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�: y <br /> APPLIC�IOI�! FOR CONSTRI�YfON <br /> PERMI'� <br /> � Ihe Everpreen <br /> � CINOF everett <br /> � everett � <br /> � BUILDING DEPARTMENT <br /> � 259-8B10 TO BE COMPLETED IN INK— PLEASE PRINT <br /> � IMIIADONESS GIiY ZIP PHONE <br /> OWNER f���TPG� <br /> ' �• <br /> ,i �� �[ �'n 4630 d�o��Sw L iNnu-/ocQ 9$'v3G "l'7/ — S�F9^! <br /> �5 T NANT MAILAOpflES9 / CITY ZIP PNONE <br /> � <br /> � Ai1CHRELTOfi0ES10NEH M��LADDPE59 CITY ZIP VMONE <br /> i <br /> ,I . <br /> � QENEMLCONTNACfOH �IL�D�PES9 GIIY 21P FHONE LICENSE• <br /> :� <br /> MEGM�NIC�LCONTR/iCiON MMLADORE9S GIiV ZIP PHONE LIGENSE♦ <br /> 'J � (:�nH i Y/T, �/D"'/ St1�i �„ �.� /0/ � ci:� 9�ii3Z �/N� vMor�ie� - — ucer� e.- <br /> �FLUMBINOGONTMC�OR �DUPE59 _ „ �O _ I�.'�� � <br /> �cJL� ��_� <br /> G1A5.40F WORK <br /> ! ❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL�NSERT ❑ BUILOINGREIOCATION <br /> j TENIJiTIMPROVEMEMORINIERIORPEMOOEIONLY CONTACT�EPSON�NOPMONENQ <br /> fANTMCT PpILE OF WORK <br /> � OESCNIBEWOPKAND60UAREFOOT�pEINVOWED <br /> � nt <br /> PFOPOSE eo eui�oiNo IHEREBYCERiIFYTHATIHAVERFADANDE7(Ah:INEDTHISAPPLICATIONAND <br /> �� n KNOWTHESAMETOBETFUEANDLORREGT.ALLPROVISIONSOFLAVlSAND <br /> i � �� �'(< <" � ORDI�ANCES GOVERNING 7HIS TYPE OF WORK WILL BE COMPLETED WI1H <br /> �e l IPTIONOFPPOPEfitV�SHOWNBELOWOBATTACHFOUflCOPIES) W}iE7HER5PECIFIEDHEREINORNOT.7HEGFANTINGOFAPERMITDOESN07 <br /> PRESU ME TJ GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br /> �or B�OCK oF ANYOTHERSTATEORLOCALLAWFEGULATINGCONSTRUCTIONORTHEPER� <br /> FUFMANCE OF CONSTRUCTION.THAT 1 AM AUTFIORIZED BV iHE OWNER OF <br /> � THIS PPOPERN 70 PERFOPM THE WORK FCR WHICH APPLICATION IS MADE <br /> AND I COMoLY WITH THE STATE CONTR4CTOR5 LAW 18.27 RCW AND <br /> ' 298.200 WAG <br /> 1 SIGNA7UREOFCONTRACTOflORAUtNOPIZEORGENT DFTE <br /> ,I <br /> � Y � <br /> � „ � <br /> 1 PNOJECtADORE54 �CRNiSCiiY8U51NE55L NSE O.FND VESSNR <br /> � <br /> 1 <br /> � PLUMBIN� MECHANICAL <br /> 1I <br /> ! NO. TYPE OF FI%TUflE Ofl ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> � WATERCLOSETITOILE'q A/C—NHNDLOUNITS—H.P. <br /> � BATHTUB FORCED AIF SYSTEMS—&T.U. M EA <br /> i <br /> � LAVATORY(WASHBASIN) UNITHEATERS—B.T.U. M <br /> � SHOWER CLOTHESDRYERS <br /> � KITCHEN SINKB DISP. VENTILATION FAN <br /> �{ DISHWASHER RANGEHOOD <br /> �J LAUNDRVTRAY H'ATERHEATER <br /> � CLOTHESWASHER WOODSTOVE <br /> � URINAL METALFIREPLACEBCHIMNEY <br /> � ORINKINO FOUN7AIN FIREPLACEINSERi <br /> i FLOOR�RAIN HEATPUMP <br /> �i BACKFLOW PREVENTERS GAS PIPING <br /> � ROOFDRAINS—RAINLEADERS EXHAUS7FAN <br /> � SINK�SERYICE—BAR,ETCJ <br /> i <br /> i <br /> SUBTOTAL S SUBTOTAL S <br /> PERMIT S PERMIT 8 <br /> TOTAI FEE S TOTAL FEE S <br /> FRONTSETBACK flEAflSETfiACK SIDESETB�GK PLANCNECNNUkBEfl FEE NECEIPfNO. <br /> USezonE lornnew veeu+rsrtE FEES VALUATION FEE <br /> O YE9 ❑NO <br /> BUILDINCa <br /> IYPEOFCANST. OLCUPANCYQPOUP NO.OFOWElLINOUNITS <br /> ALLOWABLE/ACTUAL PLUM61N6 <br /> SIZEOF9LIXi NO.OFSTOFIES BSML OCGLWIO <br /> ❑v MECHANICAL <br /> oN <br /> NEIOHiIIMIi�TION OTHER <br /> FIRESPRINNIER$FEOUIFED O YES ❑NO STATE BUILDING SURCHARGE <br /> STATE ENERGY SURCHARGE <br /> APPIIC�TIONACGBY PlANSAPPRBY <br /> PUBLIC WORKS <br /> TOTAL <br />