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�. � <br /> APPLICA�ION FOR CONSTRV�TION <br /> 1 PEFiIVI1T <br /> � fhe<<ergreen everett <br /> CITY OF <br /> everett � ; <br />� ' BUILDING DEPARTMENT ', <br /> 259•8810 TO BE COMPLE fED IN INK— PLEASE PRINT 3� z �i�r <br /> OWNER MMLAOOFE55 CIfY 26' PIIONE <br /> �AG/F/C �'uTS f C� S'7'CFS �G�ST �'7 Z�� N � l�iC-/`�7/-l�iV 3LVQ�ZC'7�- <br /> � 7ENANi • MAILApORE55 CIiY Zln PIIONE <br /> /srac,> �a ,v, l,�,a `�Boz� <br /> ARCHITECTOROESiGNER ��A�IRODI1F55 CI1Y ZIP PIIONE <br /> OENERAL WNifi�CiOR MAp 4DURE55 GIIY ZIP PIIUN[ ULENSE• <br /> O H/�(� �C — �i1F C'/FNC /� <br /> MECH�NICALGONiRACTOR MR'1�00RE55 CIIY ZIP PHONE LICENSE♦ <br /> � PLUMBINOCONTRACTOR MAILAOOPESS CItY 21P PIIONE 4LENSE• , <br /> CLASS OF WORK <br /> �.I NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ OEMOLIiION ❑ WOpDSTOVE/FRPL.INSERT ❑ BUILOWGRELOCATION I <br /> TEN�NT IMPqOVEMENT OA INiERIOR REMODEL ONLY COM/PGi PERSON AND PHONE NO � <br /> ' CANTRALTPPICEOFWONIC S3��Q.�(� `7�CE� /JCC,'[� � /Z `J��O� <br /> � DESCRIBEWONKANp50UAREF00iR INVOWEO <br /> ,tfEu� �a�s�-cuc�ne�! /Z37 Sc� F-� _ <br /> PNOPOSED USE OF BUILDING I HEREBV CERiI FY THAT I HAVE FEAD AND E%AMIN ED THIS APPLICATION AND <br /> � S�NV�-E. FM��� kE_S - KNOWTHESAAIETOBETRUEANDCORRECT.ALLPROVISIOIJSOFLAWSAND <br /> LEG�LOESLNIPTIONUFPeOPERTY�5110WN8ELOWORAiTFCHFOURCOPiES) ORDINANCESGOVERNINGTHISNPEOFWORKWILLBECOMPLETEDWITH <br /> WHETHERSPECIFIED4EREINOR NOT.THEGRANTINGOFAPERMITDOESNOT <br /> � �oi� e�oCrc oF �-��� W�� �LUFF PRE3UMETOGIVEAUTHORINTUVIOLA7EORCANCELTHEPROVISIONSOf <br /> ANY OTHER STATF_OR LOCAL LAW REGULATING CONSTRUCTION OR THE PER- <br /> FOFMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE OWNER Of <br /> � THIS PROPERN TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE <br /> — AND I COMPLV WITH THE STATE CONTRACTORS LAW 1027 RCW AND <br /> 296200 W.4C. <br /> � SiGNn1URECPGONtO�G1Uf10qpUiHOR�2E�AGENi DAiE �Z/Z`{� �� <br /> ' ���-_ <br />' �� PROJECTADDFE55 <br /> : APPLICA (.IYB SINESSLICENSENO.ANDOUSINESSN/A�E <br /> f <br /> r'�a� � r,� N�,rr � C��+�s�crs �'u�sT <br /> PLUMBING MECHANICAL <br /> NO. TVPE OF FI%TUflE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> � WATERCLOSET�TOILEn ) "- NC-NHNDLGUNITS-H.P. <br /> � dR.THTUB �� FORCED�IR SYSTEMS-B.T.U. A1 EA <br /> Z LAVATORY(WASH BASIN) � _� UNIT HEATERS-B.T.U. M <br />. � � SHOWER �� - � CLOTHES DRYERS � <br /> KITCHEN SINK 8 DISP. ���_ ,3 VENTILATION FAN . <br />���� �_ DISHWASHER �j =_L RANGE HOOD � '� <br />� �` LAUNDRYTRAY _�_ WATER HEATER <br />� '� CLOTHES WASHER � - WOOD STOVE <br /> UAINAL _� METAL FIREPL�CES CHIMNEY <br /> DRINKING FOUNTAIN FIREPLACE INSERT � <br /> ' FLOOR DRAIN HEAT PUMP <br /> BACKFLOW PflEVENTERS GAS PIPING <br /> FOOF ORA'NS-RAINLEADERS EXHAUST FAN �.vcL i,J ��{.t„� <br /> SINK(SERVICE-BAR,ETC.) ____ <br /> . SUBTOTAL S � '- SUBTOTAL 5 � <br /> �- - -__ <br /> PERMIT 5 - PEf7MlT 5 ' <br /> TOTALFEE 5 ! r TOTALFEE 5 �-' <br /> ; FFONTSET9ACN RERRSEiBACH SIOESEtOAGK PIAqCH RNUMBEO FEE � flECE1PTN0. � <br /> r) <br /> ���i 7S� /e d' L• — <br /> usE2oN 7ornnen vncnr�rsrte FEES VAW/lTION FEE <br /> _� g ��L ��,FS �, ��o �J'� <br /> iYPEOFCONST. OCCUVPNCVGPOIIP NOOFDWE�LINOUNIIS BWLDING ---_ � '�y3 ,j�� r 1 <br /> AILOWRBLEIA�u�/� _� / — PWM�ING __ J;���l <br /> �� C <br /> sizeoFeLOG NoOrsronic5 OSMI. OCGLOAD � <br /> I Z 3 '� / f�yi N _ MECHANICAL_"_'_______ __'_"'_'_ _ �p � <br /> _ � F _ <br /> �ieic�rtunu�nnor+ OTHER <br /> FIPE SPPINNLERS REOUIRED u YES '��0 STATE OUI�DING SURC�IARGE __ _ _ —�`' V <br /> � ��- �.L� <br /> STA7E ENEf7GY 5U(iCHARGE ____ I / 'i� <br /> L�.1 <br /> RPPL'CAIIONFGC BV PIANSAPPR BY / <br /> PUBLIC WORKS <br /> �.�'Cl� TOTAL ��=�f'` � <br /> ,��r� ,�,�I �_'t'Z-(_ �'� ��� C:��'� 1 �L� �=1'"6')li�_ 3 <br /> E �-.�,' c:' �-��Y"�r_��ll��- j�/\I�iC�, ��`. /Z`3.3 <br /> �U�i� <br />