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APPLICa�ION FOR CONSTRI.CTION <br /> � PERMIT <br /> fhe Everg•een �yeretl <br /> qTY OF O <br /> everett e <br /> ,, BUILDING DEPARTMFN7 <br /> 259-B6i0 TO BE COMPLETED IN INK— PLEASE PRINT <br /> � Tnx` nTr'*i*� 10500 EVE3tGREFSI W7�Y �'c7�uF`P�` 98204 259-8104 <br /> �Qfl� OWNEN MAILNOORE55 qiY ZIP PMONE , <br /> � WINNIIt �1'� DE.arFaSr�t7g <br /> .p � �lENd/!j� �� � II��IAI.AD�RE55 �� �� �j.��CIiY �'�C ZIP O� GMONE ��� '���� <br /> ��/i / '�) <br /> �i (A r1flC111TECTOR0E51GNEF M0.ILROOPE55 CILY ZIP �HONE <br /> N� '� � �T�*+ T*+r PO HOX 1430 nartit77TF� 9A275 7A5-9117 <br /> '7 � GENFPA�GONTPACTOR MAILADPRE55 CItY ZIP PNONE LIGENSE• <br /> hC <br /> . ��Q MECNANICNLGONTRRCTOP MNILAODFE55 pTY ZIP PHONE LICENSE• <br /> ��� CIVPv MTT.1rtN DTIIMRTTY` — . <br /> PLUMBINOGONTHACIOH MAILNOORE55 LIiY 21P FHONE ULENSE� <br /> Q�(..�� .....e��.�..,�.eK . <br /> QW� � NEW ❑ ADDITION ❑ ALTERFTION ❑ REPAIR ❑ DEMOLITION ❑ wOODSTOVE/FRPLINSERT ❑ BUILOINGRELOCATION _ <br /> � TEN�NTIMPROVEMENTONINTERIpPREMO�ELONIY CO`lT4LTP[RSONANpPMONENO <br /> �M0.SFCl PIGN lI� <br /> y fANTMCTPPIGE0FWO11K Cn y6 � $� DREIS 745-91�Z__ <br /> �1 pESCRIBEWORK�Np50URHEFOOTAGEINVOLVEO , � <br /> �� �'•.I�w bu' - ` -a s es <br /> H PHOPOSEDUSEOFBUILDIN IHEREBYCERTIFVTHATIHAVEPEADANUEaAMINEDTHISAPPLICATIONAND <br /> � I p 1 KNON"HESFMETOBETRUEANDCOflRECT.ALLPROVI510NSOFLAWSAND <br /> � M (X�al�fYl�d �' a r � � I�k�� ORDII9ANCESGOVFRNINGTHIS7YPEOFWORKWILLBECOMPLETEOWITH <br /> - ��� LE�ES�PIaro OFPPOPER �SMOWNBELOWOfl�TUGNFOUNCOPIE51 WHETHERSPECIFIEDHEFEINORNOT.THEGRANTINGOFAPERMITDOESNOT <br /> PRESUME TO GIVE AUTHOfiIiV TO VIOLATE OR CANCEL THE PROVISIONS OF <br /> �o* BLOCK or ANVG'YERSTATEORLOCALLAWREGULATINGCONSTRUCTIONORTHEPER� <br /> ._ . .. . FORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BV THE OWNER OF <br /> 1 THIS?ROPERTYTO PERfORM Tiic WORK FOR WHICH APPLIGATION IS MAOE <br /> AND I COMPLV WITH THE STA�E CONTRAGTORS LAW 1827 RCW AND <br /> 296200 WAC. �, /' Q <br /> �, �. • J- SIGNATUPEOFCONTNRGiOROqAU*NOPIZED4GENT OATE /�/!-��V � <br /> X,� ��, /���� <br /> PflQIECT��OFESS PFUC iSGIiY8U51NE55ULEN ENOANpO I�SNAME <br /> O 3O ��.✓ C,J <br /> " � PLUMBIN6 MECHANICAL <br /> ' 1 NO. TYPEOFFIXTUREORITEM FEE NO. TYPEOFEOUIPMENT FEE <br /> WATERCLOSEfITOILEn eZ NG—A/HNDLGUNITS—H.P. <br /> 1�' BATHTUB FORCED AIR SVSTEMS—flT.U. M EA <br /> '�' 2 LAVATORY(WASHBASIN) '�.. UNIT TERS—B.T.U. M <br /> SHOWER OTHESDRYEFS <br /> KITCHEN SINKB DISP. VENTILATION FAN <br /> '�' DISHWASHER RANGE HOO� <br /> 'f' 2 LAUNDRYTFAV WAiER HEA7ER <br /> CLOTHES WASHER WOOD STOVE <br /> 2 URINAL METALFIREPLACEBCHIMNEY <br /> 1�' DRINKING FOUNTAIN FIREPLACE INSERT <br /> '� FLOOR DRAIN HEAT PUMP <br /> � BACKFLOW PREVENTERS GAS PIPING <br /> ' _ ROOFDRAINS—RAINLEADERS E%HAUSTFAN <br /> � SMY:(SERVICE—BAR,ETC.) <br /> 1�' — <br /> I�' SUBTO7AL S SUBTO7AL S <br /> PERMIT S PERMIT S <br /> � <br /> TOTAL FEE $ TOTAL FEE 5 <br /> —" FAONTSEfBACN NEARSEtBACN SIDESETBACY. VUNCNECR FEE /O PECEIPfNO. <br /> �90�— �g5_" Snv�=��— 3 ,3� 77�� 3 .3 <br /> uSEZorv[ LOTAREA VACFNTSITE FEES VALUATION FEE <br /> �J YES ❑NO <br /> C l BUILDING � / .� <br /> TYPEOFGONST WLOi Nf,YGPOIIP NO.OFDWELIINGl1N1'S <br /> QlOW�9LE/ACTUAL �Z -�--�. PLUMBWG ' . <br /> 5¢EOFBL�G. NOOFSTOR�ES QVT �GGLO�D MECHhNICAL . <br /> 11 560 ' 1 " <br /> NEIGN IMITATION OTHER�,e�� �� � <br /> � <br /> FIPESPRiNKLERSREOUIREO ❑VES �NO STATE BUILDING SURCHARGE � <br /> STATE ENeRGY SURCHARGE <br /> pFP IL C1ilON AGG BY PLANSPPPR BY <br /> PUBIIC WORKS <br /> ti��r� <br /> F.L�./� ,.l� / TOTAL J�.3 � � <br /> M1 ` <br />