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� � <br /> APPLI�.�►TION FOR CONSTRJCTION <br /> fhe Everpreen PE RM IT <br /> CITV OF everett <br /> everett e <br /> BUILDING DEPARTMENT <br /> 259-8810 TO BE COMPLETED IN INK— PLEASE PRINT <br /> OWNEF MAI�ADORE55 CITY ZIP PMONE <br /> 7�Rkr4 Fi�2u,A �c�i/. iti� G2G (Z��.? S-t` 5,�.;.� to� �✓�.vt�� g�zoy <br /> TENANT MAILADDRESS CITY � 21p PMONE <br /> ARCMITELTOR�ESIGNER MRILFD�flESS CITY ZIP PHONE <br /> GENEMLCANTRAGTOP MAILADORE55 CIT'! 21P PHONE I N <br /> Lf�o�d c 1 <br /> (SRoK.aw ,� Ce. 3G2o R,.cic���4 �Sv�7�- 305 E. CR/t�en�. �8' 07 2V�Z iio ,rc <br /> MECHANIG�LCANTMCTOR M�ILAODRESS / ��Ty� Zlp � LICENSEr <br /> PLl1MBIN�CONTMCTOR MFILr1DDRE55 CITY 21P PHONE �ICENSE♦ <br /> �'�RN.�p l�.u„„d�..c,. �Nt�T�.m- /3S�oG so'�S/. �C? �.+et�ew�SN� `jPr�so�tC8-2s�� <br /> rn� �'ARNsAN !//L/ <br /> 111 NEW ❑ ADDI710N ❑ ALTERATION ❑ REPAIR ❑ DEMOLI710N ❑ WOODSTOVE/FRPL INSER7 ❑ BUILDING RELOCATION <br /> TENANT IMPiIOVEMENT OR INTENIOR REMODEL ONLV CONTRCT PEPSON AND PHONE N0. <br /> � � CANTMCTPRICEOFWOFK <br /> UESCPIBE WOFK AND SOUMiE f00TpGE INVOLVED <br /> PROPOSED USE OF BUILDING <br /> I HEREBY CERTIFY THAT I HAVE READ AND E%AMINED THIS APPLICATION AND <br /> WP1��Hl�t�.alF, O�Gf/, ��.t5�..eMtS KNOW?HESAMETOBETRUEANDCORRECT.ALLPROVISIONSOFLAWSAND <br /> LE(ULDE3CRIPf10N F'IOPERTY�SH N BELOW OPATfACM FOUFCOPIESI ORDINANCES GOVERNINCa THIS TYPE OF WORK WILL BE COMPLETED W�TH <br /> WHETHEP SPECIFIED HEREIN OR NOT.THE(,RANTING OFAPERM�TDOES NOT <br /> PRESUME TO CaIVE AUTHORITV TO VIOLATE OR CANCEL THE PROVISIONS OF <br /> �oi e�ocK or ANYOTHERETATEORLOCALLAWREGULATINGCONSTRUCTIONORTHEPFR• <br /> � FORMAN�E OF CONSTRUCTION.THAT t AM AUTHORIZED BY THE OWNER OF <br /> THIS PROPERNTO PERFORM THE WORK FOR WHICH APPLICATION IS MADE <br /> AND I COMFLY WITH THE STATE CONTRACTORS LAW 1827 RCW AND <br /> � 296200 WAC. <br /> � SIGNFTOPEOFCONTHRGTORONAUTMORIZEDr1GENT DATE ���/� <br /> PROJECTApORE55 l-�� O�vv ' <br /> qPPLICANTS GITY BUSINESS LIGENSE NO.RNO 9USINE55 NAME <br /> (O G�l �' r-. 7 n .r <br /> PLUMBINO MECHANICAL <br /> NO. 7YPEOFFIXTUREORITEM FEE NO. TVPEOFE�UIPMENT FEE <br /> WATER CLOSET(TOILEn q/C—A/HNDLG UNITS—H.P. <br /> BATHTUB FORCED AIR SYSTEMS—B.T.U. M EA <br /> LAVATORY(WASH BASIN) UNIT HEATERS—flT.U. M <br /> SHOWER CLOTHES DRYERS <br /> KITCHEN SINKB DISP. VENTILATION FAN <br /> DISHWASHFR RANCaE HOOD <br /> LAUNURY TRAY WATER HEATER <br /> CLOTHES WASHER WOOD STOVE <br /> URINAL METAL FIREPLACEB CHIMNEY <br /> �RINKING FOL'4TAIN FIREPLACE INSERT <br /> FLOOR DRAIN HEAT PUMP <br /> BACKFLOW PREVENTERS GAS PIPING <br /> ROOFORAINS—RAINLEADERS EXHAUS7 FAN <br /> SINK(SERVICE—DAR,ETQ) <br /> fi./L c. <br /> L� 5a�w <br /> SUBTOTAL $ SUBTOTAL 3 <br /> PERMIT $ PERMIT 5 _ <br /> TOTAL FEE 5 TOTAL FEE 5 <br /> FRONTSETBACK REpR5ET0�GN SIDESETBRLN DLANCHECKNOMBEq FEE PECEIPfNO. <br /> USezoNE LOTARFA VRCPNTSITE FEES VALU.ITION FEE <br /> ❑YES u r+o <br /> IYPEOFCANST. p�CUPANCYGROUP NOOFDWELLINGUNITS BUILDING <br /> ALLOWRBLE/RCTUAL <br /> FLUMBING <br /> 512EOFBLDG. NO.OFSTOflIES BSMT. OCGLOAD <br /> ❑r MECHANICAL <br /> ❑ N <br /> HEIGHTLIMITATION OTHER <br /> FIFESPRINNLEFSREOIIIREO ❑YES ❑NO <br /> STATE BUILDING SURCHARGE <br /> STATE ENERGY SUFCHARGE <br /> APPLICATIONACGBY PLRNSAPFp.BY <br /> PUBUC WORKS <br /> TOTAL <br />