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-i <br /> I i <br /> ', <br /> ' pppL1�.�T10N FOR CONSTR�CTION <br /> PERMIT <br /> � IM1e Ever9reen everett <br /> CITY OF � <br /> ' �verEtt <br /> BUILDING DEPARTMENT <br /> 259•�eto TO BE COMPLETED IN INK— PLEASE PRINT <br /> pWNER MAiLA0�11E55 GITY 21P PHONE <br /> Sfl�K6(� ��TNE�TQlSq//8lA. �4�/E S�E' BE�,t�t/dE,wA 98005 453 - !(000 <br /> I�Y ZIP PHONE $.03 926-�693 <br /> : Go✓slG,f E+�/j�'IeP,����,vc l/O T�l! ,D �V6. S���ILl3�Y, o� a773Zl-9J9/ � � <br /> �pGHITECTONDE5IONER MAI PDDRESS CIIY �,,-�Z,I,P, PIIONE �O� �'O��O <br /> ,�G/j�� �/.�A/LoN Edtv,s�e05 34Nl�/. �'fSfAvE.�Z�q_./�"'_"`�J� 472oy C � <br /> �ENERALCONTRRCTOR MAIL � S GTY ZIP ^ PHONE LICENSEt — <br /> r � 8,0 _�-ga� ►� �1,�_ � ��'���-�y <br /> MEGN�NIC�LCONTR�CTOR MRILPOD 55 CITY —�—��' PHONE LICENSEt _ <br /> r e� ,�,� ��?�-11���� � <br /> PLUMBINUCONTRACTOR MAILRD�FE55 CIIY � ZiP PMON! UGENSE• I <br /> T � e,o aa3-a�-Ci�vn,n���l I <br /> C�Lh5�3 OF WORK rY�f� <br /> ' �'NEW ❑ ADDITION ❑ ALTENATION ❑ f7EPAIR ❑ DEMOLITION ❑ W0003TOVE/FRPL INSERi ❑ BUILDING iiELOCATION I <br /> TENANT IMPROVEMENT OF INTENIOR PENODEL ONLY CONIAGT PERSON ANU.P�IIO/NE NO. <br /> '. CANTR�CTPPICEOFWOpK � �I U�` {�(��fl mK �J _ • '• �'•�vv I�UI� <br /> DE4CNIBEWORK�AOSOURHEFOOtROEINVOLVED �O� ^� _ O� � � <br /> 5 oB5 s�. � .v6w 8uiao��vG � � � 9 <br /> pp��USE`Feui`oli?�' � �A"� � IHEREBYCERTIFYTHATIHAVEREADANDEXAMINEDTHISAPPLICATIONAND <br /> Y' p s ,s� �f�' KNOWTHESAMETOBETRUEANDCORRECT.ALLPROVISIONSOFLAWSAND � <br /> CIRDINANC[S GOVERNING THIS TYPE OF WORK WILL BE COMPLETED WITH <br /> LE(ULOESGHIPTIONUFPHOPERiY�SHOWNBELOWORATiFGMFOURCOPIESI yyHETHERSPECIFIEDHEREIIJORNOT.THEGRANTINGOFAPERMITDOESNOT <br /> �� PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br /> � �pT aiocK oF ANYOTHERSTATEORLOJALLAWREGULATINGCONSTRUCTIONORTHEPER� <br /> i FORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BV THE OWNER OF <br /> 2rf�ll.��� THIS PROPERTY TO PERFJRM THE WORK FOR WHICH APPLICATION IS MADE <br /> �����T AND I COMPLY WITH THE STATE CONTRACTORS LAW 1827 RCW AND <br /> ' 2982J0 W 1 . , <br /> SIGNAiURE GONt C10RONAUINORIiEDAGENT �RTE <br /> X o�, a� �989 <br /> PROJEGTADDPE55 APPLICRNi5G1-- iYB�S��Essl�%ENSENO.RND6USiNGJsnnme <br /> FOUI+Y�/�fY�'Z.d' IO//7 ����� W'ay Gf/ �1JLON W .4./.A. �G . <br /> PLUMBINO MECHANICAL <br /> � NO. TYPE OF FIXTUFE ON ITEM FEE NO. TYPE OF E�UIPMENT FEE <br /> WATER CLOSET(TOILE� A/C—A/HNOLG UNITS—H.P. <br /> BATHTUB FORCED AIR SYSTEMS—B.T.U. M EA <br /> LAVATORY(WASH BASIN) UNIT HEATERS—B.T.U. M I <br /> SHOWER __ CLOTHES DRYERS <br /> KITCHEN SINK 8 DISP. _ VENTILATION FAN <br /> DISHWASHEq RANGE HOOD <br /> LAUNDRY TRAY WATER HEATER <br /> CLOTHES WASHER WOOD STOVE <br /> � URINAL METALFIREPLACE&CHIM1INEY <br /> DRINKING FOUNTAIN FIREF:ACE INSERT <br /> FLOOR OFAIN HEAT PUMP <br /> � BACKFLOW PREVENTERS GAS PIPING <br /> ROOF DRAINS—RAINLEADf.�RS EXHAUST FAN <br /> SINK(SERVICE—BAR,ETC� — <br /> i <br /> SUBTOTAL S SUBTOTAL g ', <br /> • PERMIT $ PERMIT $ '. <br /> TOTAL FEE $ tOTAL FFE g <br /> FPONTLE78FCK �EARSETBACH SIOESET&1CK PUNCNE NNUMBEP FEE '� RECEIPT�.�� � <br /> uSezoNe L�TARER vncarursite FEES VALUATION FEE <br /> �YES ❑ NO � � <br /> BUILDING � <br /> TYPEOFGONST. OCCUPRNCY�ROUP NO.OFDWELLINOUNIIS . <br /> ALLOWABLE/AC1U l � ^ � � � PLUMfiiNG il <br /> �r <br /> 52EOFBLO(3. NO.OFSTOPIES B❑SVT. OC:LOAO MECHANICAL � <br /> SUB� � �'G I <br /> HEIGNTLIMItATIPN OTHER � I <br /> FIPE SPRINNLERSRE�l11PF.D ❑YES NO __ STkTE BUILDING SURCHARGE �'� <br /> STATE ENERGY SURCHARGE I <br /> APPLICATIONACGBY^ PLANSAPPfl.BY PUBLICWORKS <br /> V , <br /> �� TOTAL � <br /> ... ._.. . . . . . ......... . .. .: . � .._ � .�. .:._��� <br />