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�APPLIC.+.�ION FOR CONSTRI,CTION <br /> PERMIT <br /> fhe Evergreon i`,i���� <br /> CI1 Y OF <br /> everett e <br /> BUILDING DEPARTMENT <br /> 259•8810 TO BE COMPLETEQ IN INK— FiL�ASE PRINT <br /> OWNEiI MAIIA��RE55 —L(IT }Jb CIIY ZIP FnON[ <br /> 1�ic lf//so� 'c�� - ��7� �3Sv%o/�„k. �olsn✓a le� Gti�• 5�/U�f 3S�-slly. <br /> TENANT MAILApORE55 CRV ZIP PHONE <br /> AFlGHREGTOADESiGN3 MAllP0�BE55 GiV Z�P VHONE <br /> G£NER�LGOHTPACiOR �ALLhDORESS CITY ZiP PMONE LIGENSE� <br /> MECHANICALCONiPACTOF VPIL�O�fiE55 CITV ZiP PNONE LiCENSE• <br /> PLUMBING(ONTRAGTOR MAILA�ORE55 CC�iY ZIP PNONE LICENSE• <br /> /-�I�/11L3/n/ (� CUNCG:?T S SUD / '%}OLr S �EA L�II� Sq/US ,�C�L '� �'Z�I /�LUMLrC 1C <br /> CLASS OF KV FK i�i,f,Z <br /> ❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION C WOODSTOVEJFRPL INSERT ❑ BUILOING FELUCATION <br /> TENRNTIMPPOVEMENTORINiER10NREMOOELONLY GONTACTPEPSONANDPNONENO <br /> CANTRACT PPICE OF WORK <br /> DESCRIBE WOPN�NC SOU�RE FOOTAGE INVOWED <br /> 7EN/d-n/% //IIGP�.UJcmt�'Ni _ - <br /> PROPOSE�lISE OF BUiLDiNG I HEREBV C.ERTIFY THAT I HAVE READ AND EXAMIN EO TI11S APPLICATION AND <br /> KNOW THE SAME TU BE TRUE AND GOFRECT.AL L PROVISIONS OF LAW S AND <br /> LEGAL�ESCRIP110NOFPROPERTY�SIIOWNBEIOWORAITACHFOURCOPIES� ORDINANCESGOVEFNINGTHISTYPEOFWORKWILLBECOMPLETE�WITH <br /> WHEiHER SPECIFIEO HEREINOR NOT.THEGRANTINGOFAPERMIT DOES NOT <br /> PRESUME TO GIVE AUTHOAITY TO VIOLATE nR CANCEL THE PROVISIONS OF <br /> �or e�ock__ ov _ ANYOTHERSTATEORLOCALLAWREGULATINGCONSTRUCTIONORTHEPER� <br /> FORMANCE OFCONSTRUCTION.THAT I AM AUTHORIZEO AY THE OWNER OF <br /> THIS PROPERTYTO PE(iFOFM THE WORK FOR WHIC:H f.PPLICATION IS MADE <br /> AND I COMPLY WITH THE S7ATE CONTRACTORS LAW 1827 RCW AND <br /> 296.200 WAC. <br /> SIGNAiUFEOFCONiFAC i O..WTHOiil2E GENT TE <br /> PPOJEGTApDfiE55 . I p�PLICAf �OSINE55 CE 3ENO.FNDBUSINESSNFME ��� <br /> �{- Z. �UG�''�C tiL��.l W <br /> PLUMBING MECHANICAL <br /> NO. TYoE OF FIXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATBR CLOSET(TOILEq !VC—A/HNDLG UNITS—H.P. <br /> BATHTUB FORCED AIR SVSTEMS—&T.U. M EA <br /> LAVATORYIWASHBASIN) UPIITHEATERS—B.T.U. M <br /> SHOWER CLOTHESDRYERS <br /> KITCHEN SINKL DISP. VENTILATION fAN ._ <br /> DISHWASHER RAIJGE HOOfI <br /> LAUNDRVTRAY _L WATER HEATER <br /> CLOTHES WASHEfi WOOD STOVE <br /> URINAL METAL FIREPLACE 8 CHIMNEY <br /> DRINKING FOUNTAIN FIREPLACE INSERT <br /> FLOOR�RAIN HEA�PUMP <br /> BACKFLOW PREVENTERS GAS PIPING <br /> . ROOFDRAINS—RAINLEADERS EXHAUSTFAN _ <br /> SINK�SERVICE—BAR,ETQ) _ --- <br /> SUBTOTAL 5 SUBTOTAL _ 5 <br /> PERMIT 5 PERMIT 5 <br /> TOTAL FEE TOTAL FEE 5 <br /> FRONTSEI9/CN 9EARSETpACK SIOESETBRCN PLANCNECKNUMBEH FEE 11ECEIPTNU. <br /> USEzor+E IOTARER VAGANTSIiE FEES VALUATION FEE <br /> O YES ❑ NO <br /> iYPEOFCONST OCCUPANGVGAOIIV NOAFOWELVNGUNITS BUILDING _ <br /> ALLOYlABLE/ACTUAL <br /> PLUMBING <br /> SIZEOFBLDG. HOAFStOPIES BSMI. OGC.LOAD <br /> ❑Y MECHANICAL <br /> ❑N <br /> MEiG11iLI�11TAilON OTHER <br /> fIRE SPRINKLERS REOIIIqEU ❑YES ❑ NO STATE BUILDING SURCHARGE <br /> STATE ENERGY SURCHARGE <br /> qPPLIGAT10N ACC BV PLPNS RPPR.BY � <br /> PUBLIC WORKS <br /> TOTAL <br /> t <br />