADE <br />AND I COMPIY WITH THE STATE CANTRACTORS LNN 1827 RCW !1ND <br />298.200 C. <br />910N�TV CONiR�QOROR�U7MORREU�OENT ��TE � <br />X �/ <br />� � a�3�9/ <br />�PVLC TS BU S.CENSB �!IOBUSMESSH�ME � . <br />MECH�NICAL <br />ac- <br />FIREPIACE <br />HEAT PUMP <br />6AS PiPINO <br />E%HAUSTF/ <br />OF EOUIPMENT <br />INITS — H.P. <br />fEMS — 9T.U. <br />B.T.U. M <br />FAN <br />SUB <br />TOTAL <br />BUILDING <br />PLl1rd81Nv <br />ME(.H'r.NICAL <br />OTNEq <br />9TATE BUILDING SUACNAtiGE <br />STA7E ENERGY SURCIIARGE <br />PUBLIC WORK$ <br />TOTAL <br />1 <br />FEE <br />