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APPLICATION FVR CONSTRUCTION <br /> rne Everpreen PE R M IT <br /> CITY OF rr�•rrU <br /> everett e <br /> BUILDING DEPARTMENT <br /> 259-eB10 TO BE COMPLETED IN INK— PLEASE PRINT <br /> OWNER M4l�DDRE55 (,IIY lIP PRpNk <br /> `T�%D b. BU�NAM SI`l lti1ETMo,�E �VE2�lT 6U�4- 9�4��/ �s39- .3E��y <br /> — - -- - -- ------ _--- --- - <br /> 1EN�Nt Mu��DURE55 Qiv )i� PHON[ � � � �- - <br /> MCNIiECTOR0E510NER — MUL�ODRESS -�---------- " —------"" - --�------ <br /> StlnrsffhDE i�'oDu�f'S '73iy -YY AIE' ���• %8270 P,(,5�.� -S'�S3 <br /> zn <br /> MfI�'YS�'�LCF <br /> /r� ----- - -- --- <br /> ENERILCONiR1GTOR MMI�O�Rk55 �pY JiP P��ONE LICENSC• <br /> {/�� J <br /> MECN��NICAI LONiN 10N MAq�O�RES9 CIIY SIP PHONE LICEHS!• <br /> PLUMBINOCOHiR�CTOR M�R�ODNES9 CRY ZIP PMONE LICENSC •- <br /> C�L(�9S O�NOHN - <br /> �61 NEW ❑ ADDITION ❑ AITERATION ❑ REPAIR ❑ UEMOLRION ❑ WOODSTOVE/FRPLINSERT ❑ BUILDINGRELOCATION <br /> TEN�NTIMPPWEMENIORINIERIORPEMODEIONLY [ONiACiPEP50N�NpPHONENO � ���- <br /> CONiR�CiPHICEOf1VVpK ,D��� T�� D, (3V21VAM 339—:36'Ly ��j� <br /> OE9GRIBEWOPN�Np90U�REfOOiAGE1NVOLVED -----'---"'--- —7II <br /> I�6 c R eT' � sX3qcE,onR DE�K <br /> v o ouseo ewim«o �lw�) — -_ ____-_. _ _ <br /> �.d ,,,�� I HEREBY CEF71'V THAT I HAVE REAO AN D E%HMINED THIS APPLICATION AND <br /> `x(,�/( KNOW?HE SAMc TO BE TRUE AND COqRECT ALL PROVISIONSOF LAWS AND <br /> �EOAIOEx vlioNoraaoPEnniSHavN BE�owonm�cNrOunCOP�E - - ORDINANCES GOVERNING THIS TVPC OF WOFN WILL BE CGMPLETED WITM <br /> � �/'._ � ,���_J., / ,� WNETHERSPFCIFIEDHEREINORNOi.TNEGRANTINGO�APERMITDOESNOT <br /> LOi e�OCK___ p� _L_((�V�V _Skl�nyl� PRESUME TQ GIVE AUTHORITY 70 VIOLATE OR CANCEL THE PROVISIONS OF <br /> ANY OTHER STATE OR LOCAL LAW REGULATI NG CONSTRUCiION OR THE PER� <br /> fJRMANCE OF CONSiRUCTION THAT I AM AUTHORIZED BV THE OWNER OF <br /> TMIS PROPEFTV TO PERFORM TNE Y/ORN FOR WHICH APP�IC4TION IS MADE <br /> — AND I COMPLV Wlifl TME STATE CONTqACTOqS lAW 1827 RCW AND <br /> 2�J6 200 WAC <br /> 6�GNI.ipFFO�GONI1UCIf�RnqPUq�ORVE(1�GEN1 U9f <br /> X I Q-tf � �*.�t-�c.�.w- S`�7' �Z� l9d'% <br /> PROJECT�DDRESS ---�--- _._j___ _ ... <br /> IYZ1-lOG��5T . S� bU. SP# (�,�/ ��P�ICPNl5fIlvpUSMES51iCIN5ENO�NpBO51NF55NRME <br /> I <br /> PLUMBINO MECHANICAL <br /> N0. TVPE OF FIXTURE OR ITEM FEE NO. IYPE OF EOUIPMENT FEE <br /> WATE R CLOSET ITOILEn !VC-NHNDLG UNI7S-HP. <br /> BATHTUB FORCEU AIR SVSTEMS--BT U M EA <br /> -__-- _ ____ <br /> UVATORV IWA3H BASIN) UNIT HFATERS-BTL M � <br /> SHOWER - --____._. ._ ._ _.__ <br /> CLOTNESDR�ERS <br /> KITCMEN SINK 8 019P. VENTILATION FAN <br /> DISHWABMFR RANGE NOOD � <br /> LAUNDRVTRAV WATER HEATER <br /> CLOTMES WASHER WOOD S70VE <br /> URINAL MEiAL FIREPLACE 8 CMIMNEV <br /> DRINKINO FOUNTAIN FIREP�ACE INSERT <br /> FLOOR DRAIN HEAT PUMP <br /> BACHFLOW PREVENTERS GASPIPIN6 <br /> ROOF DRAINS-RRINLEADERS EXHAUST FAN � <br /> 91NK�SERVICE-BAR.ETC.1 � <br /> SUB TOTAL f SUB TOTAL 5 <br /> PERMIT S PERMIT S <br /> -__ _.- __ __... _. _ ______. _-.._-___ _ . -. ___ <br /> TOTqL FEE S TOTAL FEE S <br /> FROHi�IBO�CF, RL�RSEIB�LN' SID�ET�ALN PIANC Ck�fP f� ' ^^ REC���� <br /> �S � '� <br /> useror�e wtsg�� WCANTBRE FEEB VALUATION FEE <br /> 5 rEs �CHO ;rt <br /> TVPEO�fAN4t pCC eNCYppOpP NOOFpWEILiNOUNl14 BUILDING - _ _ -��'r(�p ��I/) �� <br /> �LIOW�ELEA f 1t <br /> �� Uc <br /> '�-� y '� PLUMBINO <br /> S¢E OF BLDU NO OF BtOR1ES 0.5M1 OGC lp�D <br /> ��b CAK �' � -- MECHANICAL _ <br /> r4a'!. N — _ . <br /> Z�/p iZ�� . HEiONTLIMifAT�ON OTHER <br /> fIRE9PPINNLEn9REouIREO '!YE9 r� p ____ STATEBWLDINGSURCHAROE I <br /> � <br /> STATE ENERGY SURCHARGE � <br /> APPLIC�LiON�CC B� PL�N9�PPR B'I <br /> �`/ PUBI IC WORKS <br /> � � <br /> �C� �_� L.�i TOTAL � � � � , <br />