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� APPLIC�i�.��ION FOR CONSTRl�T10N <br /> PERMIT <br />��� Iha[very'reen <br />}�": ; CITY OP everett <br />� ev�rett e <br /> '•',% �� BUILDING DEPART�dENT <br /> ',,� 259•8810 TO BE COMPLETED IN INK— PLEASE PRINT <br />�F,�^ pWNER MA1 ��DRESS . GItY �� ^�IP ��ONE � <br />�; �l� �o ��hs�� vc �ion 17U� X 1 �" ��• ��D/7�4 Iq� 5� <br /> TEN�NT MAIIA�ORE55 CItY ZIP P10 <br />'.'; �t/m-�o <br /> — <br />•��1 �RCHITECTOPOESIGNEH � MRIIACDBE55 LIIY ZIP PHON� <br />�.'�'� (�in-C.cv�- 4 N�-O�� <br /> ➢_.' GENEFALGONTR�CTOfl / ����� � DOliESS GIiY ZIP PHONE LICENSE� <br /> ��0}I <br />�•].y .. r/A /nf•D <br /> .'u�s�i�� <br />���:�� MECH�NIC�LCONIRI� O MR4AO�RE55 GItY ZIP PNONE LICENSE� <br />��'' ' �v�P• <br /> ��- � PLUMBINOCONiRAGTOR MAI��UDRE55 Ci:v ZIP PIIONE UCENSE• <br /> ' ��n o- �-n-,�.�%��_ .��.�`�c��� u�o��n�IO <br /> C1A930F WORN <br /> 1 �- ❑ NEW ❑ A�DITION ❑ AL7ERATION ❑ REPAIq OEMOLITION ❑ WOOOSTOVE/FRPL INSERT ❑ BUILDING RELOCATION <br />�, TENANTIMPROVEMENfORINTERiOqPEMODELONLY �- CONIACLPERS�NPN�PHONENO <br />/'. <br /> f:,-..�. � CANTP�CTPRIG[OFVIORK <br />�p� IBEWORK�NOS URPEF OTAGEIN OLVEO <br /> U:.' � � �Pl�� ��� <br /> 4� PR Po9 OU9EOF6Ui OINa IHEREBVCERTIFYTHAIIHAVER�ADANDExAMINEDTHISAPPLICATIONAND <br /> 3&.:.��.� � oC i� KNOWTHESAME70BETRUEANDCORRECT.ALLPRJVISIONSOFLAWSANO <br /> Z� �-�t ORDINANCES GOV�RNING 71i15 TYPE OF WORK WILL BE GOMPLETED WITH <br /> f�: ,Y , LEOALOESCRIPTIONOFPPOPERIY�SIIOWNBELOWORRRRCHFOURCO�'IES� WHE7HERSPECIFlcOIiFREINORNOT.TFIEGRANTINGOFAPERMITDOESNOT <br />�';'� PRESUME TO GIVE AUTHpqITV 70 VIOLATE OR CANCEL THE PROVISIONS OF <br /> p.j, �. LOT BIOCK oF ANYOTHERSTATEORLOCALLAWREGULATINGCONSTRUCTIONORTHEPER� <br />� L�1 A U 1 � � ��d�_ FORMANCE OF CONSTRI�CTION.THAT I AM AU7HORIZED 9YTHE OWNER OF <br /> ry':_ ' 7HIS PROPEFTV TO PERFORM THE WOFK FOR WHICH APPLICATION IS MADE <br />{;;.;,. . --/ � l.ND I COMPLY WITH THE STATE CONTRACTORS LAW 18.27 RCW AND <br />,l , �� � � 296.200 WAC. / <br /> --� �^ � Q� SIGNR1UfiE0 ONIBACIOROBAU�HOFI2EOAGENT DRTE y/27 8y <br /> y �. .� ^ //L^Cs����jd��§ <br />��.�.�. PROJECTADCnFSS <br /> , I�O^ I � ^ �/ � /�^ . APPIIGANTSCItYBUSIN[SSUCENSENO.r1N USINESSNRME <br /> '� ^ �.� � \ S• <br /> � n GJ li <br />' . <br /> PLUMdING MECHANICAL <br />�� J NO. TYPE OF FI%TURE OR ITEM FFE N0. TYPE OF EOUIPMENT FEE <br /> 'M1 WATERCLOSET�TOILEn A/C—A/HNDLGUNITS—H.P. <br /> i BATHTUB FORCED AIR SYSTEMS—B.i.U. M EA <br /> ; LAVATORY(WASHBASIN) • UNITHEATERS—B.T.U. M <br /> � SHOWER CLOTHESDRYERS ___ <br /> .j KITCHEN SINKd DISP. VENTILATION FAN <br /> ��j DISHWASHER __ RANGE HOOD <br /> J LAUNDRVTRAY WATERHEATER <br /> ! CLOTHES WASHER WOOD STOVE _ <br />- � � URINAL METAL FIREPLACE 8 CHIMNEY <br /> _ f� DRINKING FOUNTAIN FIREPLACE INSERT _ _ _ <br /> - � FLOOR DRAIN HEAT PUA1P <br /> � _—__— <br />. . ! BACKFLOW PREVENTERS GAS PIPING <br />�� ,. ,� ti00F DRAINS—RAINLEADERS __ E%HAUST FAN <br /> SINK(SERVICE—BAR,ETC.1 <br /> r�,'.��� ' — <br />�� <br />���.� . —— —_ <br /> 1��,,�. SUBTOTAL S __ _ SUBTOTAL S <br /> i�,. PERMIT S __ PERMIT S <br /> � • TOTAL FEE $ T07AL FEE S <br />�'`,-,' ' FRONiSETBACN HERPSEiBACK SID[SELBNGN PU1N CHECY.HUMBEII FEE PECEIPiNO. <br /> r" <br /> I <br /> I <br /> � USE20NE LOiAREA VRGNNi51iE ��C VALUATION FEE <br /> ❑YES ❑NO -- <br />�-� — BUILDING <br /> - TYPEOFCONST. OCCUPANLYGlIOI1P NO.OFOWEILINGUN1i5 I <br />�:, i ALLOWABLE/0.CTUAL PLUMBING i <br /> i SIZEOFBLDO. NOAI'SIORIES �syr occio�o M[CHANICAL <br /> ' n r+ <br />� � MEIGMtLIMITRIION OTHER <br /> i , iIf1E SPRINNLERS REOUIPED ❑VES ll NO STA7E BUILDING SURCHARGE <br /> i � <br /> , STATE ENERGY SURCHARGE <br /> ;i APGLIC�TION�GG OV PLRNS�PPP.BY <br /> PUBLIC WORKS <br />'+'�� � '� TOTAI .. <br /> .. . . ... . . ., .. . , , . . _ . . <br />�� •..r....a a:,..,-n,.. �- ...,, „ .. :. . . .. . .� . .., . . . ..�.s . .-. � . �. 1. . .,� <br />