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/�\ � II' <br /> APPLICio.�ION FOR CONSTI�I+.;T10N I <br /> PERMIT , <br /> Me Everyrean � '� <br /> CITYOF �vcrett i <br /> everett e <br /> BUILDING DEPARTMENT <br /> 259-88�0 TO BE COMPLETED IN INK- PLEASE PRINT <br /> OWNER � MAILADDRESS CItY ZIP PHONE <br /> � �( 16 P� S%�?lY'J EY£2e,�t <br /> . TEN�Ni MAILA�DFE55 GitY ZIP PHONE <br /> t3caD�; F��zuti� i <br /> FRCNITEGTOROESIGNER MAILADORE55 C�TY ZIP PHONE � <br /> W. i_-CCC�F� L�W 3 <br /> GENERALCONTRACTOR MAILpD�RE55 C�TY ZIP PHONE � LICENSEx � <br /> �vg2vrr��a. 2��,ai�erua,^��.-1 '��._.'l .�,,._kc�1 v "i. a �3-1�4-y E��2G��c�( n? <br /> MECH�NIC�LCONTRRCTOR TMAILqDOFE55 CIiY ZiP PHONE LIGENSE• <br /> PIUMBINGCONTRAQON MRILq00RES5 CITY ZIP PHOI.E LiCENSE+ <br /> C1A55 OF WORN <br /> 7 <br /> NEW ❑ AD�ITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOGDSTOV[/FqPL INSERT ❑ BUILDING RELOCATION <br /> TENAlJT IMPHOVEMENT OR INiEP.IOR REMO�EI ONLY CONiACT PERSON AND PHONE NO. <br /> CANTR�GTPRICEOFWORK [� � � d r)�qZ – I��� � — . <br /> OESCFI9E WOHK AND SOU�FE FOOTAGE INVOLVED � <br /> t <br /> � PROPOSEDUSEOFBUILDING IHEREBYCERTIFY?HATIHAVEREADANDEUIMINE�THISAPPLICATIONAND <br /> � KNOW THE SAME TO BE TRUE AND CORRECT.ALL PRO\'ISIONS OF LAWS AND <br /> LEG�L�ESCRIPTIONOFPROPEPTY�SNOWN BELOW OPATTRCH FOURCOFlE51 ORDINANCES GOVEFMING THIS NPE OF WOfiK WILL JE COMPLETED WITH <br /> �. WHEfHER SPECIFIED HEREIN OR NOT.THE CaRANTING OFA PEHMIT DOES NOT <br /> � PRESUME TO GIVE AUTHORITV TO VIOLATE OR CANCEL THE?ROVISIONS OF <br /> , �O7 B�ocK oF ANVOTHERSTATEORLJCALLAWREGULATINGCONSTRUCTIONORTHEPER� <br /> FORMANCE OF CONSTRUCTION.THAT I AM AUTHORI2ED BY THE OWNER OF �� <br /> THISPROPERTYTOPERFORMTHEWOPKFORWHICHAPPLICATIONISMADE � <br /> � AND I COMPLY WITH TIIE STATE CONTfiACTORS LAW 1827 RCW AND � <br /> 296.200 WAC. <br /> 7 SIGNATUPEOiCONTPACTOROFRUiNORREOAGENT DATE l, G L� SQ <br /> � /�\ ) U <br /> �i � \ (J��' <br /> PROJCCTAODR[SS � "� <br /> � APPLICPNTS GIiY BOSiNE55 UCENSE NO.ANO BUSINESS NAME <br /> � � � �� � �L Z.�� �P�� �i� . <br /> � PLUMBIN6 MECHANICAL <br /> �� NO. 7YPE OF FD(TUitE OR ITEM FEE NO. TYPE OF EQUIPMENT FEE ' <br /> j WATERCLOSETITOILET) A/C—A/HNDLGUNITS—H.P. <br /> BATHTUB FORCED AIR SYSTEMS—B.T.U. M EA . <br /> i LAVATORV�WASHBASIN) UNITHEATERS—B.T.U. M � <br /> SHOWER CLOTHESDRYERS � <br /> � KITCHEN SINK 8 DISP. VENTILATION FAN - <br /> DISHWASHER RANGE HOOD <br /> � LAUNORYTRAY WATLR HEATER <br /> �� CLOTHESWASHER WOOOSTOVE <br /> URINAL METAI FIREPLACE 8 CHIMNEY <br /> � DRINKING FOUNTAIN f,AEPLACEINSERT <br /> FLOOR DRAIN HEAT PUMP <br /> BACKFLOW Pi7EVENTERS GAS PIPING �— <br /> ROOF DRAINS—RAINLEADERS EXHAU�71'AN <br /> SINK(SERVICE—BAR,ETC.) <br /> SUBTOTAL $ SUBTOTAL SI <br /> � PERMIT $ PERMIT 5 <br /> TOTAL FEE $ TOTA!.FEE 5 <br /> FFONTSET&1CK REAHSETBACN SIUESETBACK PLANCNECNNUMBEfl FEE qECEIPTNO. <br /> JSEZONE �OTRREA VACANTSITE FEES VALUaTION FEE <br /> ❑VES l] NO - <br /> BUILDING <br /> ttPEOFCqNST. OCGUPr1NCYGROU? NO.OFOWELUNGUNITS <br /> �LLOWABIE/RCTOAL <br /> PLUMBING <br /> SIZEOFB�DG. NO.OFSTORIES OSMT. O[GLOAD <br /> ❑ Y MECHANICAL I <br /> ❑ N —'_ {_ <br /> HEIGMTLIMITATION OTHER I <br /> FIRESPflINKlER5RE0UIRE0 ❑YES ❑NO STATEBUILDINGSURr,HARGE <br /> 9TATE ENERGY SURCHAHGE <br /> APPUCATIONRCC.dY PLAYSr1PPP.BV �— -- <br /> (,� 'A� � PUBUC WORKS <br /> ���r� <br /> 70TAL <br />