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(Y�,�� � ""� <br />� APPLIC�i�'1(�1N FOR COI��TR��TION <br />PERMIT <br />fhe Everg�een <br />CITY OF <br />everet t <br />BUILDING D[PARTMENT <br />259•8610 <br />TO BE COMPLEI ED IN INK— PLEASE PRIfVT <br />everetl <br />� <br />OWNEN MAILAOORESS GIiY 21P PMONE <br />72�M CFFlnl y?30 �vE�-�r. s.w �.y,uuwcoo 4E�s3� -t�5-2sa� <br />TENANI MRIIpU�l1ESS CIiY ZIP PNpNE <br />r11M4!'� �;, 95C�5 �VE�C�2�1 _�lL�.�ri �b1o8 �— <br />�BCNITECTOqOESIGNER MRILR�UflE55 G.IY ZIP PIIONE <br />�1.�, nrSKG�,2+� ��.�z n1.�, �wE r�,cr l.a�,�eeed���ere� 305--5'66-zzS I <br />OENEHALCONTP�CiOR MAIIRDDRF.55 CITY 21V FNONE IIGENSE• <br />1i�5(JLU�(�1 l�(Sl�'li . WDI w�!f ��eSal.l 5�'EiT/� �1i� �i`b� 6�$ <br />�"SF�S�t+�S�N.�S3NTP"c79P,�r.�/� Mu�nooaess cnv — a� �' r�� LICENSE� <br />CpLA�SS OF WpRK <br />ip NEW � ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOL�TION ❑ WOODSTOVFjFRP� INSEFT ❑ BUILDING RELOCATIOIJ <br />CONTMCTPRICEOFWOfi�L.�(�i (�J( <br />UE9CRIBEWOPK�NpSOUAFEF00T EINV( <br />SEf �Pt iusrnr�Zniw <br />vnoroseous oreuaowo <br />LEQ�L DESCPIPTION OF pR ERTY��o� <br />LOT�� BLOCK� OF . <br />tyU1SIMl A�O. ��f�-��+II <br />f?Ett`RDt� �nl �lowrvte <br />s�o��►�� ����tu ; <br />PPOJECT�DpAE55 <br />9�05 �Ycxr�e�u <br />PLUM91N9 <br />LAVATOiiY(WASH BASI <br />SHOWCR <br />KITCHEN SINKB DISP. <br />DISHWASHER <br />LAUNDRYTRAY <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />ROOF DRAINS — RAINLEADERS <br />SINKISERVICF— BAR. ETC.I <br />TOTAL F�E <br />Z <br />�i <br />FIqESPRINi,':: .r)UIqED Y ❑NO <br />� APPI ICRTIU T ACG 6Y PUNS APPfi. DY � <br />` � �� <br />FEE <br />� <br />S <br />S <br />sioe seiencr. <br />"ACANi51iE <br />❑ VES 5d10 <br />NO.OP OW ElLINO L <br />0 <br />IHEREBYCERTIFYTHATIHAVE READANDE%AMINEDTHISAPPLICATIONAND <br />KNOW THE SAME TO BE TRUE AND CORRECT. �LL PROVISIONS OF LAWS AND <br />ORDINANCES GOVERNING TH�S NPE OF WORI< WILL BE COMPLETED 1NITH <br />W HETHER SPEGIFIED H EREIN OR NOT.THE GRANTING OFA PERMIT DOES NOT <br />PF?ESUME TO GIVE AUTHORI7Y TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANYOTHER STATE OR LOCAI. LA`N REGULATING CONSTRUCTION OF 7HE PER� <br />FORMANCE OF CONSTRUCTION. THAT I AM AUTHONIZED BY THE OWNER OF <br />THIS PROPERNTO PERFORM THE W09K FOR WHICH APPLICATION IS MA�E <br />AND I COMPLY WITH ?HE STATE CONTRACTORS LAW iB27 RCW AND <br />296.200 WA�'. / <br />SIGNATUPEOF.;ONiPAC70ROPAUTHONI2EDAGENT OATE 11/�,glg� <br />« <br />x /�. �r -- -_ <br />MECHANICAL <br />NO. TYPE OF EOUIPMENT <br />fVC — AIHNDLG UNITS — H.P. <br />FORCEDAIRSYSIEMS—B.T.U. M <br />UNIT HEATERS— B.T.U. M <br />CLOTHESDRYERS <br />VENTILATION FAN <br />RANGEHOOD <br />METAL FIREPL <br />FIREPLACEIN <br />HEAT PUMP <br />GAS PIPING <br />EXHRUSTFAN <br />8 CHIMNEY <br />FEE <br />SUB TOTAL S <br />_ PERMIT $ <br />TOTA� FEE 3 <br />�UNCIIECK UMBEP FEE PECEIPTNO. <br />�� a�asz4- zsz.53 i ��� <br />FEES VALUATION FEE <br />BUILDING �J �' '3L <br />/ <br />PLUMBING <br />MECHANICAI <br />OTHER <br />STATE BU�LD'NG SURCHARGE <br />STATEENERGVSURCHARGE <br />PUBLIC WORKS <br />TOTAL <br />