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APPLICAi'ION FOR CONST'RL _TION <br /> PERMIT <br /> the EI erOreen n <br /> CITY OF <br /> everett G <br /> BUILDING <br /> H NG DEPARTMENT <br /> 1-3 a — — — <br /> UILDI70 TO BE COMPLETED IN IIJK– PLEASE PRI NT <br /> ,n <br /> FHS OWNER /�L� MAIL ADCREBS M, r7 rNONF <br /> a y y des /l A ko <br /> TIN /1 MAILADOrE55 LHY ZIp P'�OHE <br /> 3 M ACITY lIP pHON[ <br /> KHOECT OR DESIGNER Ar. 'vultss <br /> IICENaF• <br /> OENf RAL FANiRACTOR ILMI ADDRESS <br /> (q 1iH�1 <br /> z EaJr IAECHANICALEAYIMCIOR MAIL ADDaESS LIIY 21P --- FHONE LICENSE <br /> O G <br /> 0 H MATL DflE89 CITY IIP PMONk IN:CNSE <br /> UMONGCONtRAGtOR <br /> ��° PLL l�1ES v %-cr o��wrvriYE C� <br /> ❑fir 1C OFwWK <br /> y E~-3[xI yy NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR L� DEMOLITION ❑A WOODSNOVO <br /> E/FPPL INSERT ❑ BUILDING RFIOCATION <br /> C'I H 'Zy TENANT IMPROVEMENT OR INTERIOR REMODEL ONLY <br /> CO41RAtt PRICE OFWORK __ 1 <br /> b y OESCRISE WORK ANO aOUARE FOOTAGE INVOLVED <br /> prroroskou EOf SuaomG 'O ,/- I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND <br /> ON (E O S�./�J{� /' Ki" L�pN___ KNOWTHESAME VERNIN THIS TYPE <br /> RKWILALL OVISIONS OF OMPLET D AND <br /> LEGAL DE RIo�ExxxR�i ION OF PROPER ISHrwN Lcwoa AnACNFouR coPlFs ORDINANCG9 GOVERNING THIS TYPE OF WORK WILL BE COMPLETED WITH <br /> NHETHER SPECIFIED HEREIN OR NOT.THEORANTINOOFAPERMIT DOES NOT <br /> PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br /> Lor__ &OCR Or — ANYOTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PER- <br /> FORMANCEOF CONSTRUCTION.THAT I AM AUTHORIZED BY THE OWNER OF <br /> THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE <br /> -- AND I COMPLY WITH THE STATE CONTRACTORS LAW 18.27 RCW AND <br /> 288.200 WAC <br /> SWNATURE OF CONTRACTOR OR AJTIIORIZED AGENT DATE <br /> pPWECT ADDRESS APPLRNNISCO ME4a lICE N ANDBUSDIE58IIAMC <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE.OR ITEM FEE NO. TYPEOFF.OUIPMENT FEE <br /> ��, -- WATER CLOSET(TOIL ET) - -- _— A/C-MHNDLG UNITS-HP. <br /> BATHTUB FORCED AIR SYSTEMS-BT_U MEA <br /> LAVATORY(WASH BASIN _ UNIT HEATERS-B.T.U. M <br /> 1SHOWER _ — - - CLOTHES DRYERS <br /> ,� KITCHEN SINK A DIR P. VENTILATION FAN <br /> New I DISHWASHER _ <br /> RANOEHOOD <br /> LAUNDRYTRAY � L WATER HEATER <br /> CLOTHES WASHER WOOD STOVE <br /> _ URINAL METAL FIREPLACE 6 CHIMNEY <br /> DRINKING FOUNTAIN FIREPLACE INSERT <br /> FLOOR DRAIN _—_ -- HEATPUMP — I I,' <br /> BACKFLOW PREVENTERS OAS PIPING <br /> ROOF DRAINS-RAINLEADERS EXHAUST FAN <br /> SINK(SERVICE-BAR ETCI <br /> rip ou N - - --- -- — <br /> I. SUB TOTAL $ _ _ SUB TOTAL b <br /> PERMIT S -- -_ PERMIT b <br /> mm mm TOTAL FEE S TOTAL FEE b <br /> AT✓♦ FRONT SETBACK REAR 9ETBACk NDESETBACK PMIN CNECR NUMBER PEE RECEIFt NO. <br /> MEZONE LOT AREA WGNr 80E FEES VALUATION FEE <br /> OYES ONO — <br /> BUILDING <br /> PyK OF CONST OGGUpA OYOROUP HOOF DWELLING UNITS <br /> aLONABLE/ACTUAL PLUMBING <br /> SIZE OF FILM NO OF STORIES 0 v OGG Lwo MECHANICAL <br /> nN _ . <br /> HEgNT LIMIIAiION OTHER <br /> FIRE SPRINKLERS REOUIRED O YES O NO STATE BUILDING 3URCHARGE <br /> STATE ENERGY SURCHARGE <br /> APR'CATION ACC BY PLAH8 APP11 BY WORKS <br /> i <br /> [:PU:BAIC <br /> O <br /> n <br />