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��X� <br /> ' APP�.IC��TION �OR COidSTRc.CT10N �-� � <br /> �� PERMIT <br /> � Ihe Everpreen <br /> � CI7vOF � ' �evcrett <br /> everett e <br /> BUILDING DEPARTMENT <br /> ' 259-eB70 TO BE COMPLETED IN INK- PLEASE PRINT <br /> � ONNER Mnit RO�NE55 GtY ZIP FIIONE <br /> ; �`�r li P.�� 1�< < k��-t,k-t- #=ve��f �fl�� 7f,->9��� <br /> � TENFNf MRILPOOFE55 T� LIiV 21P VNONE <br /> lJ <br /> i <br /> �qGHRECTOA0E51GNEP M�IL�DONESS CITY ZIP PNONE <br /> 1 <br /> OENER�LCONiR�GiOR M�iL�ODRcSS QtY ZIP PNONE �ILENSE• <br /> CH�NICA.GONiP�CTOR M�II�D�RE55 CITY 21P PIIONE LIGENSE• <br /> ; �Q �5 ZC.e�� M��.�� �� �JI �S9-gls2 I��-cr�� <br /> RUMBINOWN ACON � MAIL�OORE55 CIIY ZIP PNONE �IGENSE• <br /> I C1A550FW0AK <br /> \ <br /> ❑ NEW ADDITION ❑ ALTERATION ❑ flEPAIR ❑ OEMOLITION ❑ WOODSTOVE/FRPL INSERT ❑ BUILOING RELOCATION <br /> � TENRNIIMP '/EMENTOHINTE(VIORREMODF40NLY fANiRQPER50NRNDPHONEND. <br /> I C/� <br /> I CQNTPAC PPILEOfWORK �� <br /> � DES_RIBEWOBN�NDSOWREFOOT�GEINVOWED <br /> �J� p/ �' C <br /> � PPO OSE�oFe i�iqy+a ' ' � IHERE6 ERTIFYTHATIHAVEREADANDE%AMINEDTHISAPPLICATIONANO <br /> � KNOWTHESAMETOBETRUEANDCORRECT.ALLPROVIS�ONSOFLAWSAND <br /> I `/ ORDINANCES GOVERNING TH�S TYPE OF WORK WILL BE COMPLETED WITH <br /> lE0AL0E5CRIFiIONOFFROPEHN�SNOWNBELOWOPATTAC11i0URWFiES� yJHETHERSPECIFIEDHEREINORNOT,THEGRANIINGOFAFERMITDOESNOT <br /> PRESUME TO GIVE AU7HORITV 10 VIOLATE OR CANCEL SHE PROVISIONS OF <br /> Lot eioLK oF ANVOTHERSTATEORLOCALLAWREGULATINGCONSTRUC710NORTHEPER- <br /> FORMANCE OF CONSTRUCTION.7HAT I AM AUTHORIZED BY THE OWNER OF <br /> THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE <br /> AND I COMPLY WITH THE STATE LONTRACiORS LAW 18.27 RCW AND <br /> i 298.200 WAC. <br /> SIONRUREOFCONiMGTOPOIiI.UTH ZED NT D�TE 9 <br /> � X �� � � Gl� �Ul �1 <br /> PROJECi�ODRE55 ICRNtSGTYBl151N SL [NSE . Np9Il51N[SSN�ME <br /> l <br /> PLUMBING MECHqNICAL <br /> NO. TYPE OF FI%TURE OH ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSEI(TOILF"f) A/C—A/HNDLG UNITS—H.P. <br /> BATHTUB FORCEDAiR5V5TEM5—B.T.U. MEA <br /> LAVATORYIWl�SHBASIM UNITHEATERS—B.T.II. M <br /> i <br /> I SHOWER CLOTHESORYERS <br /> �I KIfCHEN51NK8DISP. VENTILA710NFAN <br /> DISHWASHEl3 RANGE HOOD <br /> ' <br /> LAUNDRY TFAI' WATER HEATER <br /> � CLOTHES W/wSHER WOOD STOVE <br /> � UflINAL METALFIREPLACEBCHIMNEV <br /> � DRINKING FOUNTAIN FIREPLhCE INS RT <br /> � <br /> FLOOR DRAI�� HEAT PUMP <br /> BACKFLOW PREVENTERS GAS PIPING <br /> ROOF ORAINS—RAtNLEADERS EXHAUST FAN <br /> SINK(SERVICE—BAR,ETC.) <br /> 1 - - <br /> SUBT070.: � suerorn� a <br /> f PEF�dIT S PERMI7 5 <br /> TOLILF�E 5 70TALFEE S <br /> FRONTSETB�CN RFARSETB�CN SIpESEiBALN PLANCHECI(NUMBEp FEE PECEIPtNO. <br /> i U9EZONE �Ot�n�n VAC�NT511E PEES "ALUATION FEE <br /> � O YE9 ❑NO <br /> BUIl01NG <br /> IVPEOFCANSL OCCUP�NGYQBOUP NO.OFOWELUNOUNIiS <br /> �LLOri'hBIFUCiUAL <br /> PLUMBING <br /> 81ZEOFBLOLL NO.OFSTOlilES 95MT. OGG�OAD <br /> ❑r MECHANICAL <br /> ❑N - <br /> HEIOHiLIMI1R110N OTHER <br /> FIPESPPINNLEPSNEOUIRED ❑YES ONO <br /> STA7E BUILDING SURCHARGE <br /> SiATEENERGVSURCHARGE <br /> �PPLIC�f10NGCGBY PUNSAPPRBY <br /> PUBLIC WORKS <br /> TOTAL <br />