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APPLICs+T10N FOR CONSTRa�CT10N <br /> PERMIT <br /> f�e Ev�ryn�n evereu <br /> CI�Y OF <br /> everett <br /> BUILDIN(i DEPARTMENT <br /> 259•BB10 TO BECOMPLETED IN INK— PLEASE PRINT <br /> �,HEq � M�il����E55 GIIY ZIP PNONE <br /> ��o �' yI�/,c-�,v sNd•� �/nz S�iarc Al/�'vPv�Ti_9'B�o3.—_3�.3�3� 3 <br /> TEN�NT A• M�IL�O�PEJS G��—TY—�� IP P110NE <br /> I I " " i CIIY ZIP FNONE <br /> Aq�q�TEpTpp�STONEP M�R�DORE55 <br /> ,er71�.6'/Xi����ibT �D/D 7.��sT �'��re� �9�03 p..�3-dS 3� LiCENSE. <br /> OENER� CONTP�CTOP M�IL�D�RESS <br /> �i�vt,l�•s��/� ��3 �r_7i.�✓ f�P�E1�- ?j�lL3J si-�v-ei-/-!6/MS <br /> MECNANIC�LCONTR�CIOR MML�UORE55 CIIY 2iP PIIONE LICENSE• <br /> PLUM&NOCONTR�qOR M�IL�UORE59 Citv Irt���OHE LiCENSE• <br /> ____—"' __—_ <br /> CU480FNVNIt �� <br /> ❑ NEW ❑ �DOITION II� ALTEt1ATION ❑ F.EPAIR ❑ OEMOLITION ❑ WOODSIOVE/fRPUNSERi ❑ �UILDINGRELOCATION <br /> TEHIHTIMPROVEMENfORINTERl$OP REMODELONLv CONUG�1'ERSON�ND�HONENO ^J,,�} / <br /> COHTR�CTPRIGEOFWORK I �/�J __ __S�L_�L/_�L/SxLL�=S%�{�/,fU�S�/11L <br /> p[lC111�EWONNANDSOU�AEP�01�0 INVOlVEO , ��,(/e /y)�CIeIIN� � <br /> f�C�''L�F E.raT�# t ol�l c'9 ri l�ew ��1Ya�1� —�—�#nf4wn-J��-��— <br /> rnovrneo we or euaoi. a I HEREBV CER7IFV THAT I NAVE READ AND EXAMINED THIS APPLICAiION AND <br /> �/N ��� KNOWTMESAMETOBE?RUcANDCORRECT.ALLPROVISIONSOFLAWSAND <br /> ORDINANCES GOVERNING 7fiIS N('E OF WORK WILL 8E COMPLETED WITH <br /> lEOKOEBCRIFTIONOF ROPEHIYISNOWN9ELOWOfi�TULMfOURCOME51 WHETHERSPECIFIEUHEREINORNOT.THEGRAN71N60FAPERMITDOESNOT <br /> �i PRESUMF TO GIVE AUTNOR�n'TO VIOLATE OR CANCEI TME PROVISIONS OF <br /> �oT��FB�ppK_�, oF �-/�=re ANYOTHEqS7A1cORlOCALLAWREGULATMGCONSTRUCTIONORTHEPER� <br /> T�X d FORMANCE OF CONSTFUCTION.THAT I AM AUTHORIZED BY THE OWNEF OF <br /> .�1,Do,i ioN T.�dor�e/�l�i� v - -aza THIS PROPER7 V TO AERfORM iF1C WORK FOR WHICH APPLICATION IS MADE <br /> ANO I COMPLY WITH THE S7ATE CONTRACTORS LAW 10.27 RCW AND <br /> '� p96.2p0 WAC. <br /> SIGNAIOPEOfCONIf1PC1OR011PU1110R11[O�GENI D�IE <br /> � X <br /> 1l - ..9 -86 <br /> � ^ �/ <br /> PipJECi�UDRE59 � ,11' i 5 � � USirvfsSii [NSfNO �OAUSiNESa �ME <br /> �/' ! � <br /> PLUMSINO MECHIINICAL <br /> ' NO. 7YPE OF FUfNRE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATEP CLOSEt1iOILET) A/C-A/HNDLG UNITS-H.P. _ <br /> I FORCEO Alfi SYSTEMS_BT.U. M EA <br /> BATMTUB UNI7HEAlERS-BT.U. M <br /> LAVA�ORV(WASH BASIN) - <br /> SHOWER _ CLOTHES Df7VER5 <br /> KITCHEN SINK 8 OISP. VENiILATION FAN _ <br /> DISHWA9HER _ _ RANGEHOOD_ _ __ <br /> L�UNDRYTRAV _ WATER HEATER _ <br /> CLOTHESWASHER _ WOODSTOVE <br /> URINAL METAL FlREPLACE d CHIMNEY <br /> �RINKINO FOUNTAIN FIPEPIACE INSERT _ <br /> FLOOR DRAIN HEAT PUMP <br /> BACKFLOW PREVENTERS GAS PIPING <br /> ROOF DRAINS -HAINLEAOERS _ E%HAUST FAN <br /> SINK�SERVICE-BAR,ETC.) _ <br /> SUBTOTAL S SUBTOTAL $ <br /> ' PERMIT S _ PERMIT $ _ — <br /> TOTAL FEE S 107AL FEE $ <br /> FOpNTSETB�GM RE�F'SEIBnCK SiOES[iOnC✓. il1NCHE NNUMOEN FEE PECEIPiNO. <br /> � ' '7 7. S� � a �O�(� I z <br /> �_s <br /> UeeiOr+e� �o?nnE� VPCANi511E FEES VALUATION FEE <br /> [1 Y[5 �!O � /'/'� <br /> � OUIIDING L <br /> tYPEOFCONSt. OGGUPANGYGROUP NOOfDWELLINOUNIiS � <br /> u�ow�0� �l j�_-3 / PLUMBING _ <br /> l� <br /> e¢eore�oo. r+o.o�sronies osM-,-, occ�o�o MEC���NICAL <br /> '� f�Y � __ <br /> 5�� 5/F N _ <br /> NEiornuMnenor� OTHER <br /> FIPESPNINKLERSPEOUINEO ❑res 1�mm STATE BUILDING SURCHARGE � <br /> STA1E ENERGV SURCHARGE <br /> �PPLILQIONRGC.BY PLANS�PPN.BY AUBLICWORKS <br /> �ry�. �,� TOTAL D <br /> rr�3 <br />