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� <br /> �. ,, <br /> APPLIC�'ION FOR CONSTRti�T10N ; <br /> � PERMIT � <br /> q <br /> F�ti �M Ewroron . <br /> CITVOF everett . ,i <br /> �� everett e � <br />� ,,� BUILDING DEPARTMENT ' <br /> 268�eB10 TO BE COMPLETED IN INK— PLEASE PRINT a <br /> `� OWNER AUILADDRESS GtY ZIP PNONE � <br /> �.��9 �VI�IDI�C/L/ l=[.J�V����UO ESWZ� 7T� S�C..CRC:VE�IP � P ON—1�E " � <br /> i � <br /> %3 ARCHRECfO_=DE91(iNER M�IL�ODRESS CIiY 21P PMONE I . <br /> �±� OENEMII{1NTRACTOR MAILAO�RE59 CITY 21P PHONE LICENOE• I I <br /> �� <br /> i� MECM�NIG�LGONTFACTOR M�IL�DDRE49 LRY IIP PHONE LICENBE• ' I <br /> • 4 — I <br /> PLUM&NpCANTPACfOR M�ILADORE55 CIIY 21P PNONE LICEN9E• <br /> '6 <br /> M .� <br /> � CtA980FWONk ,�� <br /> ❑ NEW ❑ AD�ITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION lY WOODSTOVE/=RPLINSERT ❑ BUILDINGRELOCATION <br /> � ', IENANTIMPROVEMENTORINTERIORREM00ELON�Y� CpNUGiPER�AND�EN�� ��� � � <br /> ' �� CANTIUCTPi110EOFWORK JEF � <br /> DElCilllE WORK AND BOUARE FOOT�AE INVOLVED <br /> �� vno eouaeoFeuamNo IHEREBYCERTIFY7H�;TlHAVEREADANDERAMINEDTHISAPPL�CATIONAND <br /> ���� KNOW?HE SAME TO BE TRUE AND CORRECL ALL PROVISIONS OF LAWS AND <br /> � ; � ORDINANCES GOVERNING TNIS TYPE OF WORK WILL BE COMPLETED WITH <br /> L ' D RIPTIONOF , ERTYI9HOWNBEIOWOR�nACNFOt/RCOPIES� WHETHERSPECIFIEDHEREINORNOLTHEORANTINGOFAPERMITDOESNOT <br /> ;�.j PPESUME TO GIVE AUTHORITV TO VIOLA7E OR CANCEL THE PROVISIONS OF <br /> l07 e�ocK oF --� ANYOTHERSTATEORLOCAILAWREGULATINGCONSTFUCTIONORTHEPER• <br /> ' �� FORMANCE OF CONSTRUCTION.THAT I AM AUTHORI'.ED BY THE OWNER OF <br /> ��. .j THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE <br /> AND 1 COMPLY WITH THE STATE CONTRACTORS LAW 1B27 RCW AND <br /> " 296200 WAC. <br /> . SIGNRTUNEOFCONiPRCTOROHAUTNOR2E0AGENT D�TE <br /> 1, ^ <br /> � PPOJECfADUHE35 APPUC N CI INESS C SENO.ANDBU SN�M <br /> ' O 6 .6 <br /> ., <br /> i PLUMBINO - MECHANICAL <br /> '�7 NO. TYPEOF FI%7URE OR ITEM FEE NO. TYPE OF E�UlAMENT FEE <br /> '�� WATERCL09ET�TOILE'p NC—NHNDLGUNITS—H.P. <br /> ,�J BATHTl1B FORCED AIR SYSTEMS—6T.U. M EA <br /> � 'j LAVATORY(WASHBASIN) UNITHEATERS—&T.U. M ' <br /> � 9HOWER CLOTHESDFYERS i <br /> �� KITCHEN SINKB DISP. VENTILATION FAN � � <br /> � DISHWASHER RANGE HOOD ' <br /> � _ <br /> �� LAUNDRYTRAY WATERHEATER ! <br /> �� CLOTHES WASHER WOOD STOVE � <br /> � <br /> � .� URINAL METALFIREPLACEBCHIMNEY <br /> � DRINKIN�FOUNTAIN FIREPLACEINSERT <br /> FLOOR DflAIN HEAT PUMP <br /> '� BACKFLOW PFEVENTERS GAS PIPIN3 � <br /> ROOF DRAINS—RAINLEADERS EXHAUST FAN � <br /> `� SINK�SERVICE—BAR,ETC) <br /> a — <br /> j <br /> �: SUBTOTAL $ SUBTOTAL S <br /> y� PERMIT 5 __ PERMIT $ <br /> ,� TOTAL FEE 5 TOTAL FEE S <br /> ( FRONTHETBACK qE�RSEI&�CN SIDESET9nGK PIANCHECKNUMBEP FEE flECEIPiNO. <br /> .I <br /> usEzoNe LOTAREA VACFNi51iE FEES VALUATION FEE <br /> �� ❑YES ❑ NO <br /> �� BUIIDING <br /> TYPEOFCAN9T. p��UP�NGYUROUP NOAFDWELLINOUN175 <br /> ALLOW�BIEMCTU�I. <br /> PLUMBING <br /> BREOPBLDO. NO.OF970PIE9 BSM7. OCCLOA� <br /> _ ❑v MECHANICAL <br /> ❑ N — <br /> NEiONiLIMIiAiION OTHER <br /> FIRE9PPINKIERSRE0UIHED ❑YES ❑NO <br /> STATE BUILDING SURCHARGE <br /> STATEENERGYSURCHARGE <br /> i AipLIC�TION�CCBY PUN9APPFBV <br /> .� PUBLIC WORKS <br /> � TOTAL <br /> :j <br /> a ' <br /> � <br /> i <br /> i <br /> -..Jr.. o - - . . . . . . . . <br />