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-� <br /> ;�-�, <br /> APPLICAi ION FOR CONSTRI��..''TION <br />, <br /> PERMIT <br /> Ne EverUreen everett <br /> ��. CITY OF <br />�: everett � <br />,� BUILDING DEPARTMENT �� <br />� : 259•8810 TO BE COMPLETED IN INK— PLEASE PRINT <br /> y . OWNER �YtiN- — S�"E1v.Ir �`Y}� MAILRDDREiS CITY ZIP PMOYE <br /> ;y� , a�l� t'ea�,.�-��e�� t'ec joo6 Sf sf���w ��/Cr�� �fS2a3 �2SS – Z34y <br /> - TENRNT ( M�ILAO�RE55 CITY ZIP PMONE <br /> •F �v/T <br />���,'- ARCHITECTOR�ESIGNEN MAILRDDPE55 CITY ZIP PMONE <br /> .� 6��r <br /> GENERRLCONTPRLiOf: MRILa0DRE55 CITY ZIP PMONF LICENSE• <br /> �:-� 6�^✓� CaiQNCSH/Y/�TN <br /> MECMRNICAIGONTRRGTOR MAILADORE55 CRY ZIP FMONE LICENSE+ <br /> i/ <br /> ' Q�A.1"L^���' <br /> vt'; PLUM9INGCONTRACTOR/ AIFIL�D�RE55 CITV ZIP PHONE LIC[NSE• <br /> kY- �'O 4�Z Ck2ir L <br /> 4, . rwil.�% <br /> {�'. CLASSOFWVpK <br /> - � � NEW ❑ ADDITION ❑ AL7ERATION ❑ PEPAIR ❑ DEMOLITION ❑ WOODS70VE/FRP�INSERT ❑ BUIL�INGRELOCATION <br /> TEN�NT IMPRCf\'EMENT OR INTEHION REMOUEL ONLY CANTACT PERSON AND PIIIIONE t�0. / <br /> . fANTR�GTPRICEOFWORK MiI�4 (�L(.(�Q/v�C�i�� QI' �-P�'��lI.Q�I.(NS� zsb'— Z3Ny <br /> � DESGRIBGWORNPND30l1�pEF TRGEINVOlVEO, <br /> 13 5��+ `i z� `� — -- <br /> PROPOSED USE OF BUILOING I HEREBY CERTIFY THAT 1 HAVE READ AND E%AMI NED THIS APPLICATiON AND <br /> '� �!�Srl n KNO W THE SAME TO BE TRUE AND GORRECT.ALL PROVISIONS OF LAWS AND <br /> � T�`� ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLETED WITH <br /> � LEG�L�ESCRIPTIONOFPROPERiY�SNON'NBEIOWORRTTACHFOURCOP1E51 / WHETHERSPECIFIEDHEREINORNOLTHEGRANTINGOFAPEFMIT�OESNCT <br /> NIR �T �I3 ItiKNOC' NPn�h�!� PRESUMETOGIVEAUTHORINTOVIOLATEORCANGELTIIEPROVISIONSOF <br /> Lor� B�ocK_— oF � ANYOTHERSTATEORLOCA'1AWREGULATINGCONSTRUCTIOYORTHEPER- <br /> FORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BYTHE OWNER OF <br /> THIS PROPERN TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE <br /> — AND I COMPLY WITH THE STATF CONTRACTORS LAW 1827 RCW AND <br /> 296.200 WAG <br /> SIGNRIIIFF.OFCONTPAGTOROHnUiHOR12EPAGENT DATE <br /> ��.I.,�� y81(� T�,,. , c X 'VLti.�,V�� , �f-6-89 <br /> PROJEGTRODRESS pPP�ILAN�tSCITYDU51NE55LIC[NSENO.ANOB 61N j5$.NAME� / ' <br /> .X3 4 �-Qn--,'lLMc �L%�:•� <br /> PLUMBING MECHANIC.4L <br /> NO. TVPE OF FI%TURE OR ITEM FEE N0. TYPE OF EOUIPMENT FEE <br /> �j- WATER CIOSETITOILEq A/C-A/HNDLG UNITS-H.P. _ <br /> � BATHTUB �j � FORCED AIR SYSTEMS-6T.U. M EA <br /> ?� IAVATORY�WASHBASIN) i � S UNITHEATERS-B.T.U. M Kw <br /> SHOWER �7 '- CIOTHES DRYERS _._ - . <br /> KITCHEN SINKB DISR ` �" a� VENTILATION FAN C � <br /> DISHWASHER `� " I RANGE HOOD ' �!C1 <br /> p LAUNDRYTRAY WATERHEATER - � <br /> CLOTHESWASHER � '- I WOODSTOVE — <br /> URINAL Q METALFIREPLACESCHIMNEY <br /> p DRINKINGFOUNTAIN () FIREPLACEINSERT <br /> p FLOOR DRAIN O HEAT PUMP <br /> O BACKFLOW PREVENTERS O GAS PIPING <br /> ROOF DRAINS-RAINLEADERS E%HAUST FAN _ <br /> Q SINK�SERVICE-BAR,ETC.) <br /> SUBTOTAL S � � - SUBTOTAL 5 .7;'j �' <br /> PERMIT S PEaM1T 5 <br /> TOTALFEE 5 C' � TOTAL�EE 5 � <br /> FRONTSET&1CK FE�RSETB/�CN SIDESETWGK PLANCH C NU�g ER F PECEIPTNO. <br /> � ' �or �7a.M a �o ' +�-6 ' � �I`'I �`J � <br /> USE20NE IOTPPER VALFNTSITE FEES VALUATION FEE <br /> /� r' 'O T ,/ ❑rEs ❑ No BUILDING <br /> � I- '< C�I <br /> ttPEOFWNST. O:GUANCYGROUP NO.OFOWELLINQUNIT$ ,�' — <br /> ALLOWPBLE/BCNAL � 7 pLUM81NG '"�I•� <br /> J <br /> SREOYBLDG. NOAFSTOPIES BSMT. OGGLOAD MECHANICAL � C`� C./l <br /> ❑Y JL <br /> ��,�nn� � ( o N <br /> l`Y HEIGHTLIMITr1T10N OTHER <br /> FIRESPRINKlER5RE0UIflED ❑YES ❑NO STATE BUILDING SURCHARGE ��C\' <br /> STATE ENERGV SURCHARGE ���,�L\' <br /> � • <br /> APPLIC,VIONA G6Y PLANSAPPR.OY / <br /> PUBLIC WORKS ��� �`\�� <br /> -r/� <br /> � '„ � � TOTAL �(L�1 C-( 1 ��' <br />