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i�% «LN.i' tC1� � � ' � <br /> �APPi.IC..i ION �AF; CONsf'R'be�l0� , <br /> PERMIT <br /> rhe Evergr=en � <br /> CITV OF �������� 1 <br /> � � � everett � <br /> a � BUILDING DEPARTMENT <br /> C � H 259-8870 TO BE COMPLETED IN INK— PLEASE PRINT <br /> � H [n <br /> i-yt o <br /> (,���ltC� L(`LlL4C7�� �3►,`��l<o�E31�1'� 1-i.,F�����trtt �1��r<'.t� �Z1�� �P�`�J�-7�1`� <br /> �'3 � TLNANi 1AAILAppRE55 QLY ZIP iHONE <br /> �CH "i1 <br /> � H AFCNIiEGTORpE.IGNER MAILA��FE55 CITY ZIP PHONE <br /> � y � GENEPALGONTHACTOR MAILAOORE55 CIIY ZIP PlIONE IICENSE• <br /> OH <br /> � � g�y [iJ MECHANICALCONLPAGTOR MPILP�OPE55 piY ZIP PHONE LICENSE• <br /> H" "[r�+ '�<LL�e��, r�-k C�s �(c o��t�M���, ��ter�;tk �l�l���i���<<ta vNLt��I t����,- <br /> z H F. PLUTAHINGCU NCTOR MAiLF00RE5S CRY ZiP PHONE LIGENSE� <br /> � yz <br /> yy CLA60F WOPN <br /> ~ ❑ NEW ❑ ADDITION ALTERATION ❑ REPAIR ❑ DEMOLITIO� ❑ WOODSTOVE/FRPLINSERT L� BUILDINGFELOCATION <br /> S'] ty V� <br /> �� r TENANiIMPROVEAIENiOFMiER10 RE1dO0ELONLV LONtACTPER50NAf.DPNONENO <br /> [t] CONiPAGiPFILEOFWOBK <br /> Z H V� OESCFI9EWORKRNDSCUAPEFOOTAGEINVOLVEO <br /> HO [n <br /> raoaoseo us�rq /� I HEREBY CERTIFY?NAT 1 HAVE REAO AND EXAMINED THIS APPLICnTION AND <br /> �-- ! 1��/�� KNOWTHESAMETOBETRUEANDCONRECTALLPROVISIONSOFLAWSAND <br /> '�-� ORDINANCES GOVERNING THIS NPE OF WORK WILL BE COMPLETED NJITH <br /> LE6ALOESCRIPt�ONOFPROPERtt�SH WN�E OWORPTIAGMFOURCOPIE51 WHETHERSPECIFIEDHEREINORNOT.THEGRANTINGOFAPERMITDOESNOT <br /> PRESUME TO GIVE AUTHORIN TO VIOLATE OR CANCEL THE PROVISIONS OF <br /> �Gr e�OCK oF ANYOTHERSTATEORLOCALLnWREGULATINGCONSTRUCTIONORTHEPER- <br /> FORMANCE OF CONSTRUCTION.THAT I AM AUTHOR12ED BY THE OWNER OF <br /> THIS PROPER.^V TO PERFOR1d THE WORK FOR WHICH APPLICATION IS�AADE <br /> AND I COMPLV WITH THE STATE CONTRACTORS LAW 1827 FCW AND �. <br /> 296.200 WAC. '� <br /> SIGf141UPE0`LONiPGQG90PNU1MORQEDAGENi DAiE <br /> aaaec*a1op1qess � �11�1�'.��`-L' I��C l � I I I I�6�` <br /> -�.��I l� ����I—l.1lpCl �.�c\I��-�� � APP�ICANT,C�IY�US�`�65LiCENSF.NOFND�U5iNE55�lAME <br /> PLUMBIVG MECHAN�CAL <br /> f1 N'J. TYPE OF FIXTUflE OR ITEM FEE NO. 1YPE OF EQUIPMENT FEE <br /> WATER CLOSET(TOILEn A/C—A/N NDLG U NITS—H.P <br /> '�f BATHTUB FORCE�AIR SYSTEMS—B.T.U: -M EA _ <br /> 0�' LAVATORY�WASH0451N) UNITHEATERS-9.T.U. M — <br /> SHOWER CLOTHESDRYERS <br /> ' � KITCHEN SINKfl DISP. VENTILATION FAN <br /> '� DISHWASHER RANGE HOOD _ <br /> '�' LAUNDRYTRAY — r _ WATERHE,ITER _ <br /> CLOTHES WASHER Vl00�STOVE <br /> ' ' URINAL ____ METAL FIREPLPCEB CHIMNEV <br /> � �RINKING FOUNTAIN FIREPLACE INSERT <br /> �1 FLOOR DRAIN HEAT PUMP _ <br /> � BACKFLOWPREVENTERS _—L- GASPIPING <br /> � ROOf DRAINS—RAINLEADERS E%FiAJST FAN <br /> _ SIN K ISERVICE—BA�7,ETQI <br /> '' — <br /> _ _ _ <br /> ;s' SUBTUTAL 5 —— SUBTOTAL 5 <br /> _ PER�d1T 5 PEFlMIT 5 <br /> TOTAI FEE 5 TOTAL FEE 5 <br /> FpONTSEiBACN REPNS[iBPCN SIOES[iBACN PIANCHECKNUMpER FEE NECEIPTNO. <br /> usezoHe loinsen �aCnrrtsrte FEES VAWATION FEE <br /> ^YES ❑ NO <br /> eui�oiNc <br /> iYPEOFCONST. OCCUPANCYGHOIIP NOAFCWELLINGUNIiS -- <br /> ALlOWABLE/ACTWL <br /> PLUMBING <br /> SIZEOFBLDG. NO.OFSTORIES BSMT. OGCLOAD . <br /> ❑r MECHANICAL I <br /> ❑ N <br /> — nEicHi uMirntior� OTHER � <br /> nneSaaiHkLeRSaEauinEo n ves ❑NO STATE BUILDING SURCHARGE � <br /> STATEENERGVSURCHARGE ' <br /> FaPLICATIONaLCBY PLANSI.PPRBY � <br /> PUBLIC WORKS � <br /> TOTAL I <br />