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APPLIC�+►r10N FOR CONSTRC�:TION <br /> � PERMIT <br /> t�o Evergrae� everett <br /> GTY OF � <br /> everett <br /> � BUILDING DEPARTMENT <br /> 259-BB10 TO BE COMPLETED IN INK- PLEASE PRINT <br /> OWNEfl � MAILADOflE55 GITY ZIP PMO�IE <br /> � r /��� L�.L/ � 3 o i Go n� b�cc� �i-��'f' S�2✓�� 2�2 - 3//6 <br /> �"'� l MAIL�DDRESS GItY ZIP PHONE <br /> iENiNT <br /> ARGHITECTOHOES�GNER M�ILR�DRE55 CiTY ZIP PNONE <br /> DENERQGONTRACTOR MULRDDRESS CITY 21P PHONE IiCENSE• <br /> ��b,�� �,���. <br /> MECHANIG�LWNTR�CTOR MAILAUDPE55 CRY ZIP PNONE 4CENSE/ <br /> �� MR:LAODRE55 GTY 2IP PHONE IiCENSE• <br /> PUIMBiNG GONTPACTOR <br /> LP ����o, B�xsz� ��// s���J/o- �2��� ��z_216�' <br /> CL�WOP� " ��f?F� Ar�C�.�/7II.5 I�_ <br /> �NEW ❑ ADDIiION ❑ ALTERATION ❑ R[PAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPLINSERT ❑ BUILDINGRELOCATION <br /> TEN�NT IAIPROVEMENT OR INTENIOR REMO�EL ONLY CANTRCT FERSON AND PMONE N0. <br /> fONTRACT PRICE OF WORK -- <br /> � OESCNIBEWORKANOSOU�REFOOtAGEINVOWE� <br /> � vF.ovoseou�eoreui�ou+c IHEREBYCERTIFYTHATIHAVEREADANDE%AMINEDTHISAPPLICATIONAKD <br /> � KNOW THE SAME TO BE TRUE AND CORRECT.ALL PfiOVI510NS OF LAWS AYU <br /> � LEOALOI"ARIPTIONOfPROPERiY�SMJWNBEIOWOdATTACMfOURCOWE51 ORDINANCESGOVERNING7HISNPEOFWOFKWILLBECOMPLETEDWITH <br /> WHETHER SPECIFIED H EREIN OR NOT.THE GRANTING OFA PERMIT DOER NO7 <br /> � PRESUME TO GIVE AUTHORIN TO VIOLATE OF:ANCEL THE PFOVISIONS OF <br /> �oT_— e�ocn oF ANVOTHERSTATEORLOCALLAWREGULA:INGCONSTRUCTIONORTHEPER� <br /> FORMANCE OF CONSTRUCTION.TNAT 1 AM AUTNOR2ED BV THE GWNEti OF <br /> THIS PROPERN TO PERFORM THE W ORK FOR Y!H ICH APPLICAT�ON IS MAOE <br /> t __ AND I COMPLV WITH THE STATE CONTRACTORS LAW 18.27 FiCW AND <br /> x 296200 WAC. <br /> } SiGNANREOFGONTRRCTORORAUTNOFREDNGENT O�TE <br /> � � ' � <br /> � 1�D5 G'�)-O�aD — - <br /> PRQIEGiAODRESS • APF �NiSCITY [SSLICBIS .R OUSMESSNAME <br /> � , � g wA b�de:��j'- _ <br /> � PLUMBINO MECI111NICAL <br /> � NO. TYPE OF FI%TURE Ofl ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATERCLOSETO'�ILET1 Op A/C—A/HNDLGUNITS—H.P. <br /> ' BATMTUB ,Z/ — 00 _ FOFCEDAIRSYSTEMS—BT.U. A1EA _ <br /> � O UNITHEATERS—BT.U. M <br /> LAVATORV(WASH BASINI � <br /> � SHOWER QO CLOTHESDRVE(i5 _ <br /> �- KITCHENSINKBDISF. OC� VENTILATIONF4N . <br /> DISHWASHER U _ RANGE HOOD _ <br /> LAUNCRYTRnY _ D W4TERHEATER _ _ <br /> � CLOTHESWA�HER D O \VOODSTOVE — <br /> URINAL METAL FIREPLACE 8 CHIMKEY <br /> ' DRINKING FOUNIAIN FIREPLACE INSERT <br /> FLOOR DRAIN C7O HEAT PUMP _ <br /> BACKFLOW PREVEN7E175 GAS PIPING <br /> ROOFDFAINS—Rt.WLEADERS _�� C>D E%HAUSTFAN _ <br /> SINKISERVICE—BAR,E1C) <br /> SUBTOTAL 5 � C��- SUBTOTAL § <br /> PERMIT 5 Q� - PERtdIT g _ <br /> TOTAL FEE S C�U TOTAL FEE 5 <br /> Fi0NT5Ef&1CN RE�NSETOACN SIOES BA N PUNCHECRNUM9EH FEE HECEIITNO. <br /> WE:ONE LOiNRG wunrsrte FEES VALUATION FEE <br /> ❑YES ❑NO <br /> BUILDING <br /> TYPEOFCONST. OGCIIPANCVGROUP NOOFOWELLINOUNITS <br /> RLLOW�OLE/AC1U�L PLUMBING <br /> SIZEOFBLDG. NO.OFSTOPIES 0.5MT. OLGLOAp MECHANICAL <br /> ❑Y <br /> ❑ N <br /> NEIGIITLIUIiATION OTHER _ <br /> FIPESPFINNLEASAEOUIRED ❑�Es ❑ NO _ STATEBUILOINGSURCHARGE <br /> STATE ENERGY SURCHARGE <br /> �PPUC4TIONACCBV PLRNSAPFR9Y pUBLICWORKS <br /> — — TOTAL <br />