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.-� r-. <br />APPLICa�ION FOR CONSTRV�TION <br />PERMIT <br />rne Everpreen <br />CITY OF <br />everett <br />everett e <br />BUILDlNG DEPARTMENT <br />259-B810 TO BE COMPLETED IN INK— PLEASE PRINT <br />OWNEN 1 MqILpD�FE55 CITY ZIP PHONE <br />�un1R��S£ �LNJt S Iir1FNl� G_ - 63.2r� C-'C�zcaEi�v �A�/- FFf.C� //J i-�J/12 �S7�C' <br />�qCHITEGTORDE5IGNER MAILADDRE55 CITY ZIP PHONE <br />OENEMLCONTpACTOR M�ILR�ORESS CIiY ZIP PHONE LICENSE+ <br />PLIIMBINOCONTRACTOq MAILAD�RESS CITY ZIP PHONE L':ENSE+ <br />❑ NEW ❑ ADDITION <br />� CANTH�CT PqIGE OF WOpK <br />IOTJL� BLOCN OF <br />� <br />;7.:,.�,,,_� #S <br />�IS C%M/rvC c <br />PLUMBIN6 <br />VO. TYPE OF FIM <br />WATER CLOSEf (TOILF <br />BATHTUB <br />IAVATORY(WASH BA$ <br />SHOWER <br />KITCHEN SINKB DISP. <br />DISHWASHER <br />LAUNDRY TiiAY <br />CLOTHES WA3HER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />nwr �nn�rva — <br />SINK 1SERVICE — <br />ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL INSEflT ❑ BUILDING RELOCATION <br />PERM�T $ <br />TOTALFEE $ <br />� PEAHSET&1CK SID <br />, <br />ttPE CANST.-� OCCUPAN YGROUP <br />ALLOWABLE/FCTUAL �./ f�- L <br />/V �O� <br />EIZEOFBLDG NO.OFSTORIES BSM <br />/I�v SF � ❑v <br />FIRESPRINKLERSREOUIRED ❑VES�NO <br />FPPUCRTIONf�C.BY P�ANS/PPP.B� <br />-yf 1. / <br />� U <br />FEE <br />I HEREBV CERTIFV THAT I HAVE FEAD AND EXAMINED THIS APPLICATION AND <br />KNOW THE SAME TO BE TRUE AND CARRECT. ALL PROVISIONS OF LAWS AND <br />ORDINANCES GOVERNING THIS 7YPE OF WORK WILL BE COMPLETED WITH <br />W HETHER SPECIFIED HEFEIN OR NOT. THE CaRANTING OFA PERMIT DOES NOT <br />PRESUME TO GIVE AUTHOFIN TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PER• <br />FORMANCE OF CONSTRIICT10N. THAT I AM AUTHORIZED BV THE OWNER OF <br />THIS PROPEflNTO PERFORM THE WORK FOR WHICH APPLICATION IS MADE <br />AND I COMPLY WITH THE STATE CONTFACTORS LAW 1827 RCW AND <br />296200 WAC. <br />SIGNATUREOFCONTFlLiORORAUiHORIZEDAGENT �FTE <br />X C� � ,�o�, _ /� • 9/iz��R <br />APPLICFNTS BUSI E .ANDBUSINESSNr1ME �� <br />MECMANICAL <br />A/C — A/HNDLG UNITS -- H.P. <br />FORCED AIR SYSTEMS— &T.U. M EA <br />UNITHEATERS—B.T.U. M <br />CIOTHESDRYERS <br />WATER HEATER <br />WOOD STOVE <br />HEAT PUMP <br />GAS PIPING <br />EXHAUST FAN <br />SUBTOTAL <br />PERMIT <br />TOTAL FEE <br />;KNUMBER FEE <br />t��a� gz <br />❑ vEs �No FEES <br />NO.OFDWELLINGUNITS BUILDING <br />� PLUMBING <br />OLr. LOAU <br />/z MECHANICAL <br />HEIGMTLIMITA�% OTHER <br />/ S1ATE BUILDING SURCHARGE <br />STATE ENERGYSURCHARGE <br />PUBLIC WORKS <br />TOTAL <br />✓� <br />S <br />S <br />FEE <br />�3 3 <br />y� <br />