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� �� �� ��r�� <br /> _ • APPLIZ:�iT10N FOR CONSTR�.�CTION <br /> PERMIT <br /> the Everpreen <br /> CITY OF c�rrett <br /> everett - � e <br /> BUILDING JEPARTMENT <br /> 259-8810 TO BE COMPLETED IN INK— PLEASE PRINT <br /> t VU�W�-��I lU,�(.0 W���i.1Q//�Aw�.�V� ��Vvr'� h4C�C.r11t_.t��Uli7 zir �on�� ��I <br /> IEN�NI T MAIL��DIiE:S Gtt ZiP PHONE <br /> ♦fIpHITEGTON0E5�GNEN M�IL�ODNE54 CILY ZIP PHONE <br /> GENEN�LGONTR�GiOR M�IL�OOOES$ G�IY ZIP PNONE LIC.ENSE• <br /> M CN N�C�LCOlIR(� lp�� ' � �iL�DDNE55� CITy _ �n / ���� ��� <br /> � � nr � ,/� A �7..e ._.J <br /> � �v U" � ({_{�LI� J IY�V�LL <br /> RUMBINOLO �GTOR M�ILApDRE55 a GITY ZIP PHOHE �ip� <br /> LU590�WORN <br /> ❑ NEW ❑ AD�ITION LTEPATION G REPAIR ❑ DEMOLIt10N ❑ WOODSTOVFJF{1Pl INSERT ❑ BUIIDING FELOCATION <br /> LEN�HiIMPROVfMENtORIHTER PEMODE/L�ONLV ('pNUCTPEHSpN�NOPIWNENO. <br /> CANiR�CiPNICEO(WOt1K � ��/'J <br /> `��WpRR�Np$pU�REF0pTR0EINVpIVED/ .�� � �1 e- � <br /> 4KflI1 %% %1 I / 1 /+.�if•/� /ID�//I <br /> ✓ 41��J\_ ����V1/V (J�-UC L�iL(.1�..\ <br /> PROPOSE�USE oFeuwpwa� 1 HEREBV GERTIFY THAT 1 H�VE READ AND EXAMINED TMIS APPLICATION AND <br /> � KNOW THE SAME TO BE TRUE ANU CORRECT.ALL PRpVIS10N3 OF UWS AND <br /> IEG�L D[SCRI�iIDII Of PROPERLY�SNOWH BELOW OR�IIALN fOUflCOPIES) ORDINANCES GOVERNING THIS TVPE OF WORK WILL 8E CAMRETEO WITH <br /> WHETI1Eti SPECIFIED HEf7EIN OR NOT.THEGRANTINOOFAPEFMIT DOES NOT <br /> PRESUME TO 61VE AU7HORI71 TO VIOUTE OR CANCEL THE PROVISIONS OF <br /> iOT etocK o� . .ANYOTHERSTATEORLOCALLAWREGULATINGCONSTRUCTIONOR7HEPER• <br /> FORMANCE OF CONSTRUCTION.THAT I AM AUTHORI2ED BV THE OWNER OF <br /> THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATON IS M�DE <br /> AND I COMPLV WIiH TI1E STATE Cf1NT17ACTOHS lAW 1827 RCW ANO <br /> 296.200 WAG <br /> SIGNAT REOfCONiP/�CIOOOiA/p�i110RIZE0�0ENT DQE � <br /> �/�I/' � �� <br /> PROJECi�DOPE55 � A �NTSC�LYBII51 SSRCENSENO IOBUSi ESSN�ME � � <br /> 4 5 �� G�-�.�-C;,� 1� � <br /> PLUMBINO MECHAHICAL � <br /> NO. TYPE OF FIXTURE OR ItEM FEE NO. TYPE OF EOUIPMENT FEE � � <br /> i <br /> WATERCLOSET�TOILEn A/C—NHNOLOUNITS—H.P. ! � <br /> BATHTU9 � FORCED AIR SVSTEMS—61:� M EA � I <br /> LAVATORV�WASH BASIN� UNIT NEATERS—B.T.U. M I <br /> SHOWER CLOTHES DRYERS — I <br /> KITCHEN SINKB DISP. VENTILAiION FAN <br /> OISHWASIiER qpNGE HOOD <br /> LAUNDRY TRAV WATER HEATER <br /> CLOTHES WASNER WOOD STOVE � <br /> UFINAL METP.I FIREPLACE d CHIMNEV <br /> DRINKING FOUNTAIN FIFEPLACEINSERT <br /> FLOORDRAIN HEATPUMP <br /> BAGKFIOW PREVENTERS :iAS PIPING ' <br /> ROOFORAINS—RAINLEADERS � EXHAUSTFAN <br /> SINK(SERVICE—BAR,ETC) <br /> SUBTOTAL S SUBTOTAL S — <br /> PERMIT S PERMIT S � <br /> TOTAL FEE 5 TOTAL FEE S � � <br /> iRONISETB�CK OE�RSEIBGGN S�OES[TORCK PUNCHECKNUMlER FEE 11ECEIITMO. <br /> I <br /> UsezoNE IOTPREA MC�NT91iE FCES VALUATION FEE � <br /> o ves n Ho ' �� <br /> BUILDING <br /> TYPEOFCANST. pppJPANCYOROUP NOAFOWELLINOUNIB <br /> •LLOW�BLFJACTUAL . <br /> PLUMBINQ <br /> 512EOFBl04. NOAPSTOflIEB &SMC OGG.LOAO <br /> o r MECHANICAL � <br /> ❑N INelO11TLIMIUl10N OTHER <br /> �IOESPRINNLEf15 REWIPED ❑res ❑No STATE BUILDING SURCIIARGE li <br /> S1ATE CNERGY SURCHARGE I <br /> erruCuior+ecC.er ru�searn.er <br /> PUOLIC WORKS <br />' TOTAL � <br />