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, APPLICA�ION FOR CONSTRV.:TION <br /> ' PERM{T <br /> ths Everpreen everett <br /> CITY OF <br /> everett <br /> BUILDING DEPARTMENT <br /> 259-8810 TO BE COMPLETED IN INK— PLEASE PRINT <br /> M�IL APpPE55 GITY LF VMONE <br /> RE6�. RogSoN 2ti3t '�RoanwR'�-��.�.9�Z� p„o„?�i2-518 <br /> tENANT MAIL�DURESS <br /> 5A M E A�5 A�3o✓P <br /> �RCN^REQ OR DES�ONEP M�IL��DPE(5�9 G.R1�.-`_� ZiP GHONE <br /> SI,/-\ 1 D 1/�/� :/�V� ^�P��Y^-__ Z���'�ILIEN6E• <br /> pENER�ICAHiH�CTOR M�IL�DURE55 �� y�rao� ����Vo/ <br /> eo�3a� �oNsr- ?ogox 1�9� <br /> MEGN�HIG�L CONTN�LiOR M�II�DDRESS CITY 21P PHONE LIGENSE• <br /> 'DucT'S o�t L� <br /> VLUMBIN CONTR�LTOH M�ILAD�RE55 CIfY ZIP PHONE UCENSE• <br /> �oNE I�PQui�2.�n <br /> G�SOF K <br /> ❑ NEW ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPLINSERT ❑ BUILOINGRELOCAiION <br /> iEN�Ni IMPROVEMEM OR IMERIOR REMOOEI ONLY � LONTAGI P[RSON I.Np PHONE NO ,\ /� <br /> CONTIII�CTPNICEOiWd1K � ��'JC•� �/W —�L �• "'+-- ������ I�V•��� • <br /> pEBCqIBEWORK�N�BOUME T�OEINVOLVED <br /> App 2 SlLA�Y ADDIt/d►1 /�5�����/58�C T. <br /> PROPOBED UBE OF BUI OIN6 I HEREBY i.EFTIFV THAT I I1AVE READ ANU E%�MINED TN19 APPLICATION AND <br /> oEC/�L ��tL���� ��� KNOWTHESAMETOBETRUEhNDCOFlRECT.ALLPROVISIONSOFLAWSAND <br /> r r ���� N7 ORDINANCES GOVERNINO THIS n'PF OF WORK WILL BE COMPLETED WITH <br /> LEO�IDESCB�Pf�ONUiPROVENTYISMCWNBELOYIORAR�GHFOURGOPIE81 WHETMERSPEGFIEDHEREINORNOT.TMEGRANTIN60FAPERMITDOE9N0T <br /> c PRESUME 70 GIVE AUTHORIN TO VIOLATE OR CRNCEL THE PROVISIONS OF <br /> �pTI.7 9�oGK�� OF ANYOTHEFSTATEORLOCAILAWREGULATINGCONSTRUCTIONORTMEPER- <br /> FORMRNCE OF CONSTRUCTION.TMAT 1 AM AUTHORIZED BV THE OWNER OF <br /> THIS PFOPEFTY TO PEfiFORM THE WORK FOR WHICH APPLIGATION IS MI1DE <br /> AND 1 COMPLY WITH THE STATE CONTRAGTORS LRW 1827 RCW AND <br /> 288.200 WAC. <br /> SIONATUREOF NiR�CTOROH�UTNOH2ED�0ENi �����'�� <br /> X <br /> �E�p�Qtg � � � � �PPLIG�H GITv USWE L�LENO'O/��.ME58wo.������08� <br /> {. <br /> PlUMe1N0 MECHANICAL <br /> NO. TYPE OF FI%TURE OP ITEM FEE NO. TVPE OF EOUIPMENT FEE � <br /> WATER CLOEET(TOILEn A/C—F/HNDLG UNITS—HP. � <br /> BATHTUB FORCEDAIPSVS7EM5—B7 . MeA ; <br /> IAVATORY�VYASH BASIN) UNIT HEATERS—B.� � <br /> SHOWER CLO7HESDRYERS , <br /> KITCHENSINK6DISP. _ VENTILATION N il <br /> DISHWASHER RANGE HO �, <br /> LAUNDFVTRAY WATE <br /> CLOTMES A R WOOD <br /> URINAL META I EPLACEBCHIMNEV <br /> DFIN NTAIN FIR LACEINSERT <br /> FLOO RIN AT PUMP <br /> Bp PREVENTERS AS PIPING <br /> F DRRINS—F7AINLEADERS E%HAUST FAN <br /> SINK(SERVICE—BRR,ETC.) G <br /> Sl1B TOTAL S SUB TOTAL S <br /> PERMIT 5 PERMIi S <br /> TOTALFEE S TOTAIFEE S <br /> FRONT BETBIICN PF�1R SEiBAGN SIDE SEiBACN PIAN GN�NUMBER FE���Gr� pECE�O=�� <br /> y r� <br /> � � <br /> u5ezone � �our+e� v�eer�Terte FEES VAIUATION FEE <br /> �^ ❑YE9 1�10 <br /> BUILDING <br /> IYPEOFCANST. _ OCCUPANCYOROUP NO.OF�M/EIIINOUNlT9 <br /> �LIOW�BLE/ACTU�L � N p Z „�.. pLUM81N0 _ <br /> 4J <br /> 91LEOFBLOf3_ NO.OF6TOFIE9 BSMT. G�CGLO�D MECHANICAL <br /> i2�4 S¢�4cp 2 xN d� <br /> ��� y sP� GRusS HEIOMTLIMITATION OTHER <br /> R,EoS RI�LF.R9REOUIRED O YEB NO �• STATE BUIL�ING SURCHARGE <br /> STATE ENERGY SURCHARGE <br /> . �PPL'G�TIONACC BY, PLRNS�PP� PUBLICWORKS . <br /> �7"Yfl �1�� `..Zn� <br /> �Jy O TOTAL o.1/ .�v <br /> ,�� � ir ,i�/��l����? �— � 1 L PC ? �9L�i��J17 <br />