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� F.:.a <br /> � APPLIC1�-f10N FOR CONSTRI�TlON <br /> PERNIIT <br /> ! the Ere�preen everett <br /> CITY OF � <br /> ; ev�rett <br /> ; BUILDING DEPARTMENT g1 I,,� ^ 7 <br /> � 269• 10 �M"j�' ���5 Tf ���COM��E�� INFS,-�C�W6'N`YV1Ft � ��-U� � / <br /> i Vf/I <br /> ER. MALLNCOPESS O�LY 21P INONE <br /> � �/1�1'1�1 ��� �I�PZN'�_—�� �t���- w� b rg� y�f 7 <br /> - JEW:NT M�Ilrl pRE55 If ZIP PHONE <br /> � /ACMITELiORUE5IGNER MAILAOO�E55 CIfY ZIP FNONE <br /> OENEMLCOYTN�CTOR MMLADORE55 GItY ZIP PHONE LICENSE• <br /> � <br /> 1 <br /> M CM�NIC�LGONTHr1ClOR MRILhODRF'.S GItY ZIP PHONE LIGENSE� <br /> PLUM61NaGONTpACTOR M/ILRD�RE55 CiIY ZIP PHONE LICENSE� <br /> . CLA390FWORN <br /> , ❑ NEW � ADDITION ❑ ALTERATION ❑ FEPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL INSERT ❑ BUILDING RELOGATION <br /> IENANTIMPROVEMENT OR INLEP10�1 REMOOEL ONLv CONiPCI PF.RSON AND PIIONC NO <br /> CANTRACT PRICE OF WORK <br /> � OESCRIBEWORKAN^.30U�REFOOtAGEINVOLVEO <br /> ��uwt�,� <br /> � PFOP09EDUSEOFBUILOINO IHEREBYCER7IFVTHATIHAVEREADANDEXAMINEDTHISAPPLICATIONAND <br /> T! I� nr � J117 2� _ Kf:OWTHESAMETOBETqUEANDCORRECT.ALLPROVISION50FLAWSANO <br /> LEOI�L UES PIPiI N OFPR � ER /SMOWN BELOW OPAiTRCH FOURGOPIESI ORDINANCES GOVERNING THIS NPE OF WORK�!ILL BE COMPLETED WITH <br /> WHETHERSPECIFIEDHEREINORNOT.THEGRAN?IN;OFAPERMITDOESNOT <br /> PRESUME TO GIVE AUTHORITV TO VIOLATE OR CANC=L THE PROVISIONS OF <br /> � LOT elocK oF ANYOTHERSTA7EORLOCALLAWREGULATINGCONS'IRUCTIONORTHEPER• <br /> ? FORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZt:D BYTHE OWNER OF <br /> � THIS PROPERN TO PERFORM THE WORK FOFi WHICH APPLICATION IS MADE <br /> •� AND I COMPLY WITH THE STATE CONTRACTOR� LAqW 1827 RCVd AN <br /> 296.200 WAC. y��/� <br /> SIGNPTUREOFCONiPRG10RORPUiHOB2E0AGENT OFTE � —��j <br /> , I I L� I� I°� S�i ,4'.� � S f �� f'J X � PlT- `� �-"dl.� S <br /> PHOJECTAODRESS ��� � ��� qPPLICANiSCITYdUSINESSLICENSENO.ANOBUSINE55NAlAE <br /> �/ <br /> � PLUMBIN6 MECNANICAL <br /> � NO. TYFEOFFIXTUREOflITEM fEE NO. TYPEOFEOUIPMENT FEE <br /> �� WATERCLOSET(TO�LEn A/C—A/HNDLGUNITS—HP. <br /> � BATHTUB FORCED AIR SYSTEME—fiT.U. M EA <br /> LAVATORY(WASHBASIN) �_ UNITHEATERS- 0.7.U. M <br /> SHOWER _ CLOTHESDNYERS _ <br /> KITCHEN SINKB DISP. VENTIlAT10N FAN <br /> ! DISHWASHER RANGEI100D _ <br /> • LAUNDRYTRAY WATERHEATER <br /> � CLOTHESWASHER WOODSTOVE <br /> URINAL METAL FIREPLACE 8 CHIMNEY _ <br /> ,� DRINKINQ FOUNTAIN PIREPLACE WSERT <br /> i FLOOR DFAIN HEAT PUMP <br /> ' BACKFLOW PREVENTERS GASi�PING <br /> ROOF DRAINS—RAINLEADERS E%NAUST FAN _ <br /> , SINKISERVICE—BAR,ETC.) —_ <br /> SUBTOTAL 5 SUBTO7A! S <br /> � PERMIT 5 _ PERMIT 6 <br /> . TOTAL FEE E TOTAL FE[ S I <br /> � FRONTSET94GK RE/RSEi8r1CN SIOESET9AGY. PUNCNECKNUMBEN FEE AECEIPiNO. I <br /> USEioNE LO:NBEA VACANLSIIE FEES VALUATION FEE <br /> n ves n r+o I <br /> BUILDING � <br /> TYPEOFCANST. OGCUP�NCYGROUP NDAFpWELLING1N115 <br /> 0.LOWABLE/ACTU�L PLUMBING � <br /> BREOFBLDO. NO.OFS70filE5 BSA11. OGCLONO I <br /> � ❑ y MECHANICAL � <br /> ❑ N <br /> ' NEIGNILIMItAiION OTHcR _ <br /> FIPESPPINN�ERSREOUIRED ❑YES ❑NO STATE BUILDING SURCFIARGE <br /> ' STATE ENERGV SURCHARGE <br /> �PPLICATIONAGGBY PLFNSAFPR.BY PUBLICWORKS <br /> 'i OTpL <br /> I <br />