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a <br />i <br />r <br />; <br />Ihe Everpreen <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />259-8810 <br />�� <br />APPLICwT10N �OR CONSTR�CT�ON <br />PERMIT <br />everelt <br />� <br />TO BE COMPLETED IN INK— PLEASE PRINT <br />citv 1 �ir PMOtIE <br />lC°t.� F�.1Kn�.t���, g�9'1(e 1�i`�'—a`f��' <br />CITY ZIP PHONE <br />ARCHITECTORDESIGNER h1A1LADDR'.55 -- CITY 21f PHONE <br />� 1�r1s t-�o+�i�uccT �Z�-3��l� <br />GENERALCONTRACiOR MNILAODRE55 CITV ZIP PHONE LICENSE• <br />(�L'1� E�2UJ oe dl Cu_s'E'ax� la-.,w�.s i� C v.�Ti� � Y�a � 3 3`f ^'Z-� q 1 <br />MECHRNICALCONTFRCTOR MRILADORE55 CITY 21P PHONE LICENSE• <br />T �3'p ALD 6 ��—Nr��kt �'L <br />PLUMBINGCONTR�CTOR MAILADDREti'_ ' CITV ZiP PIIONE LICENSE� <br />� NEW ❑ ADUITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPLINSERT ❑ BUILDINGRELOGATION <br />TEN�NT IMPROVEMENT OR INTEHIOR PEh100E1.ONLY CONTAGT P[RSON AND PHONE NO. <br />bu�eoi DH ♦� /�� .A�-�}C 2l� �(o <br />CONTR�CTPRICEOFWORIC �.{I�I1I tl �r_ ��'IS � � � ~ 1 ` J + � • _�� • l <br />, ......� ...............................�..,,,.....�...'__'__ <br />P l v� N C...1�...rIL l 0'1 <br />G PROPOSEDUSEOFBl11L01NG <br />i 5 F R-- <br />{�' LEG�L ESCRIPTIONOFPROPEPTYISNOWNBELOWORRTTAGNFO01 <br />^ LOT Z" BLOCK OF rTt L�+^-� <br />.� \\ �. e, T ��n.'�S . V <br />�M_�_ LA <br />C� <br />� ' � --1� <br />PflOJEC' <DORE55 <br />���5 � <br />PLUMBINO <br />.' NO. TYPEI <br />WATER CLOSEf <br />BATHTUB <br />LAVATORYIWAS <br />SHOWER <br />KITCHEN SINK t <br />DISHWASHER <br />LAUNDfiY TRAY <br />fIRE <br />� . �..�% A C � .\' \ <br />J`P — s�P legQl oh�a� <br />FI%TUFiE OR ITEM <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />ROOF DRAINS— RAINI <br />SW K (SERVICE— BAR. <br />TOTALFEE <br />�Q/ RE� llJ" f�y <br />LOTRREA <br />•—1 13,3/7 <br />ST. OCLUPANCYGR011P <br />nCIDRI <br />.� <br />NOAFSTORIES &SM <br />� i�iqx I A N <br />.ensneouineo aves p(uo <br />�PPLILRTIOq AGG BV <br />IVV•' ` <br />5•�. �7�V 1 <br />� <br />5 <br />$ <br />ID[ SET9nCN <br />�� <br />RCPNT SIT[ <br />/YES ❑ NO <br />10 OF DWELLII <br />/ <br />iCQ LOAD <br />IEIGMTLI T� <br />��� <br />FEE <br />Y�'�'A'�.'�'t'�Q P�u4iJKt1T ��`E"'v�Q�� <br />i H EREBY GERT'FY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND <br />KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS AND <br />ORDINANCES GOVERNING THIS 7VPE OF WORK WILL BE COMPLETED WITH <br />W HETHER SPECIFIED H EREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT <br />PRESUME TO GIVE AUTHORIN TO VIOLATE OR CANCEL THE ?ROVISIONS OF <br />ANY OiHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PER- <br />FORMANCE OF CONSTRUCTION. THAT I AM AUTHOF12ED BV THE OWNER OF <br />THIS PROP- TO PERFOAM THE WORK FOR WHICH APPLICATION IS MADE <br />AND I CO PL WITH THE STATE CONTRACTORS LAW 1827 RCVJ AND <br />296.200 W G <br />SIGNATURE CO PTCTOROIiaU1NORiZEOPGENT NtE <br />X VI�1�1 <br />APPLICNNTSCITYB WESSLICENSENO.RNDBUSINESSNAME <br />MECHANICAL <br />,• <br />TYPE OF EOUIPMENT <br />rv�.— rvnrvOLG UNITS— H.P. <br />FORCED AIR SYSTEMS <br />UNIT HEATERS— 9T.U. <br />CLOTHESDRYERS <br />VENTILATION FAN <br />M <br />RANGEHOOD <br />WATER HEATER <br />WOOD STOVE <br />ME7AL FIREPLACE 8 CHIMNcI <br />FIREPLACEINSEFT <br />HEAT PUMP <br />GAS PIPING <br />FEES <br />M <br />SUBTOTAL <br />PERMIT <br />TOTAL FEE <br />FEE <br />Z�l$-3° <br />__. <br />VAIUATION <br />BUILDING y'�O. /C�I <br />PLUMBING <br />MECHANICAL <br />OTHER p �� <br />STATE BU�LDING SURCHARGE <br />STATE�NERGYSURCHARGE <br />PUBLIC WORKS <br />TOTAL <br />E <br />FEE <br />s�� <br />7s� <br />'� � <br />y <br />r <br />