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� <br /> APPLICA�ION �OR CONSTRIr�:T10N <br /> PERMIT <br /> fhe Ewrpreen <br /> CITY OF everett <br /> ev�erett e <br /> BUILDING DEPA�3'fMENT <br /> 259-8810 TO BE COMPLETED IN INK— PLEASE PRINT <br /> �g�y�q M�IL�DORE55 CIIY ZIP PHONE <br /> � <br /> ���0� � l K-LA..�IT�AIANRO ��L L�O���� GIT� � q, vl.��r PHONE �53-4`739 <br /> �� <br /> ARCNITECTORDE316NEP M�ILAUORE55 j C:TY ZiF MHONf <br /> OENEfULCONiRhC7UP �ILADDRESS GITY ZIP PHO��TU1�{J/��ffOP{�- <br /> MECYI�NICALCONTMCTOF �"` t, �� DD �. CITY ZIP SHONE LICENSE• <br /> �sa �C1 Q <br /> e <br /> PLL'M&NOCANTPACfOR CITY ZIP PHONE LIGENSEs <br /> QA880FNORN '. <br /> ❑ NEW ❑ ADDITION ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOUDS70VFJFqPL INSERT ❑ BUILDING REIOCATION <br /> � � ''� 7ENNITIMPROVEMEMOFINTERIORREMOOELONLY �ANTACTVE�DPNONENO �+ <br /> CONTR�CTPNICFOFWORk � • �v <br /> DEBCRIBEWOPK�ND90UMEFOOTMiEINVOLVED � v�,— I <br /> r-,a,c �P�P i �J �o <br /> I f rnoroseouseoreuaar+o IHEREBVCERTIFYTHATIHAVEREADANDEXAMINEDTHISAPPLICATIONAND � <br /> �� ! �, �'��� KNOWTHE3AMETOBETHUEANDCARRECT.ALLPROVI810NSOFLAWSAND <br /> LEMLDE9CRIPTIONOFPROPEHfY�5MOWNBEIOWORATf�CNFOURGOGIE3� ORDINANCESGOVERNIN^uTHIS7VPEOFWORKWILLBECAMPLEfEDWITH <br /> �. W HETHER SPECI FIED HEREIN OR NOL THE GRANTING OFA PERMIT DOES NOT <br /> �� �� PRESUMETOGIVEAUTHORIT/TOVIOUTEORCANCEITHEPqONSIONSOF <br /> . . � lor e�ocK ov ANVOTHERSTATEORLOCALLAWREOULATIN�CANSTRUCTIONORTHEPER• . <br /> FORMAh;CE OF CONSTRUCTION.THAT I AM AUTHORIZED 3Y THE OWNER OF <br /> i THIS PROPERTYTO PERFORM THE WORK FOR WHICH AP?LICATION IS MADE <br /> . � ANC I COMPLY WITH THE 3TATE CONTRACTOHS lAW 1827 RCW AND <br /> � � 296200 WAC. <br /> � - � SIGN�TIIFEOFCONTMCTOROR�UTHONRED.UlENT DRE <br /> . . PBOJECTADDRE99 ^ �_ � �p I�ANTSCRV9U51NE55LICE�.ANOBJSINESSN�ME //���/ <br /> .. . �I l ' • '�� <br /> PLUMSINO MECMANICAL <br /> 1q, TY�L OF flXTURE OR ITEM FEE NO. 7YPE OF EOUIPMENT FEE . '�,,, <br /> WATER CL08ET(TOILEn q/C—MHNDLG UNITS—H.P. �,, <br /> ��. BATHTUB FORCED AIR SYSTEMS—&T.U. M EA ', <br /> � LAWTOFY(WASHBASIM UNITHEATERS—&T.U. M ' <br /> � $HOWER CLOTHESORYERS <br /> KITCHEN SINKB DISP. VENTIUTION FAN , <br /> OISHWA3HER RANQE HOOD ',. <br /> LAUNDRY TRAV WATER HEATER '� <br /> CLOTHES WASHER WOOD STOVE _ � <br /> � URINAL METALFIREPLACEBCHIMNEY <br /> URINKINO FOUNTAIN FIREPLACEINSERT <br /> FLOOR DRAIN HEAT PUMP � <br /> BACKFI.OW PREVENTERS 6AS PIPING <br /> ROOF DRAINS—MINLEADERS EXHAUST FAN <br /> 91NK(SERVICE—BAR,ETC.) <br /> SUBTOTAL S SUBTOTAL S <br /> PERMIT S PERMIT S <br /> TOTALFEE S TOTALFEE S � <br /> FpONT8ET9�CN PEARSETB�CK SIDESETBI�CK PUNCHECKNUM9ER FEE NEC[IPfNO. <br /> uSezOnE LOTAREA WGNT5ITE FEES VALUATION FEE <br /> ❑YES ❑NO <br /> BUILDING <br /> TYPEOFCONST. OCCUPANCYOROUP NO.OFDWELLINOUNITS <br /> w��'���A� PLUMBIUG <br /> sizEOFe�oo. NOOF870NIE9 OMT. OCGLO�U MECHANICAL <br /> ❑ N <br /> NEIGMTLIMITFTION OTHER <br /> FINESPRINNLERSREIXIIPED ❑YES ❑NO STATE BUIL�ING SURCHARGE <br /> STATE ENERGY SURCHARGE <br /> APPLICATION�CGBY PL�NSAPPR.BY PUBLICWORKS <br /> TOTAL <br />