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APPLIC�.�ION FOR CONSTRVCTION <br />. PERMIT � <br /> Me Everpreen <br /> CITY OF cveretl <br /> everett e <br /> BUILDING DEPARTMENT <br /> 259•8810 TO BE COMPLETED IN INK— PLEASE PRINT <br /> OWNER M�ILA�DRE55 CITY IIP PNONE �,c`•Z � U <br /> k��cT j�'er.c.��F,p- ��,ay% T�a�,val S7— 6vc�cTr ��s-� . ' <br /> IENANT MRILRO NES—�S GI�V 21P PMONE <br /> �OCHRECTOH�ESIGNER MRILA�DHE55 CITY 21P PMONE <br /> �.,•wr2, �u/�c7`SG /�/cy <br /> aENEH�L CONTB�LiOR MAII ROORE55 GIIY ZIP �IONE LIGENSE• <br /> x���i��% S,` 6,�i ���>f�-�� aoiz 5��r�ST D��a;�.-rl��h u,ti 73j-�� <br /> MGM�NIC�LCOHTP�CTON M�ILADUflESS CITY 21P���V, 'L1i0NE�sE�SCLI�EN�E��� <br /> f� 1 <br /> PLUM&NO GONTP�GTOfl MAII�DOHESS GITY 21P PMONE IILENSE• <br /> C1A950FWOHN . �L�^/a�L . M/��/�� � <br /> V <br /> NEW ❑ ADDITION ❑ AL7EMTION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVFJFRPLINSERT ❑ BUILOINGRELOCATION � <br /> TENNITIMPPOVEMENTORINTERIORREMOOELONLY GONTRCiPER50NANOPHONENO <br /> x fANTMCT�PICEOFWOFK VV�+`� QC� W �/�'��`�(� � ��fs0 � : <br /> DESCNIBEWOHI(�N�SOU�9E TAGEINWL ED { ` �� <br /> � J ��3 �w.�-.-..�- � � <br /> k 87t8 cl/F's; s.v I?� �z'Aw.-,.;'.•.s _ �- �L` T S:6'� y2 .S�t��-ri;�is <br /> vrWrOS/E�ous OFBIIILDIN� IHEREBYCERTIFVTHATIHAVEREADANDEXAMINEDTHISAPPLICATIONAND <br /> 'X d/C(� ` I�L•:IP�I�L � � KNOWTMESAMETOBETRUEANDCORRECT.ALLPROVIS�ONSOFLAWSAND <br /> � �cwiu�sB IPTIONOFPpOPEfl1Y�5110WNBELOWONRUCHFOUBCOPIES� ORDINANCESGOVERNINGTHIStYPEOFWORKWILLBECOMPLETEDWITH <br /> WHETNER SPECIFIEO HEREIN OR NOT.7HE GRANTING OFA PERMIT DOES NOT <br /> ' PRESl1ME TO GIVE AUTHORITV 70 VIOLAi E OR CANCEL THE PROVIS�ONS OF <br /> i �oT e�ocK oF ANYOTHERSTATEORLOCALLAWREGULATINGCONSTRUCTIONORTHEPER• <br /> FORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BV THE OWNER OF <br /> THIS PROPERN TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE <br /> AND I COMPLV WITH THE STATE CONTFACTORS LAW 1827 RCW AND <br /> 296.200 WAG �,��y� <br /> SIGNANPEOFLONTR�CTOflOPAUiNORI2E0AGENT O�TE O <br /> � <br /> X � <br /> vao� cr�ooneas � l�l <' i � <br /> � � � \ AP .iGRNTSGIIV BUSINESS IICENSE NO ANO BUSINESS N�ME <br /> 1 / <br /> PLUMBINO CHANICAI ' <br /> i <br /> NO. TYPE OP FI%TURE ON ITEM FEE O. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILEn AIC—A/HNDLG UNITS—H.R � <br /> BATHTUB FORCED AIR SYSTEMS—B.T.U. M EA <br /> LAVATORYIWASHBASINI UNITHEATERS—B.T.U. M <br /> SHOWER CLOTHESDRYERS <br /> KITCHEN SINKd DISP. VENTILATION FAN � <br /> DISHWASHER ' RANGE HOOD � <br /> LAUNDRYTRAY ' WATER HEATER � <br /> CLOTHES WASHER WOOD STOVE <br /> URINAL METAL FIREPLACE 8 CHIMNEY I <br /> DRINKINO FOUNTAIN FIREPLACEINSERT i <br /> FLOOR DRAIN HEAT PUMP <br /> BACKFLOW PREVENTERS GAS PIPING i <br /> ROOF DRAINS—RAINLEADERS EXHAUST FAN � <br /> SINK�SERVICE—BAR,ETC) <br /> r <br /> SlIBTOTAL 5 SUBTOTAL S <br /> PERMIT S FERMIT S <br /> TOTALFEE 5 TOTALFEE S i <br /> FRONTSEfB�GK PE�RSETB�CK SIOESETB�CN �� �NUMBf�i � I FEE �/ RECEIPTNO.�, <br /> ri :ti� v-� �.3„ <br /> do'-1 K� � O <br /> USEioNE toi�nE� VACANTSITE FEES VALUATION FEE <br /> ❑YES ❑NO <br /> ttPEOFCONST OCWPRNCYGROUP NOAFOWEL4NOUNIT9 BUILDING V SUO � <br /> ALLOW�BIFJACIDM. PLUMBING <br /> SIZEOPBIDa NO.OFSTOHIES BSML OCGIO�D <br /> o v MECHANICAL , <br /> ON I <br /> NEIGHTIIMIUTION OTHER <br /> FINESPNINNlEH5HE0UIRE� O YES 0 NO STATE BUILDING SURCHARGE <br /> STATE ENERGY SURCHARGE � <br /> APPLIL�TIONAGGBY PLANSAPPp6� � <br /> PUBLIC WORKS <br /> � TOTAL <br /> I <br /> I <br />