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1, ,�� �, ;�"��'� I <br /> APPLI�A?'ION FOE'i CONSTRl1�L`TION <br /> PERMIT <br /> Ihe Everpraen everett <br /> GTY OF � <br /> everett '� <br /> BUILDING DEPARTMENT ; <br /> 259•8810 TO BE COMPLETED IN INK— PLEASE PRINT � <br /> � OWNEN .e � MlILAOOPE55 GIiY 21P PHONE I <br /> �� �jS� �`i�JDI NUP/[% C /'L �/� � CITY 11P PHONE , <br /> 7ENANT / M�ILAUORESS L , � <br /> �_K c�.,,r4n/T �U3� � �UP/ �l/ � E/'/"�T �il/.� � <br /> �PCNITECT N ESIGNE MAILPODRESS CITY ZIP PMONE I <br /> .��L >„� I 3�/ s 3.��� c� �� Si,..c c1� ¢v/r� �a�-�f�-�o7a <br /> �ENERALCOHTF�CT R M�IL�ODFLSS CI1Y ZIP PHONE LICENSE� <br /> � k'< <f��.,a,.�f..� l�lUc�J �rin s� SL.� �t�. ��Fiiq fo/- 9y�-�f�s� T.[3�-��2,�/z7�� <br /> ME N�NICRLCONTFRGTOR MAILADDRESS CIiY ZIP PNONE LICENSE� I <br /> PLUMBINOCONiRAGTOR MR^.R�DNESS CIIY ZIP PIIONE IICENSE� <br /> , CIASSOFWONH <br /> ❑ NEW ADDITION ❑ ALTERATION ❑ FEPAIR ❑ DEMOLITION C� JJOODSTOVFJFRPL INSERT ❑ BUILDING RELOCATION <br /> TEN/�NTIMPRO'/EMENT OR INiENIOR PEMOOEL ON�Y .:O^NTAGT PERSON NNUeeePIIONE NO. <br /> ' CANTRACTPflICEOFWORK ��02� � JJIY�(F � //''//�'�er� /T��FF��// ���-��"6-� <br /> �ES/CRIBE WOHK�ND SOU�HE FOOTPGE INVOLVED / L <br /> � ,r�GC/,��G„7„�„��,fu/ �i�,,�i� !'6 �c,o orPkJs�� �3r.., SU ���r��,JN� T� �� .�' � � r�.s <br /> : PROP09EDUSEOF9UP.DI/NG� I EREBVCER7IFYTHATIHFVEREADANDEXAMINEDTHISAPPUCATIONAND <br /> � h�r�� l����G�l fG�� KNOWTHESAMETOBETRUEANDCORPECLALLPROVISIONSOFLAWSAND <br /> � � ORDINANCES GOVERNING THIS n'PE OF WORK WILL BE COMPLETED WITH <br /> 'LE(lALDESCHIP110NOFPROPEPtt�5N01'INBELOWORRTI�\CHFOURCOPIES� WHETIiERSPECIFIEDHEREINORNOT.THEGRANTINGOFAPERMITDOESNOT <br /> �' PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br /> � LOT BLOCK oF ANYOTHEFSTATEORLOCALLAWREGULATINGCONSTRUCTIONORTHEPER- <br /> FORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE OW NER OF <br /> ! TI11S PROPERNTO PERFORM THE WORK FOR WHICH APPLICATION IS MADE <br /> , AND I COMPLY N'ITH THE STATE CONTRACTORS LAW 1827 RCW A��D <br /> � 296.200 WAC. <br /> SIGNRiUflEOFCOMRACtOPOBRUiNOPI2E0RGENT OATE <br /> � �-���:�11"/f�°,�,r ..,� T,t3S -�.�lv.�r�i <br /> � PROJECTAWflE55 APPLICANT IIY9USINESSLICENSENO BU ESSNRME <br /> S 30 /"v�✓ -r .uu�� <br /> PLUMBINO �✓L�✓y'Y� MECHANICAL <br /> NO. TYPE OF FIXTURE OH ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> �� WATERCLOSET(TOILET A/�—A/HNDLGUNITS—H.P. <br /> �. BATHTUB FORCED AIR SYSTEMS—B.T.U. M E0. <br /> LAVATORY(WASH BAS�N) UNIT HEATERS—B.T.U. M <br /> ', SHOWER CLOTHESDRYERS <br /> . KITCHEN SINK 8 DISP. VENTILATION FAN <br /> D�SHWASHER RANGE HOOD <br /> LAUNDRY TRAY WATER HEATER <br /> � CLOTHESWASHER WOODSTOVE <br /> URINAL METAL FIFEPLACE 8 CHIMNEY <br /> DRINKING FOUNTAIN FIREPLACE INSERT <br /> � FLOORDRAIN HEATPUMP <br /> � BACKFLOW PREVENTERS GAS PIPING <br /> � ROOFORAINS—RAINLEADERS EXHAUSTFqN <br /> � SINK(SERVICE—BAR,ETC.) <br /> i <br /> i <br /> . SU6TOTAL 5 SUBTOTAL 8 I <br /> � PERMIT S _ PERMIT $ I <br /> ' TOTAL FEE S TOTAL FEE $ <br /> FAONTSETBACft REFHSETBACN SIOESEiBACY. PUNCHECNNUMBEF FEE PECEIPTNO. <br /> I � � <br /> uSEZOr+e LOiAREA �ACRNT51iE FEES VAIUATION FEE <br /> /��' ❑YES O NO <br /> �'� BUILDINCo L`�—� I <br /> IYPEOFCqNSi. OCCUPO!!CYG U N FOWELLINGUNIiS <br /> A�LOW�BLE/AC7UAL PLUMBING <br /> SIZEOFBLDO. RO.OFSTOfnES B❑SyT. OCGIOFU MECHAY�CAL <br /> ❑N <br /> MEIGII7�IMIiAT10N QTHER <br /> FIRESPRINI<LERS REOUIREO ❑YES ❑NO STATE BUILDING SURCHARGE � <br /> STATE ENERGY SURCHARGE , <br /> �PPLICATIONACGtlY PLPNSRVPR v pUBLICWORKS <br /> TOTAL <br />