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APPLICar10N FOR CONSTRI.�TION <br /> PERMET <br /> fhe Everpreen <br /> CITY OF cverett <br /> everett � <br /> BUILDING DEPARTMENT <br /> 259-8810 TO BE COMPLETED IN INK— PLEASE PRINT <br /> OWN[P AfAILPDORE55 QiY ZIP FNONE <br /> 1 <br /> (,�r..c,r - .s�w (-{�wETa„olrru�tr��ff1H� 3cc6 SIjLYyw C�Q+c�} a,�7.e3 '258-23yy <br /> TENRNT AIAI�ADORE55 CITY ZiP f`HONE <br /> N��} <br /> ARCNITECTOROESIGNER MAI�f�DRE55 GITY ZIP PMONE <br /> G W�hC�v • <br /> • <br /> GENERALCONTRACTOR MAILA�OPE55 CITY ZIP PMDNE UCENSEw <br /> dt.n�.,- C a�4 u ESHW/.u`N <br /> . MECH�NIC�LCCNTpnCTON MAILAOORE55 CITY ZIP PHONC LICENSE� <br /> QwkW <br /> PLUMBINOCONTRACTOR MALRDORESS CITY ZIP PNONE �ILENSE• <br /> th 6Q ��e�eM�-�k� <br /> C�U/SS OF WOGK <br /> L1y NEW ❑ ADDITION ❑ ALTERA710N ❑ REPAIR ❑ DEMOLI710N ❑ WOODSTOVFIFRPL INSERT ❑ BUILDING RELOCA710N <br /> TEN�NTIMPROVEMENTORINTERIORREMOOFLONLY �✓ / CONTACTPENSONANpPNONENO <br /> CONTNACTPFILEOiWORK �� (�l�L� �II�C RQ��Q/�C/aV�Oti" �1'EI �a;A..�re\ •��� -�3yy <br /> DESCRIBEWORKFNOSOU4R FOOI�GEINWLVED <br /> I�G�t y2�,� <br /> PROP0��7USEOFBUILDING IHEREBYCERTIFVT-�ATIHAVEREADANDEXAMINEDTHISAPPLICATIONAND � <br /> NF.W S I–R KNOWTHESAMETOBETRUEANOCORRECT.ALLPROVISIONSOFLAWSAND <br /> LEG/�LDESGRIPTIONOFPROPEflTY�SMOWNBELOWJPFTTACNFOURLOPIES� ORDINANCESGOVEr7NINGTHISTYPEOFWORKWILLBECOMPLETEDWITM <br /> I� ��� / WH ETHER SPECIFIED HEREIN OR NOT.THE GRANTING OFA FEFMIT DOES NOT <br /> l0T` B�OCR_LLL— oF Lt� 3 /VJ„ ) PRESUMETOGIVEAl1THORITYTOVIOLATEORCANCELTHEPROVISIONSOF <br /> ANV OTH[R STATE OR IOCAL lAW REGULATING CONSTRUCTI V N OR THE PER• <br /> FORMANCE OF CONST RUCTION.THAT I AM AUTHORIZED BY THE OW NER OF <br /> THIS PROPERTY TO PERFORM THE WORK FOR W HICH APPLICATION IS MADE <br /> AND I COMPLY WITH THE STATE CONTRACTORS LAW 18.27 RCW AND <br /> � � 296200 WAC. <br /> 51CNATUREOFLONiRACtORORAUtHOR12ED�GENT OATE <br /> _ be�.,�.Q �f 8zZ ('•�.�, e X � ��_l�b��:� `/- 6 -.�9 <br /> PFQIEGT ADORESS PPPLICANTS pTY BUSINE55 LI�ENSE AO.ANL BUSINESS NRME <br /> +� O - S�,f NAu.rl- <br /> PLUMBIN6 MECMANICAL - <br /> NO. 7YPE OF FIXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE � � <br /> 2 WATERCLOSET(TOILEp (� A/C–A/HNDLGUNITS–H.P. � � <br /> BATHTUB FORCED AIR SYSTEMS–B.T.U. M EA <br /> 'Z LAVATORV�WASHBASIN) – UNITHEATERS–B.T.U. M . <br /> � SHOWLn � CLOTHES DRYERS <br /> KITCMEN SINKB DISP. VENTILATION FAN <br /> _� DISHWASHER � FiANGf HOOD <br /> 0 LAUNDRYTRAY WATERHEATER <br /> / CLOTHESWASHER — WOODSTOVE <br /> Q URINAL METALFIREPLACEBCHIMNEY <br /> ORINKING FOUNTAIN FIREPLACE INSERT <br /> FLOOR DRAIN HEAT PUMP <br /> Q BACKFLOW PREVENTERS GAS PIPING <br /> ROOF DRAINS–RAINLEADERS E%HAUS7 FAN <br /> Q SINK�SERVICE–BAR,ETC) <br /> SUBTOTAL 8 SUBTOTAL S <br /> PERMIi S PERMIT 5 <br /> TOTAL FEE S TOTAL FEE 5 <br /> FRONTSETB�CK fFARSETBALK SIOESETB/�CK PUNCHE NUM6GR FEE �� RECEIPiNO. <br /> Zo ' io '��"' c • � �o ' a.1G35 <br /> USE20NE :.OTRREA ViLRNT5ITE FEES VALUATION FEE <br /> '�- 1 � �/6 oYE,�o <br /> BUILDING /� � � <br /> ttPEOFCANST. OGGUPA CYGROUP NO.OFDWELLINGUNITS <br /> e�iow�ei��cru�� n� � / <br /> � PLUMBING <br /> SI:.E OF BLOG. NO.OF STOR195 BSMT OGG LOAD d �! <br /> �33 2 S� � � � �1�/� MECHANICAL <br /> !}Z�G.A�FG MEIGIQLIMILATION OTHER ' �� <br /> FlPESPRINN�ERSREOUIPEO oves o 2" STATEBUILDINGSURCHARGE <br /> STA'�E ENERGV SURCHARGE � <br /> pPPLIC�TION r1CG BY PLANSAPPp 6V <br /> �^ /J PUBLIC WORKS <br /> /��� TOTAL / ^ ✓ <br />