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APPLIC�:::�ION FOR CONSTR��TION <br /> PERMIT <br /> tAe Everpreen <br /> CtiY OF <br /> everett <br /> everett e <br /> BUILDING DEPARTMENT <br /> 259-8870 TO BE COMPLETED IN INK— PLEASE PRINT <br /> I <br /> OWNE-Ar V MMLhD�RL55 Np GIY IIP PNONE'�� ��� <br /> c/A�'l /�Lf�i/irEGF 2Sh�32-/�2 OC C Mon/ROf /P82�2 GZ 3 a3 ai oFFic� <br /> IENAHT MAIL DpRE55 GTY LP CMONE <br /> I <br /> MLnrtEGTORDESiGNEX 4WL�UpRE55 GTY ZIP RqNE <br /> OEMEP��/IG�ONiR�CTOR MMLA�pRE55 qTY 21P PNONE LiCENSE• <br /> Uwn IPY <br /> MECN�NI�µ�',pNTlULTOH MI11LApDRES$ GiY IIP PXpHE LIGENSE• <br /> RUM&HGCqHTHACfON MNL�pDRE55 QTY ZIP PMONE IIGENSE• <br /> ClAS!OF M9RR <br /> ❑ NEW ❑ ADDITION ❑ ALTEHATION ❑ PEPAIR ❑ DEMOLITION ❑ WOOOSTOVFJFRPLINSERT ❑ BUIl01NGRELOCATION <br /> TENMIT IMPROV[MENP OP MTEFiqi REMODEL ONIY (JpNi/�T PER6pN�ry0 PMONE NO <br /> coHrvurmiceorwonK J�k . ,s/,v.r.=i,=" _/9j—O 3�j� <br /> DEbGRIlE Wpqv IJ10 SOU�HE fOCTAGE INVOLVED ♦ <br /> � O .r <br /> vnoroseo use or e�aowa <br /> I HEREBY CERTIFV i11AT I HAVE FEAD AND EaAM!NED THIS APPLICATION AND <br /> �/�G KNOW THE SAME TO BE TRUE AND CORRECT.ALL PROVIS�ONS OF LAWS AND <br /> LEOKUESCNIPTiBNOfPqppcPtY�SNOWNBELpYOR�tUCHfOURCORES� ORDINANCESGOVERNINGTHISTYPEOFWORKWILLBECOMPLE7EDWITH <br /> I %•Qt�' �3� Q�� WHETHERSPECIFIEDMEREINORNOLTHEGRnNiINGOFAPERM4DOESNOT <br /> �ory�� e�ocKS�L ov v�AT O� �(/E= �f PRESUMETOGIVEAUTHORI7YTOVIOLATEORCANCELTHEPROVIStON30F <br />, ANV OTH Efi STATE OR LOCAL LAW RFGULATING CONS7RUCTION OP THE PER� <br /> ,/� �� e FORMANCE OF CONS7RUCilON.THAT I AM�UTHOR12ED BV THE OWNER OF <br /> !/�✓• THIS PROPERI V TO PERi'ORM Tl1E WORK FOR WN�CH APPLIC�TION IS MADE <br /> AND I COMPLY WITH THE STATE CO'JiRACTORS LAN' 18.27 RCW AND <br /> 286200 WAC. <br /> !°GDi?DEO � �Ls..y� 3 ��� T S�ONATUBEOFWNIq�C10BOF�UtHONIZEOIGCNi oere <br /> AA X�'ti��� -�o- d <br /> PRO.IEGT MDAE55 <br /> A I �NTSGIYBV9�NCSSLILEN5ENO.AN IHESSNAM <br /> 20 �OL i3 ' AY <br /> PIUM�INO MECNAHIGIL <br /> MC• T'VE OF FIXTUNE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) A/C—A/HNOLG UNITS—H.P. <br /> BATMTUB FORCEDAIRSVSTEMS-6T.U. ME0. <br /> LAVATORY(W45HBASIM UNI7HEATEP.S—B.T.U. M <br /> SHOWEH CLOTHESORYERS <br /> KITCHENSINKBDISP. __ VENTILATIONFAN <br /> _. DISHW.'wSHER qpNGEHOGD <br /> LAUNDRYTRAY WATER HEATER <br /> CLOTMES WASHEH WOOD STOVE <br /> UH�NAL ME!AL fIREPUCEd CMIMNEV <br /> DRINKINO FOUNTAIN FIREPLACEINSERT <br /> FIOOR DqAIN HEAT PUMP <br /> BACKFLOW PREVENTERS GAS PIPING <br /> ROOF DR�IN5—RAINLEADERS E%HAUST FAN <br /> SINK(SERVICE—BAR ETC.� <br /> t <br /> SU9TOTAL s <br /> SUB TOTAL f <br /> PERMIT y <br /> PEfiMIT s <br /> TOTAL FEE S TOTAL FEE S <br /> F�T�T�K PFAFSETB�CR 9iDESETB�Cv, PIANCNECKMUMOEII FEE 11ECFIRNO. <br /> IIBE20NE LOT�q�A V�GNi61tE <br /> I a Yes U No PEEB VALU�TION FEE <br /> IYPEOFCOryST. OCCUP�NGYGPOUP NO.OFDWE��INpUNIB BUILDING <br /> �ILLONMBIfI�GTU�L <br /> PLUMBING <br /> M2EOFBlDO. NO.OFSTORIEB BSMi. OCCIO�U <br /> or MECHANiCAL <br /> ❑N <br /> NEIONTLIMIT�iION OTHER <br /> FIPEgPp;NKLEPBHfWINEO OYES ❑NO ' <br /> STATE BUILDING SURCHARGE <br /> STATEENERGYSUFCHARGE <br /> �PP'IG�TIONACGBV PL�VlSAPPR.BV <br /> PUBLiC WORKS <br /> TO7AL <br />