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� ..,a� <br /> APPLIC�+rP10N FOR CONSTRI.<;TION <br /> PERMIT <br /> fhe Erorpresn <br /> CITY OF everetl <br /> everett e <br /> BUILDING DEPARTMENT <br /> 259•eB10 TO BE COMPLETED IN INK— PLEASE PRINT <br /> OWNER M�ILqDONE55 CI�Y 21P PHONE <br /> l7• U1RSot� 3�u3 STM:k+ A�e �aek{- Ax�nl 2Sz-383�i <br /> TENFNT M1141lADDRE55 LIIT Zlo PNOHE <br /> � <br /> ♦RGNI1ECfpq1DE914NER MAIL�POR[55 CIIY IIP p11pNE <br /> OENER�ICLON1 AC10P M�iIAD�RESS pnr - Zm VIIONE �ILENSE• <br /> I�/l V <br /> MECH�NIC�LC ' .ani'm m�i�nUUnE55 CII♦ ZIP PHONE �ICENSE• <br /> ��in <br /> RUMBINOCON AciOR M LApOPE55 Gltv ZiP PHONE LIGENSE• <br /> �V <br /> 7 <br /> CL�59 OF MOqK <br /> � NEW ❑ pDDIiION ❑ ALTERATION ❑ REPAIR ❑ DEMOIITION ❑ WOODSTOVE/Fii1+L INSERT ❑ BUILOINQ RELOCA710N <br /> IEN�Ni IMPpOVEMENT ON IMEPIOq REMO[fEL ONLY ppNll•C�PF.RSDN�NO PIIONE NO . <br /> fANtA�CTPRICEOFWORK �� � �� ��5a�'�. 1�;z•383t �SE�c-(klo��-�'a�l <br /> DESCPIBEWORR�NDSOU�RE OO�GEINVOLVEO C — ^ <br /> ��� JIZ� ���!� <br /> VRO EO U BUROINO ' <br /> /,n,� w�' I NEREBY CERLIFV THAT I HAVE READ ANO EXAMINED THIS APPLICATION AND <br /> •/���a•X KNO W THE SAME TO BE TPUE AND CORRECT.ALl PROVISIONS OF LAWS AND <br /> LEMl0E9C1vPl ON�11ROf'ERTY�SHDWN BEIOW OR A11eCN FOURLOP�[5� ORDINANCES GOVERNING THIS TVPE OF WORK WI�L BE COMPLETED WITH <br /> WHETHER SPECIFIED HEREIN OR NOT.iHE GRANTING OFA PEPMIT DOES NOT <br /> �or B�xK or PRESUMETOGIVEAUTHORITVTOVIOLATEORCANCELTHEPROVISIONSOF <br /> q' ANV OTIIER STATE OR LOCAL LAW REGULAiING CONSTRUCTION OR THE PER� <br /> OZ� ��Z'�/Ip FORMANCEOFCONSTRUCTION.THATIAMAUTHORIZEDBVTHEOWNEROF <br /> THIS PROPERTV 70 PERFORM THE WORK FOR WHICHAPPLICATION IS MA�E <br /> �� fG �.� AND 1 LOMPLV WITH THE STATE CONTRACTORS LAW 1827 RCW AND <br /> U J 296200 WAC. (/p <br /> BI(�(� -D�� D�D7 S�CN<IURE Of CONItUCfpqpp I1IRORIZ[D�GENi D�IE �I�Z��O O <br /> y-5o' s�. ►�� tU0 W¢tiE o(. ktlev� X <br /> AI�c1� fbti .a,,., <br /> PROJECTMDRESS <br /> 3qo3 SwuFu A�e GA/,C./�� �P�'��C�N CIi F SIICENSENOPN�OlI51NE55N4ME <br /> v�l P�1 f�'��� � <br /> PLUMBINO � a MECNIINICIIL <br /> � <br /> NO. PEOF FIXTURE OR ITEM FEE NO. TYP OF EOUIPMENT FEE <br /> WATERCLOSE7�TOILEn A/C-A/HNDLGUNITS-H.P. � <br /> BATHiUO FORCED AIR SYSTEMS-B.TU. M E0. <br /> LAVATORY�WASHBASIN) UNITHEATERS-B.T.U. M <br /> BHOWER CLOTHES DRVERS <br /> KITCMEN SINKB�ISP. VENTILATION fAN <br /> DISHWASHER RANGE HOOD <br /> LAUNDPY TRAV WqTER HEATER <br /> CLOTHES WASHER WOOD S70VE <br /> URINAL METAL FIREPLACE 8 CHIMNEY <br /> DRINKINO FOUNTAIN FIREPLACE INSERT <br /> FLOOR DRA�N HEAT PUMP <br /> BACKFLOW PREVENTERS GAS PIPING <br /> ROOF DRAINS-RAINLEAOERS E%IiAUST�AN <br /> SINK(SERVICE-BAR,EiC.) <br /> SUB TOTAL 5 SUB 707AL S <br /> � PEfildlT S — — - ��--_- -�PERMIT 5 <br /> TOTAL FEE S T07AL PEE S <br /> FBONTusTC9�CNn pE�f15EtB�Cn Si0E5El0eCR /� 4tt puNCNECK MBER �1� FEE 'I �C pECEIVTNO. <br /> � `�' S , �� l�w $8' �3 �o'/ � � �Q� <br /> usczor+E �oiene� vne ntsi e FEES VALUATION FEE <br /> C�Z �OOO � n�ES NO r, <br /> T'PEOFCAN51. OCGLP�NLVaROUP Np.OFOWEI.LIN0UN115 BUILDING u � <br /> AILOWABLFI�CtUAI <br /> _1] <br /> __�-�I _�__��'� J� PLUMBING <br /> 312EOFBL00 r�u.orsionies esuc occ�ono — <br /> ° MECHANICAL <br /> SIZ [d. _/ a� — ----- --- — <br /> uncr�iiiMn:�noN OTHER <br /> FIPESPRINRLEPSRWJIqEO ❑YES f O _ STAIEBUILDINGSURCHARGE ��+/� <br /> ✓_(� <br /> STATE ENERGV SURCHMGE <br /> APPLtC�T10N ACC BY PLAN$APPq.BV — <br /> PUBLIC WOFKS <br /> � �Y1 .� c,J� <br /> TOTAL � <br />