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APPLICOrION FOR CONSTRWTION <br />PEvAlT <br />IA. [r.rpn.n <br />CITY OF <br />M <br />everett <br />BUILDING DEPARTMENT <br />259-8810 <br />TO BE COMPLETED IN INK - PLEASE PRINT <br />n.tw.res an T+ mo,e <br />QRtAr .N.W. CpNST. 2?U-116s7st- vvr&--r7 9t2Oy Y 1>-W5-3 _ <br />rzNw, M kA. Ep afr !P RO{ <br />HT G <br />RUYMNO fANER1C,M <br />E HEW ❑ ADDITION ❑ ALTEMTKM ❑ REM1R ❑ DEMOLOIDN O MWDSTomrnPLINSERE ❑ BUILDINORELOCATION <br />N",I4VI1WF4[N, M MI[R(YI R[YCO[L <br />[gM,RIC, .IC. a WON( <br />• <br />R11NlN.NDFDN[NO <br />aw.M NOM wD M[U.9[ lwl.a M wo <br />I If 41 <br />SPO AtB <br />Pro.aEou.e a INnwNo <br />SAC (( <br />I HEREBYCERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND <br />KNOW THE SAME TO BE TRUE AND CORRECT ALL PROVISIONS OF LAWS AND <br />ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLETED WITH <br />WHETHERSPECIFIEDHEREINORNOT MEORANTINOOFAPERMROOES NOT <br />PRESUME TO ONE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR ME PEW <br />FORMANCE OF CONSTRUCTION THAT I AM AUMOR12E0 BY THE OWNER OF <br />THIS PROPERTY 10 PERFORM THE WORK FOR WHICH APPLICATION IS MADE <br />AND 1 COMPLY WITH ME STATE CONTRACTORS LAW 1821 RCW AND <br />296 200 WAG <br />bONMUMEa1X1N1AACRK1 D. w,NomnP.D[Nt wrz <br />X �J <br />L[wo[.cllnRr»arRa[anONwwptowoll.n.cNr <br />tYO0- t1 -.G <br />Lot waN_a liA - <br />�/ <br />(-a�—crie SE" <br />mOlrcl.npn[ss <br />PLUMBING <br />X—r.1 <br />.RLICw,FaTr IWYN.IULF; No wo WMM[ Nul[ <br />c <br />MECHANICAL <br />NO. <br />I TYPEOFFIXTUREORITEM <br />FEE <br />NO. TYPE OF EOUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />AIC- A/HNOLG UNITS - HP <br />BAnmB <br />FORCED AIR SYSTEMS - BTU . MEA <br />LAVATORY (WASH BASIM <br />a`I <br />- <br />UNIT HEATERS -BTU M R, Ile LJ <br />SHOWER <br />CLOTHES DRYERS <br />KITCHEN SINK A DISP. <br />VENTILATION FAN <br />1 <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WWBHER <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE A CHIMNEY <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />HEAT PUMP <br />BACKFLONPREVENTERS <br />GAS PIPING <br />ROOF DRAINS -RAINLEAOERS <br />EXHAUSTFAN <br />SINKISERVICE-UK ETC <br />_ <br />✓ <br />e <br />- <br />SUBTOTAL <br />{ <br />BUS TOT { <br />vo <br />PERMIT <br />S <br />PERMIT { <br />_ <br />TOTAL FEE <br />{ <br />J" <br />- <br />TOTAL <br />FEE { <br />_ <br />9e <br />- <br />rIgN,M,MC, E <br />RVR.[l <br />, <br />YDf [F, <br />RAN V,%T <br />r..3O <br />mc.,I. Sj <br />6.FEE <br />ufE.D <br />R aC9NB, <br />L uu <br />r <br />FEEB <br />VALUATION <br />BUILDING <br />Ss <br />�Q <br />NLOw.Ru.CN4 <br />♦ <br />MI <br />aDMEL4N0 VMN <br />J <br />PLUMBING <br />OG <br />P2[ a up0 <br />19L 9F- t <br />oN . <br />! <br />XN <br />LO.p <br />•V^. <br />MECHANICAL <br />fo <br />0 O <br />nP[.rRro.unF REan.Eo nm KNo <br />WXW IIMI.I,)N <br />E <br />OTHER <br />STATE BUILD!NO SURCHARGE <br />Sa <br />.FAKAfpNILCF gwtEJM1 F1 <br />"/ <br />�721/I2 <br />JM <br />BTA15.iNERGV.iYE1CNABOE <br />PUBLIC WORKS <br />o20 <br />OG <br />TOTAL <br />z 9 <br />oG <br />