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1 <br /> (. :�, ��'��C-,�" ;' `�l i <br /> APPLICk�t°I�N FOR C���ION l ��1 � <br /> PERIVIIT <br /> theEverpreen everelt ��. <br /> CITYOF � i <br /> everett � <br /> BUILUING DEPARTMENT � <br /> 259•BB70 TO BE COMPLETED IN IWK— PLEASE PRINT <br /> MNILAOOPESS GITY ZIP PHONE <br /> c`�ll a I�a �� � ��r3 � lotr�kxcrr4 ���'� ��'h����Ol �-��'1�-�-7 j , <br /> NAN MAllN00PE55 CITY ZIP PHON <br /> MCHITECTOROESIGNEH MAILNOCRESS GITV ZIP FNONE <br /> OENEMLCONTRACTON MFILqD:PESS CITV ZIP PNONE LILENSE• <br /> ECHANIC�LCONTPRCTOR MAILAODNE35 CITY 21P PNONE LILENSE• � <br /> �p.1;1c,.� f�r�. C��,S ���c,�, t�n�� ��o (�.�- L �P�xe�-1 �1�01 ��..5�1�5�l�a �l�u.��',I� ; <br /> 7.UMBINGC N�GTOR C—�— MALLAODFE55 �j CITY ZIV PHONE . ICENSE� <br /> CLAGSOF WVRK � <br /> ❑ NEW ❑ ADDITION ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL INSERT ❑ BUILDING RELOCATION � <br /> 7ENANT IMP80VEI.IERT OR INTERI OEL ONLY W NiFGT PERSON ANO PNONE NO. <br /> f <br /> CpNTR�CT PRICE OF WOFIC � <br /> OE9CFIBEWORKANOSOU�RE T�GEINVOIVED � <br /> 7��I�L�.L ��� VLACe �!'I,�Y-i-��l�. ,- <br /> Pnorosgqu�E.4rypuoiHa IHEREBVCERTIFYTHAS�IHAVEREADAMDEXAMINEDTHISAPPLICATIONAND .. <br /> �,�NL KNOW THE SAME TO BE TRUE AND CORREC7.ALL PROVISIONS OF LAWS AND <br /> LEMIDESCFIPTIONOFPROPERttISHOWNBELOWORATTRCHFOUPGOPIES� ORDINANCESGOVERNINGTHISTYPEOFWORKWILLBECOMPLETEDWITH <br /> W HETHER SPECIFIED HEREIN OR NOT.THE GRANTING OFA PERMIT DOES NOT <br /> PRESUMETOGIVEAUTHORITYTOVIOLATEORCANCELTF:EPROVISIONSOF i <br /> LOT BLocK oF ANYOTHEFSTATEORLOCALLAWREGULATINGCONSTRUCTIONORTHEPER• i <br /> FURMANCEOFCONSTRUCTION.THATIAMAUTHORIZEDBYTHEOWNEROF ! <br /> THIS PRDPERTYTO PERFORM THE WOFiK FOR WHICH APPLICA110N IS MADE <br /> AND I COMPLV WITH THE STATE COMTtiACTORS LAW i827 RCW AND <br /> 296200 WAC. i <br /> SIGNATUFEOFCONTHRCTORORAIITNORRE�AGENT CAiE � <br /> X� ACITYBUSWE�.PNDBUSWESSI�t�TAME� �� ' <br /> PRQIECT,ADQRE��� �'�^�����' ���_ APPL CANT <br /> P i l <br /> PLUMBIN4 MECHANICAL <br /> Mp, TYPE OF FIXTUHE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILE'� A/C—A/HNDLG UN ITS—H.P. <br /> BATHTUB FORCED AIR=YSTEMS—&T.U. EA � <br /> LAVATORYIWASHBASIN) UNITHEATERS—B.T.U. M � <br /> SHOWER CLOTHESDRYERS i <br /> KITCHEN SIIJKB DISP. VENTILATION FAN <br /> DISHWASHER RANGEHOOD — <br /> LAUNDRY'i RAY WATER HEATER <br /> � CLOTHESWASHER WOODSTOVE <br /> UFINAL METAL FIREPLACE 8 CHIMNEY <br /> DRINKING FOUNTAIN FIREPLACEINSERT I <br /> FLOOR DRAIN _HEAT PUMP � <br /> BACKFLOW f'REVENTERS GAS PIPING � <br /> ROOFORAINS—RAINLEADERS ' EXHAUSTfAN � <br /> SI NK(SEfiVICE—BAR,ETC.) � <br /> i <br /> — 1 <br /> _-- I <br /> SUBTOTAL $ SUBTOTAL g _ I <br /> PERMIT 5 PERMIT � — <br /> TOTALFEE $ TOTALFEE 5 ' <br /> FNONTSETBACN FEAHSETBFCK SIDESETBAGN PLI�NCMECNNUMBEfl FEE PECEIPfNO. ` <br /> usElonE LOTAREA �ACnNrSrtE FEES VALUATION FEE 1 <br /> O YES ❑NO <br /> BUILDING � <br /> 1YPEOFCANST. OCGUPANCYGROUP NO.OFDWELLINpUNITS <br /> QLOWRBLFJACfUAL PLUMBING <br /> SILEOFBLOG. NO.OFSTOFIES BSMT. OGGLOAO MECHANICAL <br /> ❑Y <br /> ❑ N <br /> HEIGHTLIMR�TION OTHER <br /> FIHE9PRINNLERS FEOl11RE0 ❑�ES ❑NO STATE BUILDING SURCHARGE <br /> STATE ENERGY SURCHARGE <br /> APPIICATIONRCGUY PLANSAPP0.BY PUBLICWORKS <br /> TOTAL <br /> i <br /> i <br /> , .n�.w�(T^,v�n +nm�'i.i �..1 . � T.^`:..1 �','�^�,. .. .. ..':"'_' �.. '..._;.. - '.fn . '.'�3SliR+.�..:. � <br /> .A.f . �.�.. <br />