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APPLIG..TION FOR CONSTRvCT10N <br /> ^ERMIT <br /> Ne Everpreen reeirtt <br /> CITV OF � <br /> everett <br /> BUILDING DEPARTMENT <br /> 259•eet0 TO 8E COMPLETED IN INK— PLEASE PRINT <br /> {'MONE <br /> UIYNER \ I� /� r�AILPDDNE55 �^/,, �I�1�/� yC�I�Y 1� / ZIP ��� �_�`'� <br /> j� �l. �� 11 I1 � _ ��� 1 I.LA l,� 1 �41.! \ CV/�4 21P {'MON[ <br /> 1[NANI M1�/IL ApORESS <br /> H , ^^^ <br /> � b ���jv y y`�. <br /> � v- ' MRILAODRE55 CILY ZIP PIIONE <br /> p nnLNIIEQ OA DESIGNEA <br /> r y �] <br /> RIARpDUNE55 J� PNONE /� I LILCNSE• <br /> G[N[iiALLONTRACTOR Cli � �}P �� 1 �N/� /�/�L� <br /> K � ���, � y i�-r` �-ac���s n�c��u�� -��-s a r,� v `�_�. ��..5���.L.��- <br /> GtY ZIP PNONE , yJ/� ��� <br /> MECN�NIG CONTR�C A MAILPD�PESS �--( � i <br /> O � O � <br /> x y � <br /> iy MAILAODRE55 CIIY ZIP PIIONE UGENSE� <br /> z �V P�pMBINCGONTRAGTOR <br /> � � O <br /> v <br /> � M CLRSSOFWOPK <br /> ~ � � ❑ NEW ❑ ADDITION.-� T16N ❑ REPAIP ❑ DEMOLITION ❑ WOOOSTOVE/FRPI�NSERT ❑ BUIL�INGRELOCATION <br /> � CONinCT PEPSON nNO PMONE NO <br /> M i[NANt IMPPOVEMEHT OP INTERIOR REMO�EL ONtl" <br /> � " � CIZ,. <br /> y CONiPACT FRILE OF 1VOPK <br /> Ry �[SGPIOEWORKANOSOWAEi �TAGEINYOLVE�� <br /> ?S o y T�j��,�l,� .L �C — <br /> � C � FPOPOSEDUSEOFBUILOING ( IHEREBVCERTIFVTHATIHaVEREADANDEXAh11NEDTHISAPPLICAT�ONAND <br /> I*1 KNO W THE SAME TO BE TRUE AND CORtiECT.ALL PROVISIONS OF LA\NS NND <br /> y � ORDINANCES GOVERNINu THIS TYPE OF WORK WILL BE COMPLETED 1NITH <br /> O N LEGALOESGA�PTIONOFPPOPERttISNOWNBELOWONRTFGMfOORGOPIES) WHETHERSPEGFIEDHEREINORNOT.THEGRANTINGOFAPERMITDOESNO7 <br /> PRESUME TO GIVE AUTHOA�n'TO VIOLATE OR CANCEL THE PROVISIONS OF <br /> �ot e�oCK oF _ ANYOTH[RSTATEORLOCALLAWREGULATINGCONSTRUCTIONORTHEPER� <br /> FOR1dANCE OF CONSTRUCTION.TNAT I AM AUTHORIZED BV THE OWNER OF <br /> , ANIDIRCOMPLYTWPMRTNEnSTA1E CONTfl CTORSHLAWL182T7ORCWMANO <br /> 296200 WAG <br /> � SIGA'tUAEOFGONTNACTOROFN0t110RIlEDAGENT DATE <br /> X <br /> �POJEGTAODRESS � ��'PliCa��tSCItY0u5M[SSLICENSENO.ANDBUSMESSNNRI[ <br /> �}- 3a ,r� �- +��-n <br /> PLUMBING MECHANICAL _, .�.'�, <br /> FEE NO. TYPE OF EOUIPMENT FEE ":y�,y�'�.'�F?�."-� <br /> NO. rPEOFPI%TUHEOFIITEM _ , <br /> � -� A/C—A�HNDLG UNITS—H.R � i; i <br /> � <br /> �•� WATER CLOSET�TOILE7� —J_ FORCED AIR SYSTEAIS—B.T.U.� EA � <br /> ��� BATHTUB _ '— � <br /> - LAVATORVIWASHBASIN) UNITHEATERS—BT.U. M '��� �c .,?�f�� � <br /> • CLOTHESDRYEFS — ' <br /> 1 , — SHOWER — <br /> KITCHEN SINKB DISP. VENTILFTION FAN <br /> I � DISHWASHER RANGEHOOD — <br /> ' ���' LAUNDRYTPAV WATERHEATER <br /> ' CLO7MESWASHER WOODSTOVE - —� <br /> METAL FIREPLACE 8 CHIMNEY __._. <br /> i URINAL — <br /> I '�� DRINKING FOUNTAIN _ FIREPLACE INSERT — <br /> ��' FLOOR DRAIN HEAT PUMP <br /> � BACKFLOW PREVENTERS _L GAS PIPING <br /> ROOFDFAINS—RAINLEADERS E%HAUSTFAN — — <br /> � '_'�' SINK(SERVICE—BAR.ETC I — <br /> I — <br /> + -- <br /> � ��� � SUB TOTAL S � aY <br /> ' � SUBTOTAL 5 _ <br /> PERMIT S '_ PERMIT 5 IS (Z <br /> �' 10TAL FEE 5 S � <br /> -' TOTALFEE 5 FEE NECEIPTNO. <br /> �1_. FRONL SETBACK NEPR SEfBACN SiOE SETOACN PUH CNECN NUM9Ffl <br /> uSEZON[ toinaen vnuNiSrtE FEES VALUATION FEE <br /> ❑YES ❑NO <br /> BUILDING — <br /> ttVEOFGONST. OGLUFANGYGROUP NOAfDWElLIN0UN1i5 <br /> �ILOWABIE'�GTWL PLUMBING <br /> $REOfBLOG. NO.OFSiOWES BSMT. OCG�O�D MECHANICAL �� O <br /> ❑Y <br /> ❑N <br /> NEIGHTIIMITATION OTHER — <br /> viaEsvnmrc�easnmuiaeo ❑YES ❑�+o STATE BUILDING SURCHARGE _ <br /> STATE ENERGY SURCNARGE <br /> AFRIG���ONACGBY PLRNSAPPP.6Y PUBLICWORKS / ,\ <br /> TOTAL �� W <br />