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; aR /lus isa �� �oY �'��, <br /> ; .i� �F�`�`�uv�-e�aQ � <br /> ; APRLIC�'�IONI FOR CaNSTRIia:TIONb��� <br /> � � PERMIT <br /> ti fhe Everpreen <br /> i G7Y OF everett <br /> � �verett e <br /> � BUILDING DEPARTMENT <br /> � 259•8810 TO BE COMPLETED IN 1NK— PLEASE PRINT n_,` 2 „-I � I .�2�� <br /> r'1e. f��V 7- <br /> ^ Q�NNhER /� MAILA�OiVE59 CITY ZIP PHONE <br /> ; I� l C��_ l.��l'1..��1�'1 ���J �OYi"1��Jc�/'�.� __��.2,tf ��2D� <br /> TEN�NT MRILP�URE55 CIi1' ZIP PHONE <br /> 1 <br /> � AM'HITECIONOESIGNER MAI�A�OfiE55 CITI' ZIP PNONE <br /> 1 <br /> � UENEf1AlCONTRFCTOR MRILA�DRE55 GITY 21P PHONE LICENSE• <br /> i �^ '��o��,r��n1 �n�', /432(5��°�,e- nw c1�1�e.� �'32'7U 252-04C�a (J�S�Cj�N�Z�P7 <br /> � �UMBINOGO IACT�� ' ��C, M.p[JGDV]5 I �-� (�i�.�t/(Af.�U\ 1_l�('!Z�el�'����7(i �W�C NS��C.L <br /> , <br /> �y CLASSOFWORK <br /> ❑ NEW ❑ AODITION ALTEFATION ❑ REPAIR ❑ DEMOLITION ❑ WDODSTOVE/FRPL INSERT ❑ BU�LDING RELOCATION <br /> � TEN�NTIMPflOVEMENiOHIME�fl/ION) RE/M�O-��ELpI1lY CONTACTPERSONRNDPHONENO. <br /> �� GONTqACTPPICEOFWORIC ✓�+vv w <br /> .� DESCRIBEWONKANDSOUAqEFO0U4E1NVOWEJ ( <br /> �y,Sfia!-� qas -�.r,� e s W�' I�a�(t1Z <br /> � VNOPOS USEOFBUI ING ' <br /> , �P� IHEREBYCERTIFYTNATIHAVEREADANDE7CAMINEDTHISAPPLICATIONAND <br /> v KNOW THE�AME TO BE TRUE AND CORRECT.ALL PROVISIONS OF LAWS AND <br /> ' ORDINANCES GOVERNING THIS NPE OF WOFK WILL B'c COMPLETED WITH <br /> j LE(3ALDESCHIPTIONOFPROPERtt(SMOWNBELOWOliATTAGHFOUflCOPIES� yyHET�1ERSPECIFIEDHEREINORNOT.THEGRANTINGOFAPERMITDOESNOT <br /> ;� PRESUME TO GIVE AUTHORIN TO VIOLATE OR CANCEL THE PROVISIONS OF <br /> :i �or BLOCK oF ANYOTHERSTATEORLOCALLAWREGULATINGCONSTRUCTIONORTHEPER� <br /> FORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE OWNER OF <br /> THIS PROPERNTO PERFORM THE WOflK FOR WHICH APPLICATION IS MADE <br /> � AND 1 COMPLY WITH THE STATE CONTRACTORS LAW 18.27 RCW AND <br /> 296200 WAC. <br /> SIGNATUNEOFLONTRAGTOROfAUTHORREDAOENi DATE <br /> R y �/f f�i q. <br /> �, /\ .C,�(ifT tt2/ C%tGl(/..GCv Y��/�/ <br /> � PHOJECTADORESS y� APPLIC� iSGITYBUSINESSLICENSENO.AN00U51NESSNNME <br /> j L L �O <br /> �28 2GrvL.G��' ��v�-� <br /> 4 PLUMBING MECHANICAL <br /> � NO. TYPE OF FIXTUHE OR ITEM FEE NO.� TYPE OF EQUIPMENT FEE _ <br /> ti WATERCLOSET(iOILEn !VC—A/HNOLGUNITS—H.P. <br /> % BATHTUB FORCED AIR SYSTEMS—B.T.U.7(�M EA <br /> { LAVATORY�WASH 9ASIN) UNIT HEATERS—B.T.U. M <br /> � SHOWER � CLOTHESDRYERS <br /> �, <br /> � KITCHEN SINKB DISP. VENTILATION FAN <br /> RANGEHOOD <br /> �si � DISHWASHEF I WATER HEATER <br /> + LAUNDRYTRAY <br /> 11 CLOTHES WASHER WOOD STOVE <br /> 0 � URINAL METAL FIREPLACEB CHIMNEY <br /> ��I DRINKING FOUNTAIN FIREPLACE IN ERT <br /> �� FLOORDRAIN HEATPUMP <br /> � BACKFLOW PREVENTERS GAS PIPING <br /> ' ROOFDRAINS--RAINLEADERS EXHAUSTFAN <br /> � SINK(SERVICE—BAR,ETC) <br /> � <br /> 'I <br /> i <br /> � <br /> � <br /> � SUBTOTAL $ SUBTOTAL S <br /> PERMIT $ PERMIT S <br /> � TOTAL FEE S TOTAL FEE S <br /> j FPONiSEtBACN PEARSETBRLK SIOESETBACK VIANCHECNNUMBEN FEE NECEIPfNO. <br /> � USEzoNe LOiAREA `/AC�NTSITE FEES VALUATION FEE <br /> i ❑YES ❑!JO <br /> BUILDING <br /> ! TYPEOFCON9T. OCCUPANGYONOUP NO.OFOWELLINOUNIIS <br /> ALLOW�BLFJAGTUFL PLUMBING <br /> ii <br /> 8�2EOFBlDQ NO.OFSTORIES BSMi. OGGIO�D <br /> ❑v MECHANICAL <br /> ❑N <br /> NEIOHT�IMttAiION OTHER <br /> �� flf1E5PRINKLERSFEOUIRED ❑YES ONO <br /> STA7E DUILDING SURCHARGE <br /> i <br /> i STATE ENERGY SURCHARGE <br /> � APPLICRTIONRCGBV PUNSRPF0.6Y <br /> i PUBLIC WORKS <br /> ,J <br /> TOTAL <br />