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� .�' '!'� . i <br /> + AF���.IG�ION �OR COI�IST�tI�TION <br /> P�E�M1'i° , 'i <br /> . fheEve:green ', . ;.'� <br /> CI7Y OF everelt <br /> ev�rett � ' ' <br /> BUILUING DEPARTMENT '� <br /> 25s-aeio TO BE COMPLETED IN INK— PLEA;E PRINT ; <br /> ow�$ N/Y/ � �� i.nooaes� �Q OX '�9.7cirr �` S��E/' P��o�3 g I <br /> .� Jr/rl / i� 1�� � <br /> � TENANT �dAi�qO�RESS CITY ZIF PppNE <br /> Gs3-aoas <br /> AHGHITECTOROESIGNEP MRILA�ORE55 GItV ZIP PHONE �I .. <br /> � GENERALLONiMCTOR MAILADDitE55 CITY ZIP pHpNE UGENSEx I ' <br /> Sa' me f fY�e.�[arll /80 �7 j <br /> MECMRN'CALCONTBACtOR MRILApDRE55 CITY ZIP PNONE LICENSE• <br /> PLUMBINQGUNTRACTOR MAIL�ODPE55 CILV ZIP PMONE LICENSE• �II <br /> . CUSSOFWOFN � , II <br /> � ❑ NEW ❑ ADDITION ❑ ALTERAiION ❑ REFAIR ❑ DEMOLIiION ❑ WOODSTOVE/FRPL INSERT ❑ BUIIDING RELOCATION 'i II <br /> TEN�NTIMPPOVEMENTOFINi[RIOHREMODELONLV CONiAGTFER50NANOPMONENO. . �. <br /> j �y �' <br /> � CANTNACTPqIf,EOFWORIE ��Sv� �� <br /> OESCF!BEK'OPKr1NO50UAflEFOOTRGEINV LV[ <br /> i ..Si 7.9' �< �e��n� �,y �� <br /> �, raow�s—eousEoPeuaovua IHEREBYCERTIFVTHA7IHAVEREA�ANDEXAMINEDTHISAPPLICATIONAND <br /> �. KNOW THE SA�dE TO BE 7RUE AND CORRECT.ALL PROVISIONS OF LAW6 AN D <br /> LEGRl0E5CRIPTIONOF PROPERLV�SHOWN BEL,W OIIAiTAGH FOUR PtES� ORDINANCES GOVE/iWING THIS Tl'PE OF WORK WILL BE COMPLETED WITH <br /> y ,�s L-��J_ WHETHERSPECIFIEDHEREINOR NOT.THEGRANTINGOFAPERMITDOESNOT <br /> �oi� owcK oF S�� ^_ PRESUMETOGIVEAUTHORITYTOVIOLFlTEORCANCELTHEPROViSION50F <br /> ANY OTN Er7 STA7E OR LOCAI.LAW REGULATING CONSTFiUCTION OR TH E PER- <br /> , FORMANCE OF CONSTRUCTION,THAT I Ah1 AUTHORIZED�Y THE OWNER OF <br /> ; THIS PROPf:RN 70 PERFOR1d THE WOHK FOR WHICH APPLICA710N�S MADE <br /> - AND I COMPLV WITH THE STATE CONTRACTORS LAW 1�27 RCVI AND <br /> I 296200 WAC. <br /> • ��� I � ��f� sic��nruneoFcor�rr+ncior,onnunwmzeoacer+r unre <br /> -- 5_ ,� sc-- � �a 8� <br /> � PR'JJEGD� RE� /0 �� �� ��� ____ � � <br /> � APPLICANiSGtvF)CyNE55lIGE SENO.N�DBl19NE55Nn1AE <br /> PLUM�ING MECHANICAI <br /> i NO. TYPE OF FI%TURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> � WATEFCLOSET�TOILEn ' NC-A/HNDLGUNITS-H.P. <br /> , BATNTUB /� FORCED AIF SYSTEMS-B.T.U. M EA <br /> . IAVATORY(WASH BASIN) - — UNIT HEA7ERS-B.T.U. M <br /> � SHOWER —� CLOTHESORYERS <br /> � KITCHEN SINK&DISP. �-) _� VENTILATION FAN _ � � i <br /> DISHWASHER �I " {I--- RANGE HOOD <br /> � LAUNDRYTRAY —f WATERHEATER <br /> ' CLOiHESWASHER 'rj � WOODS70VE <br /> � URINAL METAL FIREPLACE 8 CHIMNEY <br /> DRINKING FOUNTAIN FIREPLACE INSERT <br /> FLOOR DRAIN HEAT PUMP <br /> ' BACHFLOW PREVENTERS GAS PIPINC� <br /> ROOF�RAINS-RAINLEADERS EXHHUST FAN <br /> ' SINK�SERVICE-BAR,ETC.) <br /> SUBTOTAI 5 "i -� SUBTOiAL 5 <br /> . PERMIT S - PERMIi S <br /> TOTALFEE 5 L � � TOTALFEE 5 �� <br /> � Ffi0Ni5ET0AGK RENRSEIBAGN SipESEIpAGN PUNCN GRNUMOEli FE�--� ECEIP�NO. <br /> � yp ' 20 �y' � �f<<,�� 1 �'Z'l t�1.�C�' f <br /> , usEiorvE L0IAREA vncnNrsrt[ FEES VALUATION FEE <br /> l ❑YES ❑ NO <br /> ' R' I I�a BUILUING �-I`I � r _ •,'�J'� -W-�' <br /> � TYPEOFGONSL OCCUPANCVGROUP NG OFpWCLlIN4UNITS _ •{ <br /> ALLOWABLE/ACTURL �,I\ <br /> , PLUMBING � �I � � 1J <br /> 512EOF9LDG. NO.OFSiOflIES dSMI. OGGlONO /�rt /� <br /> n v MECHANICAL .-�� �� � <br /> ❑ N <br /> �i[im�rurairnnOr+ OTHER <br /> FIpESPFINNLERSREOUIqED ❑YES ❑NO jTATE BUI�DING SURCHAqGE "l L y � <br /> —+G�,li_S <br /> STATE ENEflGY SURCHARG[ J <br /> � I°� ,C? <br /> . APPLICAiIONACC.�Y FLANSIVP Y /�' ��l <br /> PUBLIC WONKS , <br /> , � TOTAL � � � <br />