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APPLIC�ION FOR CONSTRI.�TION <br /> PERMIT <br /> fAe Everpreen everelt <br /> CITV OF <br /> everett e <br /> BUILDING DEPARTMENT <br /> 2�9•8810 TO BE COMPLETED IN INK— PLEASE PRINT <br /> � <br /> OWNF4 AILADONE55 GITY .IP PHON[ <br /> ,.hv�r.�»-J/o���s,G�avoti. r�co� Rm�,�z Ev.�Tr Q�roi as�-9aa2 <br />'{ TENANI MAILA�DRE55 C�TV ZI� PNONE <br /> I{ /C !1 ��It ll �� Il « 1 I! <br /> f �q[MITEGTORDESIGNER MRIL�ODRC55 CITY 2m , PNONE <br />' f�v�s�,4ircNrrrcTy oo�al iao8 �� __ 96zo6 zs8-647/ <br /> OEN[R�l�pIiBAGiOR M�ILAD�RE55 • CiT ZIP PHONE �L��LE�N E�� <br />' �O�QP �01��� c.� � �. ,�/51�5� �cJe,�y',GC.(' �-i <br /> MECHANIG�LCONTRhGTOR MML♦ E55 _ ��T�/ /� / =�P �'�-/�"✓/ ` LiCENSE� � <br /> l L• <br /> Ww41 <br /> PLUMBINGCONTF�CTOP MqILRpORESS LrtY 2iP PNON[ LICENSE� <br /> CUSS OF WJAK �q <br /> ❑ NEW � ADDITION pr, ALTERATION ❑ REPAI9 � �EMCLITION ❑ WOODSTOVE/FRPI INSERT ❑ BUILDING RELOCATION <br /> TENANT IMPROVEMENT OR INTERIOP R[MODEL ONLY N_ CONTACT nER/5�0�N�AND PNONE N / w <br /> CANTR�CTPRILEOFWOAk��,7/H4 �d +— �— ���—"-"������K�����_�+J-/ <br /> qef Ri wo�� u�ae rooucE in��0 1W/SGCbjC ITlGl.JY//=B <br /> a <br /> ���� s�?4 sc <br /> �-PiOSEDU EOFBUIL�IHG IHEREBYCERTIFVTHATIHAVEREADANDEXAMWEDTHISAPPLICATIONANO <br /> �iw��r/�/ i/QU '//,,, KNOWTHESAMETOBETRUEANDCORRECT.ALLPROVISIONSOFLAWSAND <br /> �S't�«1'•7 M �'�6 ORDINANCES GOVERNING THIS 7VPE OF WORK WILL BE COMPLETED WITH <br /> LEO�lDESCRIPTIONOFPROPERiY�SNOWNBELOWOflA1T�GNFOURG0OlE51 WHETHERSPECIFIEDHEREINORNOT.THEGRAN7INGOFAPERMITDOESN07 <br /> PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br /> �ot e�ocK__ Or — ANVOTHEFSTATEORLOCALLAWREGULATINGCONSTRUCTIONORTHEPER� <br /> �TL� 2/ f�� ,��/ �/���K. 7�� �� TH�ISPROPERTV OPE FORM HEWORK^FORWH�ICHAPPLICTEONISMADE <br /> AND I COIdPLV \NITH THE STATE CONTRACTORS LAW 1827 RCW AND <br /> � .�r /.r�.��/�� 29G.200 N'AC. <br /> �DCaS / ��'��J�/GLyG►w.(�� SIGNATl1RE0fCONTRACiOROPAl1THORIZEDAGENT ��TE <br /> PROJECT�OORE55 qppL�'N 5���E�LCNSE N���INE55 N�ME I�/�/ /�!� <br /> U ,�a� �Il�� f?3 <br />� <br /> PLUMBINO MECHANICIIL <br /> NO. IYPE OF FII(TURE OR ITEM PEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET ITOILEn A/C—A/H NDLG UYITS—M.P. _ <br /> BATHTUB FORCEDAIRSVSTEMS—BT.U. MEA <br /> LAVATORYIWASHBASIN) UNITHEATERS—B.TU. �d <br /> SHOWER CLOTHESGRYERS _ <br /> KITCHEN SINK 8 DISP. VENTILA710N FAN <br /> DISHWASHER RANGEHOOD <br /> � LAUNDRYTRAV WATERHEATER <br /> CLOTHES WASHEFi WOOD STOVE <br /> URINAL METAL FIREPLACE 8 CHIMNEY <br /> i ORINKING FOUNTAIN FIREPLACEINSERT <br /> FLOOR DRAIN HEAT PUMP <br /> � BACKFLOW PPEVENTERS GAS PIPING _ <br /> ROOF DRAINS—RAINLEADERS F%HAUST FAN <br /> � _ SINK�SERVICE—BAR,ETC) — <br /> � <br /> 1 SUBTOTAL S SUBTO7AL 5 <br /> � PERMIT S _ PERMIT S <br /> TOTAL FEE S TOTAL FEE 5 <br /> FRONTSETBAGK RE/RSETBALN SIOESGTBAGN PIANCNECKNUMBEP FEE HELEIPiNO. <br /> E /O D : S � 7V aCe o!�O �L3 �1��/!G <br /> t 115E20NE IOTRRER VAGRNTSITE FEES V T FEE <br /> � `�� �l- G^^ ❑YES �NO <br /> V uCJ <br /> BUILDING <br /> �� IYPEOFCANST. OLWPRNCYG6 P NO.OF�WElLIN011NIiS qq <br /> RLIOWABIE/RCTJRL � _ f /j_ PLUMBING 9V(/ � D <br /> 1 � �f <br /> SiZEO BLD6. NOAFST IES BSMT. OGGLOAD <br /> Q � ❑� MECHANICAL <br /> � / 0 � N Ol �`\ <br /> l. ^'') <br /> NEIG LIMITATION OTHER � ��/ _ � � K�_ <br /> rwesvniNK�eAsneomeEo res ❑ No �TATEBUILDINGSURCHARGE S <br /> L <br /> STATE ENEfiGV SURCHARGE <br /> AFPLIGATIONFCL.BV P�A APPAOY PUBLICWORKS <br /> ��� TOTAL <br /> .��CO.-��_l <br />