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APPLILATION FOR CONSTAJCTION <br /> PERMIT <br /> 11re Ererprn� <br /> CITY OF Ovpn•fl <br /> everett <br /> BUILDING DEPARTMENT <br /> 2E')8810 TO BE COMPLETED IN INK— PLEASE PRINT <br /> ��ON((xO/I, IMILN oREss GT. IF <br /> TENANT <br /> CNA •kLA I N 31& Loo-1- 54 S.E CUE ' `)FLS�3 3 53 5F-E) �_ <br /> 4AILAOME55 MY ZIP' PHONE <br /> ARCHP-CTCROES.ONER MNL ADOPEUr <br /> GTY IIP PHDAIf <br /> WAILFUL ETATRbTOR MAIL ADDRESS GTY ZIP PHONE LIDENlEIII <br /> pr�• UIn IP- I GTY ZIP -- NINE <br /> efWI � 1ticoTR n ^Inl( VAi [w DOb � SICAEHb <br /> 4 31F'S <br /> PWMSINOCMTR 011 Mb ADMEN CRY ZIP %KINE LCENIF <br /> CLASSOFRVRK <br /> ❑ NEW ❑ ADDITION C�ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL INSERT ❑ BUILDING RELOCATION <br /> TENANT IMPIONEMENtOR INDEADA REMODEL ONLY CONTACT PERSON AND PHONE NO <br /> CONDUCT MCI OF KORK <br /> RIES vAK INDiWMEPOOTb MVtA <br /> cc3r <br /> l ! DUlEapIIRGAIU IHERESYCERTIFT THAT I HAVE READ AND EXAMINED THIS APPLICATION AND <br /> A KNOW THE SAME TO BE TRUE AND CORRECT ALL PROVISIONS OF LAWS AND <br /> FOAL El TCN OI PNOPER1Yll" W GELOINOPATTACHrOURCOD[R ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLETED WITH <br /> WHETHER SPECIFIEDHEREINORNOT.THEGRANTINGOFA PERMIT DOESNOT <br /> PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br /> Lor eLacK__a ANYOTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PFR I <br /> FORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE OWNER OF <br /> THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION 19 MADE ' <br /> AND I COMPLY WID1 THE STATE CONTRACTORS LAIN 1877 RCW AND <br /> AG W <br /> 00 Z <br /> �PSS. I 29600OOHTPA41 NIORAIR110 ED OLAI CASESX_ <br /> /TL111J1 <br /> PLUMBING -IE J rY MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEF j NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) NC—AIHNOLG UNITS—H P. <br /> BATHTUB FORCED AIR SYSTEMS—ST <br /> LAVATORY(WASH BASIN) UNIT HEATERS—ST.U. M <br /> SHOWER CLOTHES DRYERS <br /> KITCHEN SINK B DISP. VENTILATION FAN <br /> DISHWASHER RANGE HOOD j <br /> LAUNDRY TRAY WATER HEATER I <br /> CLOTHES WASHER WOOD STOVE <br /> URINAL METAL FIREPLACE S CHIMNEY <br /> DRINKING FOUNTAIN FIREPLACE INSERT <br /> FLOOR GRAIN HEAT PUMP <br /> BACKFLOW PREVENTERS OAS PIPING <br /> ROOF DRAINS—RAINLEADERS EXHAUST FAN _ <br /> SINK(SERVICE—BAR ETC) <br /> 1 <br /> BUB TOTAL S SUB TOTAL S <br /> PERMIT S PERMIT _ S <br /> TOTAL FEE i TOTAL FEE S <br /> INMIT SCTFULK MAP SETIACK SIDE SFTSLCK P7"CNECK NUMSER Fit RECUR NO. <br /> I <br /> USE ZONE LOTANEA MEANT SITE FEES VALUATION FEB <br /> TI YES O NO <br /> TvMaTnxlT wNCr DIKvrP NO aowELLINO urin BUILDING <br /> ALLONASLE/ALNAL PLUMBING <br /> SIZEOIPLDC — HD OISTOAIEB MUT OCC LOAD MECHANICAL <br /> ON — <br /> HLAEHTNwuTION OTHER _ <br /> RRESPNINKLEPSPEOUIMO On! OND STATE BUILDING SURCHARGE <br /> STATE ENERGY SURCHARGE <br /> APP(IGPON ALL SY RANS APM FY <br /> PUBLIC WORKS <br /> Y' TOTAL <br /> I <br />