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I <br /> APPLIC.�TION FOR CONSTRUCTION - <br /> ?ERMIT <br /> Ihe Evorgrem �������� <br /> CITY OF � <br /> everett <br /> BUILDING DEPARTMENT <br /> 259-8870 TO BE COMPLETED IN INK— PLEASE PRINT <br /> � CWULP b�ARnDDn[55 <br /> cav :,�• vno��� <br /> 3s.T-3 zs-� <br /> �R,� h«rR. t �hcryl /I�JJ 3yi7 J'h��� R�c �✓e�a-t w.,. i?zo3 - v�,o�.� -- <br /> i[N�M M�ILAO�PC55 LIIY Zi�' <br /> /.ItCMitEGiORpESiGNER MAIL�O�AE55 OtY 2iP CNONE <br /> ��e %�-�g/�•"�Q 3�'Yv K�ome� re �ve�e71' l,�� 9pcoi 2.Si -S'?7t <br /> GEN[P�LLO4iRACTOR L1AIL�ODRC55 LIIY ZIP PNOHC LIG[NSE• <br /> �itrn'� � 1� � KusJ s �/7 .Il� � A✓� i��e�{- �id' ioS 3,�=�� z�t <br /> I C.�C`ti J`t titv zm o t ucENse• <br /> y MELNANIC�LWNiPALiOR M�IUDOF[55 <br /> � prv 21P PNONE UGENSE• <br /> 'yf][n 1'WMBINGCONiR�GIOR M�ILADORE55 <br /> H �� <br /> K � CLASSOiNVRN -- <br /> 1-3".L1 ❑ NEW � ADDITION ❑ ALTERATION C, REPAIF ❑ OEMOLITION ❑ N'OODSiOVE/FRPLWSEPT ❑ BUILDINGFELOCAitON __ I <br /> WNinct rtnsorv�No nrwNE No <br /> � yH —[ TENANi1MPRpVEMLNiORINiCfyF�IORRCMO`OEIONIY ,c <br /> �I I\CqNiR�GiPRIC[O�WOPK / J"'� --� — -�^—�iv�--����� ex���� <br /> � 'jo+`iaP.]� 1 O�ESGRIBEN'ORNA�N�DnSOU<NEfOOiAGEINVOLVCO� J / <br /> 1�� '' /�' fi.� 4AK,( ,0,� ( <.IS..�c /`t:.�e l''� ---_. .--------� -- <br /> O H vnovo�ouse Ili[REBYGERiIFVTMAiIHAVEREAD/NDE%AMINEDTHISAPPLILATIONAND <br /> �( /' r NNOl7:HE SAME TO BE TRUE AND COFRECi ALl PROVISIONS OF lAW 5 AND <br /> �y[iJ� f� �QS�KL t"�""� Sr� OADItJANCES GOVERNING T145 iVPE OF WORK WILL BE COMPLETED WITH <br /> � �EG�LOESCaivnONorvnDVERttISNrnvrvonowOaAn�A7CH�oURLoviesi y�MEiHERSPECIFlEOHEFEINORNOT.TMEGRANiINGOFAPERMIT00ESNOT <br /> 'Y. M� � �S q S�7C�C /�C/'4I�Cr(I��O^� PRESUMETOGIVEAUTHORITVTOVIOLATEORCANCELTMEPROVISIO�SOf <br /> � BLOCK�1.� a� ANVOTHERSTATEORLGCALLFWREGUTATINGCONSTRUCTIONORTHEPER� <br /> ,�y y � �� /J Q ,/ p FORMANCE OF CONSTRUCTION.THAT I AM AU7HORIZED BY THE OWNER OF <br /> ~y / 1 /c '�.CA��4 /�t (/�I p � THISPROPERTYTOPERFOP6�TNEWORKFORYlHIC��AP7LIC�1ilONISMFDE <br /> �y y N TO �✓erG AND I COMPLY INITN TME STATE CONTRPCTORS LAW 1827 RCIY ANO <br /> � �y � / / q 296200 WAC. <br /> /f P e ,�Z' �/10NO�+t/.J�/� 1:.0Un.f�J sicr+niunEorGW��onnt�unun�ouizEDncE� on[ <br /> ��� a J X � / <br /> � _ / <br /> H[n �Uc. . .t� 1��-C��____—- <br /> y �N �PaOILCiP00FE55 ( PP�LifnNi5G�1YpU51NE55lICt'lSENOPbO ' S'�NESSN��A[ <br /> 3v� l� c/`c. ✓e. <br /> MECNANICAL <br /> PLUMBING <br /> NO. TYPE OF FIXTUHE OR ITEM <br /> FEE NO. iVPEOFEOUIPMENT FEE <br /> WATERCLOSET�TOILET) OU A/C-WHNDLGUNITS-HP. ___ <br /> FORCEDAIRSYSTEMS�-BTU. �:EA . <br /> BATMTUB — — <br /> �'� LAVATORY(WASMBASIN� nd UNITHEATERS-B.T.U. M_ _ <br /> !' SMOWER CLOiMESURVERS -- <br /> KITCMEN SINKB DISP. S VENTILAiION FAN <br /> DISHWASMER � RANGE MOOD _ <br /> fe �' WATER HEATER — <br /> LAUNDRYTRAV <br /> � ,� 1VOODSTOVE _ — <br /> CLOTMES WASHER __j_ �y� <br /> METAL FIREPLACE 8 CHIMNEY _���.. <br /> URINAL — <br /> FlPEPLAGEINSERT <br /> � DR�NKING FOUNTAIN — <br /> !! FLOOR ORAIN HEAT PUMP — <br /> BACKFLOW PFEVENTERS GAS PIPING <br /> ROOFDRAINS-RAINLEADERS _ E%HAUSTFAN — <br /> �`'i SINK�SERVICE-BAR.ETC) _ <br /> '� i - -— <br /> � p <br /> SUBTOTAL 5 __� � SUBTOTAL S _}�-J — <br /> 'v'�' PERMIT E _ PERMIT 5 _ — <br /> TOTALFEE 5 TOTALFEE 5 <br /> fPO4i5Ei0AGK �U�SE1B/.CK SIOES[1BACN CLANLNECK OMBE��� �EE (�y AE�E��N�� � <br /> � c ' j ' � Z <br /> O �y7 , �� FEE <br /> " �� use� �m eae� v�C��+r srtc FEES VALUnTION <br /> �S 23 500� `� r�s kr+o <br /> BUILDING '�3o Z3 -a_Q(_GC� <br /> nPEOfCON51 OGLUPANLYGPDUP NOOFOWELLINGUMIiS _---�- —�— 2 /� <br /> �uowr.e�v�cmei 1 PLUMBING _ 1�_V_D <br /> si;�pp HO OFSroaies e5M1. oct iD�o MECMANICAL -5 � <br /> 697 Sf Aove:n ur<1.. I �ti _ �� �� <br /> AOAL-f����- nucnrtirni�iiorv OiNER <br /> �4� / — � <br /> rwesrainrc�[asa[owaeo ores X�o IS STAT[BUILDINGSURCNARG[ __ <br /> STA![ENERGV SURC�iPRGE _ _ _ . <br /> �PGLiUi�ONACC BY PLANSAPPR O-Y/ PU9LIC WORK$ <br /> J� �� �N TOTAL � <br />