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'� -> , <br />' APPLICI�iION FOR CONSTRI �TION <br />PERMIT <br />� the Everpraen � everett <br />� CITY OF <br />; everett e <br />BUILDING DEPARTMENT <br />259•B810 TO BE COMPLETED IN INK— PLEASE PRINT <br />OWNER MNILADORE GiiY ZiP � PHONE , � <br />�� YY1a-f� 13ti���t2-5, �.r�C M4n,y�.,.1�e, 1,vy (a53-zo5-S <br />; TEN�NT MRILR DRESS CIiY ZIP PIIONE � <br />�� �rq�,M�+ITECTOR(O'E�SIdNER n ,,- M�ILA�ORESS �i1Y 21P PNONE <br />' ` `� 1✓ � N�I�dW.� �►�C � l / • /( / • � � <br />OENEMLCONTR TOR MRILRDDRE55 CIiY ZIP PHONE LICENSE� <br />;(��tJ'U� w\&�cn.>, p� (3oX $( �� i`(�a►2���.11e k7� D13UZ�� l51 <br />� MECH�NIC�LCONTRRCTOH ML�OORE55 CITY L PMONE LICENSEf <br />,, n �^0. �. <br />� PLUMBINGCONTRACiO`�` MyL,p�E�� ��� ����` u\11[y�P � PHONE LIGFNSE♦ <br />; tha-O 3 \�� �� .,— � _ <br />'� CLlSSOFWORK <br />� � NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMrO�LITION OODSTOV NPL INSEfii ❑ BUILDING RELOCATION _ <br />� EN�NTIMPFOVEMENTORIMERIORNEMODELONIY J� �v CONiA NDPIIONE�NQ\ � <br />, GDNTR�GTP8ICEOF WOFk � J�� � � • �• ' ' ./� <br />DESCHIBE WOHN FND SOUARE FOOT�GE INV[�LVED <br />cw 125� s • (oS3- �'sS Cm�.rt�so:llc) <br />raoroseDUs F6UILOINp IHEREBVCERTIFYTHATIHAVEREADANDE%AMINEDTHISAPPLICATIONAND <br />, S ( KNOWTHESAMETOBETRUEANDCORRECT.ALLPROVISIONSOFLAWSAND <br />—! ORDINANCES CaOVERNING iHIS NPE OF WORK WILL BE COMPLETED WITH <br />LE(LILDESCFIPiIONOFPflOPEN7Y15HOWNBELOWORAtTRCHFOURLOPIES� � WHETHERSPECIFIEDHERE�NORNOLTHEGRANTINGOFAPERMITDOESNOT <br />� � PRESUMETOGIVEAUTHORITYTOVIOLATEORCANCELTHEPROVISIONSOF <br />• �oT B�oCK or ANYOTHERSTATEORLOCALLAWREGULATINGCONSTRUCTIONORTHEPER- <br />, �eC �� 1 w p � �' - FOFMANGE OF CONSTRUCTION. THAT I AM AUTHORIZED BYTHE OWNER CF <br />THIS PROPERN TO PERFOPM THE WORK FOR WHICH APPLICATION IS MADE <br />,��-- AND I COMPLY WITH THE STATE CONTFACTORS LAW 1827 FCW AND <br />i /1 � � �.. _ � ����� 296200WAC. <br />i.! ; C� SIGNR1tIRE0FCONLRRCiOPORFUINORI2EDA Nt OATE <br />� �r y' °79 - ��� � �� � �`�� <br />' PROJECTADDRE55 pE ICANiSCITYBUSINE55LICENSENORNOBU51NE55N E <br />� PLUMBING MECHANICAL <br />t NO. TYPE OF FIXTURE OF ITEM FEE NO. TYPE OF EOUIPMENT FEE <br />WATER CLOSE'. (TOILEI) A/C – A/HNDLG UNITS – H.P. <br />BATHTUB � FOfiCED AIR SYSTEMS– B.T.U. M EA <br />LAVATORY(W�1SH BASIN) � UNIT HEATERS– B.T.U. M <br />�� SHOWER CLOTHESDRYERS <br />� KITCHENSI�IKBDISP. � VENTILATIONFAN � <br />� DISHWASHFR �' RANGEHOOD <br />' LAUN[�ryTqpy WATERHEATER <br />GLOTHESWASHER � WOODSTOVE � <br />j URINAL METALFIREPLACEBCHIMNEV <br />DRINKING FOUNTAIN FIREPLACE INSERT <br />FLOOR DRAIN HEAT PUMP <br />• BACKFLOW PREVENTERS GAS PIPING <br />. ROOF DRAINS– RAINLEADERS EXHAUST FAN <br />SINK �SERVICE – BAR, ETQ) <br />i — — <br />� ���..-,...� : � � — SUEITOTAL 5 _ i . <br />' FHONTSEfBFC` f1EA <br />�� <br />EZON'c LOt <br />���� �� <br />' ttPEOFCONST. OCCI <br />�LIOW�BLE/�CTU�L <br />�i �' ti <br />SIZE OF BLD�. / N0. C <br />d' l/ZFi <br />33Ce <br />FIRESPRINNLEPSREOUIRED ❑ YES <br />J <br />PEFMIT $ <br />TOTALFEE S <br />RSETBACH ' SIC <br />�� <br />RBEA VAf <br />-- � x <br />i7•3 <br />v <br />� w <br />❑ NO <br />PERMIT <br />� FEES VALUATION <br />eui�oiNc S /+ � g 8 <br />PLU�ABING <br />MECHANICAL <br />OTHER _ <br />STATE BUILDING SUHCHARGE <br />STATE ENERGI' SURCHARGE <br />PUBLIC WORIiS <br />TOTAL <br />�_ <br />ECEIPf <br />a <br />