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1���� <br /> , APPLIC ` IOW FOR CONSTR ''''� TION <br /> PERIVIIT <br /> '�e Evorpreen <br /> �� GTYOF everett <br /> ; ever�tt � <br /> 4 BUILDING �FPARTMENT <br /> a 259-8810 TO BE COMPLETED IN INK-- PLEASE PRINT <br /> �WNER MAILA00liE55 LIiY ZIP PIIONE <br /> herv� �nn PC�o�o�s� lo ri s-io`"�`��2 s� E�eretf" � 8ao� ��� -a8 �o <br /> ' TENRNT MAILAODRE55 QtY 21P PHONE <br /> PHCNITECTOP�ESIGNER MRILAODRE55 LRY ZiP PMOHE <br /> OENEFALCONiRRCTOR ` - MA4AO�RE55 GITY ZtP PMONE UCENSE� — <br /> � J 4d.i���.J1 'u��� <br /> MECMANICALG TRAGTOR MGIL/ODRE55 CIiY 21P PMONE ,1..66SE• <br /> .���1� <br /> � PLUMBNOLUNTRACTOR MAILADORE55 GIiV ZiP PIIONE UCENSE� <br /> CLAS90F WOPR <br /> � NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITIGN� YlOO�STOVE/FRPLINSERT ❑ BUILDINGRELOCATION <br /> � ENANTIMPPOVEMENIOFINiER10RREMOOELONLY C NiACiV[RSONRNpP110NEN0 <br /> W NTRACT PRICE OF WOFK <br /> . DESCRIBEWOPKRND$OUAREi00TAGEINVOWEO — — <br /> I � � <br /> ap PO,S�EJ,U^EaFoui�oi IHERC-BYCERTIFYTHA7IH�VEREADANDEXAMINEDTHISAPPLICATIONAND <br /> � ��--1/L KNOWTHES�METOBETRUEANDCORRECT.ALLPROVISIONSOFLAWSANL' <br /> � �� ORDINAIJCES GCVFR�J:NG THIS TYPE OF WOHK WILL BE COMPLETED WITH <br /> LEOALOESCRIPiIONUFPPOPERIVISNOWN9ELOWORAIiACHFOURCOPIES� yyHETHERSPECIfIEDHEREINORNOT.THEGRANTINGOFAPERMITDOESNOT <br /> PRESUME TO GNE AUTHORIN TO VIOLATE OR CANCEL THE PROVISIONS OF <br /> ' loT e�oCK �F APf�OTHERSTATEOP.IOCALLAWREGULATINGCONSTRUCTIONORTHEPER• <br /> ' PUf+�AANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE OWNER OF <br /> . Th;15 PR(�PFR7"YTU PERFORM THE WORK FOR WHICH APPLICATION IS MADE <br /> —. -- AND I COMPLY WITH THE STATE CONTRACTORS LAW 18.27 RCW AND <br /> �, 2g6200 WAC. <br /> ' SIGNALUREOFCONtliAGiORONnUi110RIZEDAGEFi OAiE <br /> /\ <br /> � PFOJECTPODRE55 — "�—��-'--'--" ' — <br /> � � A'.'LiC�CTSCIiV�U51N655LI�:cNSLNO.ANpBUSiNE55NAME <br /> � � <br /> � PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TURE OFi�TEM FEE NO. TYPE OF E�UIPMENT FEE <br /> � WATERCLOSET(TOILE'f) _ A/C—A/HNDLGUNITS—H.P. _ �. <br /> BATHTUB _ FORC[D AIF.SYSTE!v1S—B.T.U. M EA <br /> , LAVATORY�WASH BASIN) ' UNIT HEFTEFiS—�.T.U. M __ _ <br /> SHOWER CLOTHESDRYERS _ �, <br /> KITCHEN SINKB DISP. VENTILATION FAN '', <br /> , DISHWASHER FtAN�E HOOD . <br /> LAUNDRYTRAY WATER HEATER . <br /> CLUTHES WASHER ( V�ppD STOVE �� <br /> � URINAL METALFlREPLACEBCHIMNEY <br /> - DRINKING FOUNTAIN FIREPLACEINSERT . <br /> �� FLOORDRAIN HEATPUMP <br /> � BACKFL'JW PREVENTF_RS GAS PIPING <br /> ROOF�RAINS—FAI NLEADERS EXHAUST FAN <br /> � SINK�SEFlVICE—BAR,ETC.) <br /> SUBTOTAL $ SU6TOTAL $ <br /> � PENMIT S PERMIT 5 <br /> � TOTAL FEE S TOTAL FE[ 5 <br /> FRONTSEiBAGK fiENRSETBAGN Si0E5EtBACK VUNCNECKNIIM6E0 FEE �ECEIfTNO. <br /> . uSeioNe LOTPREA WGANTSILE FEES VALUATION FEE <br /> [] YES C] ND � <br /> TYPEOFCONST. OGCUPANCYGRDOP ND.UFDWELLINGUNIIS BUILDIIJG -- _ <br /> qLLOWABL&RCTUA� PLUMB W G <br /> . E12EOFBLDO. NO.OFSIORIES ESlAT. OCC�OAD <br /> , o v MECHANICAL <br /> ❑ N — " <br /> MEIGIRLIMIIATION OTHER <br /> FIRESPRINNLERSREOl11fiE0 ❑YES ❑HO <br /> STATE BUILDING SURCHARGE <br /> STATE ENERGY SURCHARGE <br /> APPJCNiIOtIAGC�'! PLPNSRPPR.B� . <br /> PUBLIC WORI:S <br /> TOTAL <br /> — _� <br />