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� I�i► <br />APPLICAT��DN FOR CONSTRUC i ION <br />PERMIT <br />Me Everprnen <br />ciTr or <br />everett <br />ILDING DEPARTMENT <br />everrtt <br />e <br />9U <br />259-BBtO TO BE COMPLETED IN INK — PLEASE PRINT <br />ONN P MMLM1U111..5 GIIY LP 1910NC <br />{�aul L.owc-t� 2Sc)Q�Trn.� la� L)r�-- �veReii' 9Qi2o3 353 135�i <br />�EN�w� � Mrainuuncss — r.irv rm r�wrv[ <br />•pCNOEGI0ODE510NC11 M�IL�O1111[55 GfY 21P MIONE <br />GENCF�I.CONiR�f.tOR M�IL�OOR[SS CIIY ]IP PNONE IILENSE• <br />MEGN�NIC?LCONiP�C1UR M�II �OIIR[55 GIIY IIP P�IONE IICENSE • <br />(�e'��cAblc� 5���1�'1e_{a\ Ily�{'{ �2�� r!C j<;rtkla.�,�� 9SUi3 _4�Z3hE�6"� <br />PLUMBINOCONbUG10R M�IL�OU�[55 Ci�Y l�l` �'��ONE , tif,[NSE� <br />Rc-��-�5-�►iti-3�KS <br />�i cusso�wonn <br />G 4EW ❑ �DDITION rS. A���RAT�ON ❑ REPAIR ❑ OEMOLIIION ❑ H'OODS70VE/PRPL INSGR7 ❑ UUI�DING REIOCAT10N <br />TEN�Nt IMPROVEMFNI OO iN1EA�011 PCMO01 L ONtY CONI/�Gf PC1150N GND 1`110NE NO <br />I CONtRAGTPRICEOfWOfiN _ �— ---- <br />1 lvv..�..� <br />'�1ace me�t o -u�z�,ace f <br />rosev use er eunoiwo <br />S� �CSIC�et�CC <br />IEO�I OESCPmiiON Of VRO�ERtt ISN�'H PCLOW 04 <br />ioi niocK or _ <br />2So� Taylo�e n� <br />PLUM�INU <br />Np, T/VE OF FIKTUNE OR ITEM <br />WATER CLOSET (TO�LE1) _ _ <br />BATHTUB __. <br />UV�TORV ryJASM BASINI <br />SHOWER <br />KITCMEN SINN 8 DISP. <br />DISHWASHER <br />LAUNDRVTRAY <br />CLOTMES W�SI'ER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />ROOF DRAINS — RAINLEADERS <br />SUB TOTAL <br />PERMIT <br />TOTAL FEE <br />���pWABLF/ACTU�L <br />OY <br />L] N <br />i1RE5�'RINNLERSRE0111RE0 ❑ Y[5 ❑ NO <br />FEE <br />E <br />E <br />❑ Y[5 ❑ NO <br />I HEREBV CERTIFY THAT 1 HAVE READ AND E�AMINEU THIS RPPIiCAiION AND <br />KN0IVTNESAMETOBETRUEAN�CORRECi.ALLPROVISIONSOFLAWSAND <br />OROINANC[5 GOVERNING TH'S TYPE OF WOf7K WILL BE COMPLETED WITH <br />W H�THER SPECIFIED HEREIN OR NOT. TME GRANTING OFAPERMIT DOES NOT <br />PRESUME TO GNE AUTHORITV TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHER STATE OR IOCAL LAW REGULATING CONSTFUCTION OH 7HE PER- <br />FORMANCE OF fANSTRUCTION. THAT I AM AUTHORIZED BV TNE OWNER OF <br />THIS PROPEPttTO PERFORM TNE WORK FOR WHICH APPUCATION IS MADE <br />AND 1 COMPLV WIiM THE STATE CONTRACTORS LAW 18.27 RCW AND <br />zee zoo w.�c. <br />sicruiuneor ornnncmnnunumonizcoece A*E <br />x if�"Y �'��,a�/ /`J/_' _ �l�i� <br />MECNANICAL <br />A/C— A/HNULG UNIiS— H.P. <br />FORCED AIR SYSTEMS— B.TU. M <br />UNIi HEATERS— B.TU. M <br />CLOTHESDRVERS <br />RANGE <br />�L FIREPLACE 8 <br />PLACEINSERT <br />PUMP <br />PIPING <br />\UST FAN <br />� L4R— <br />,s otne <br />TOTAL <br />BUILDING <br />PLUMBING <br />MECHANICAL <br />OTl1ER <br />51ATE OUILDING SUfiCHARGE <br />STATE ENERGV SURGHARGE <br />PUBLIC WORKS <br />TOTAL <br />S <br />FEE <br />� <br />Cb7 <br />