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�, �� i <br /> APPLIC.,.fION FOR CON�TRI�.:.TION i <br /> PERMIT � <br /> Me Evergreen cvercll <br /> GTYOF � <br /> everett <br /> E`UILOING DEPARTMENT <br /> 259-8810 TO BE COMPLETED IN INiC— PLEASE PRINT <br /> OWHER MFIL/OORE55 GIiV (�Z FIIONE ,. <br /> �� ,I�I'2-"`)��/� c`Z`��� �c'S1�7 ��"�,��� U �-!�'�'� � <br /> TENANT MRILAODRESS CIiV 21P PMON <br /> 6r_. a5a- 1�7 ; <br /> ARLNITEGTOROESIGNEA MAILADDRE55 G�iY 21P PMONE 'I <br /> � GENER�LGONTRAGTOR �UILADORE55 GIiY 21P PMONE LIC[NSE• I <br /> � Dlc.Nt�/U <br /> MEGN�NIG�LCONTRRCT09 MAILRODRESS CITV ZIP PMONE LICENSE� <br /> PLUMBINGCONiR�CTOP MRILADORE55 CITY 21P PMONE �ICENSE+ <br /> CLAS$OF WORN <br /> ❑ NEW ❑ ADDITION ❑ AL7ERA710N ❑ REPAIR ❑ DEMOLITION ❑ WOODS70VFJFRPLINSER7 ❑ BUILDINGRELOCATION <br /> TENANTIMPROVEMENiORINTERIO��E�YLY _ � � ,N� CONTRCiPER50NANDPNONENO. <br /> /� �' � (/l/ <br /> CONTRRGTPPICEOFWORK' C< <� <br /> DESGfiIBE WORK AND SOU�RE FOOTAGE INVOLVEO <br /> � � � <br />(, � VRO � SEDIISEOFBUi DIN P IHEREBVCERTIFYTHATIHAVEREADANDEXAMWEDTHISAPPIICATIONAND <br /> � � KNOWTHESAMETOBETRUEANDCORRECT.ALLPROVISIONSOFLAWSAND <br /> LEWLOESGR fIONOFPROPERTY1S11pWNBELOWORRUGNFOURCOVIES) ORDINANCESGOVERNINGTHISNPEOFWORKWILLBECOMPLETEDWITH <br /> W HETH ER SPECIFI ED HEREIN OR NOT.THE GRANTING OFA PERMIT DOES NOT <br /> PRESUME TO GIVE AUTHORITY TO VIOLATE CR CANCEL THE PROVISIONS OF <br /> �OT BIxK OF ANVOTHERSTATEORLOCALLAWREGULATINGCONSTRUCTIONORTHEPER- <br /> � FORMANCE OF CONSTfiUCTION.THAT I AM AUTHORIZED BVTHE OWNER OF <br /> THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICAIION IS MADE <br /> AND I COMPLY WITH THE S1ATE CONTRACTORS lAW 78.27 RCW AND <br /> 296.200 WAC. <br /> SIGN EOF NfRACi0A01/yiM08REDPGENT ATE <br /> �� / L <br /> PROJEGTRDORESS P CANiSG�TYBUS �LICENSENO.RNDBUSWESSNAME <br /> 1 �;� �.CL�I� /A <br /> PLUMBIN� ECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE N0. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILEn A/C—A/HNDLCa UNITS—H.P. _ <br /> BATHTUB FORCED AIR SVSTEMS—6T.U. M EA <br /> LAVATORYIWASHBASIN) UNITHEATEt75—&T.U. M <br /> SHOWER CLOTHESDRYERS <br /> KITCHEN SINKB DISP. VENTILATION FAN <br /> DISHWASHER RANGE HOOD <br /> LAUN�RV TRAY WATER HEATEF . <br /> CLOTHES WASHER WOOD STOVE � <br /> URINAL METAL FIFEPLACE 8 CHIMNEY <br /> DRINKING FOUNTAIN FIREPIACEINSERT <br /> FLOOR DRAIN HEAT PUMP <br /> BACKFLOW PREVENTERS GAS PIPINCa � <br /> ROOF DRAINS—RAI NLEADERS EXHAUST FAN <br /> SINK 15ERVICE—BAR,ETC.) <br /> SUBTOTAL 5 SUBTOTAL S <br /> PERMIT 5 PERMIT S <br /> TOTAL fEE S TOTAL FEE S <br /> iRONT5ET8ACK PEARSETMCN SIpESEi&LCY. VUNCNECKNUMBEfl FEE 11ECEIPiNO. <br /> uSEZOt�E LOTRRFA VACANTSITE FeES VALUATION FEE ' <br /> ❑YES ❑ NO � <br /> BUILD�NG V � <br /> TYPEOFCANST OGGUPANCYGFOOP NO.OFOWELLINGUNIiS <br /> ALLOWABLElAGTURL PLUMBING <br /> 52EOFBlDO. NO.OFSTOWES BSMT OCGLOnU <br /> ❑v MECHANICAL <br /> ❑N �,� <br /> ME�GMTLIMIfAT10N OTHER � <br /> FlRESPRINKLERSREOUIRED G VE$ ❑NO STATE BUILDING SURCHAFGE <br /> °J <br /> STATE E4ERGY SURCHARGE <br /> AfPLICATION RCG BY PLANS APPR BY <br /> � PUBLIr,yyORKS , <br /> � TOTAL � <br /> //� �5 ' <br />