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w �� <br /> APPI.IC.+TION FOR C �STF�t�GYION <br /> �PERfViIT <br /> Ihe Evergree�. ����'��'I� <br /> CITY OF � <br /> everett <br /> BUILDING DEPARTh1ENT � <br /> 259-8810 TO BE COMPLETED IN INK- PLEASE PRINT <br /> o':iuen <br /> r.�a�o�or.tss Cnr z:i, PNorve <br /> �nn/ 1����C�71� �F1y2 �' Ti✓Tt/'(•'Ti !J✓E ��fRFT��'�� a�EJ` yu� ��.__- <br /> iN:4rJi MAILAODRE55 CIiY IIP <br /> <��0111EGiOFOEf'��ER MAILADO�E55 CI1V ZIp �NONE <br /> `3 n'� r� ? 35.3 E�5�3/ <br /> x["'7 � �jr(�/v �-iNts �c�io �s- 5T SL ,E�vfrtTT �Q <br /> ['�h� i �qq�� rylqpCtOA IseI�AD�AE55 CIT� ZIP PMONE �ICENSE+ <br /> m�H 7�n �, r(>Rlrc/'TToU,�1sT /R%� l LVI?-,zcrT�, �d�,•«T �A�1dfs 3ss�/�9A�6ti�✓�+/�lri" <br /> [ tpipNlLqLGONTflnLIOR MAIIAD�l1C55 CIiY ZIP PHONE LICEtJSE� <br /> t9" x� �. .�7n1�/Z.' /�C�1�1� <br /> H 9� — CiiY ZIP PNONE L�CORE• <br /> F3 z�"� c�.W'DiMGGONTPACTOF MAILApDFE55 <br /> K C'1 <br /> H 7J - <br /> '�-7 H� ��,ssorwoaK , _ �Ort1ET <br /> fn H JA ��Eyy ❑ ADOITION ❑ ALTEPATION ❑ REPAIF ❑ DEMOLITION L�e+�FoSTOVE/FRPL INSEFT ❑ BUILDING RELOCATION _ <br /> tOYNiI1.IPflOVEh1ENiORIMEPtORREMOOELONIY . ,� q� (^ C09lALiPEP50NAN�YnONENQ <br /> H �� /� � <br /> ,�/�//���� �f <br /> � y d cc�:iaacrvaitEorwoarc � � .,�i.� �J_=/�.i-c./1—�5��- " J <br /> n6CFIpE WORe AND 50 WAE FOpiAGE INVOL\'EO <br /> � �o e. � „ron� /s5�2 � 1S�'��'%' ���f�` `/�5 �/.� _ <br /> N _�_CQ�r-.. <br /> L�� C] raoroseouseocbu,ioirvo IHEREBYCERTI�YTHATIHAVEREADANDEXAMWEDTHISAPPLICAT�ONA1dD <br /> �"'� .C„ KNOK^HESAldETOBETRUEANDCORRECTFLLPROV1510NSOFLAWSAND <br /> � y z �i �y�C F/��J'" /L � '�ASN(�� ORDINaNGES GOVERNING THIS TVPE OF VfOf7K WILL BE COMPLETE�VJITH <br /> �EGa�oF Pivnallo�cAOPEr+n6�orn+BE�owoanTtaGN�OUPcoflEA VJHETHERSPECIFIEDH[REINORNOT.THEGRANTINGOFAPERIdITDOESNOT <br /> �..�y PRESUME TO GiV'c AUTHORIN TO VIOLATE OR CANCEL THE PROVISIONS OF <br /> �y y �pr BLOCK or _ ANYOTHEPSTFTEORLOCALI�WflEGULATINGCONSTRUCTIONORTHEFER� <br /> p H FORldANCE OF CONSTFUCTION.THAT I AM AUTHORIZED BY THE O\h?JER OF <br /> O G� r' c• THISPFOPERTVTOP[RFORh1THEWORKFpRVJFIICI�4PPLICAT:0Y15M11ADE <br /> � q� JF�L /g'TT�� AND I CO�dPLV WITN THE STATE CONTRACTORS Li:�� �%'% RCC: AND <br /> ��� 29G 200 W4C <br /> zH� _.,..tW�LU�CON1P1C1(�flnp_�➢�CFRED�GCNi f*:'. <br /> H O fn - <br /> - X L���'�/-�Yc�c��'�'-9�''- - <br /> , <br /> rc5ler:rRooaEss - - - __-_ -_ — ..�., �,..u�,un�tlusm u.,v�seroo+Noausv.essr.ar.a <br /> F EP1�� clt_ �I en� t.�5 - <br /> PLUMBING MECHANICAL <br /> Np, TYPE OF FIXTURE OR ITEM FEE NO. T'PE OF E�l11PMENT FEE <br /> 'M �s �_ VJATEP CLOSET ITOI�ET) _ (�,�' - A'C--NHNDLG UNRS-H P ____ ___ <br /> I ' Z l � � FORCEDaIf15YSTLldS- BTU �d[A_ __ <br /> e-, � BA7HTUB - __- - � ------- -- <br /> � LAVAiORVIWA$HBASIIr1 � UNITHEAT[RS-B.TU Id ____. _ <br /> SHOWER —1-_ CLOTHESDRVERS ___ <br /> p� �' KITCMEN SINN 8 OISP. —�� '- L _VENTILATION FAN _._ <br /> ��' �ISHVJASHEF RANGE HOOD ___ __ <br /> LAUNORYTRAV __,_ WATERHEATER __ _ <br /> '-- +�' CLOiHESWASMER wOODSTOVE - - <br /> -I_ -- <br /> -. � URINAL ____ METALFIREPLACEBCHIMNE� <br /> DRINKING FOUNTAIN FIREPLACE INSERT _____ <br /> FLOOR DRAIN MEAT PUMP ___. <br /> (. ��3� BACHFLOWPREVENTERS __ GASPIPING _ _ _. <br /> ' ROOF DRAINS-RAINLEADERS E%HAUST FAN_ _ ____ . <br /> SINK ISEFVICE-BAR.ETC1 -- <br /> � -_ ' <br /> � � — - .�-r _. <br /> � _ � ,L'� SUBTOIAL 5 } <br /> SUBTOTAL 5 _J � _ __' _—--_._ _ - —_-- <br /> PEFMIi 5 -__ __ PERMIT _ S � <br /> � -- <br /> TOTAL FEE 5 TOTAL FEE S L' <br /> ' �nJ'�iSEffi�LK Pl'aF5[iflnCK Si�Ii5E1 nCM VUNCHEG NUM�EP FEE NECEIPTNO. <br /> 2v' ' � ' , �r�� 3o ys �,3���c <br /> irezoi�[ �o*<� °^Cee�Sne FEES VALUATION FEE <br /> � 1 �� ❑YES ❑NO - <br /> eui�oiNc � <br /> tt�'EOfCOHST. OLCUP� CVGROUP NOOFUWELLINGUNIIS -- ��r��� �� � <br /> auav.o�E,.�r�.� r �P��MB�N� 1 �- <br /> �7''3 '_ _ <br /> s�zeo� noorsaaies nsrnr occioeo MECHANICAL ' <br /> />Y3 Sr-f -�r �1� � ___ <br /> y3 5� Ca " n/ . <br /> � K �rt��ai*uMi*n*ior� OTHER ]�. � ��. t,�C �l�J <br /> � 2 B � ,'�..�t`_ / ry <br /> fInCSPPINNLER5RE0111PED �]YES YNO STATEBUILDINGSURCHARGE <br /> STATE EPIEFGY SURCHARGE <br /> -rvrt Y v�nr+sna�va/eY PU�LIC WORKS ��l �� I��� J <br /> ���t +1�e /�/f-q /1� <br /> f ( �- TOTAL ��'Y(. �� � <br /> �;; .`� ���� <br /> — _ _ V ✓V�� <br /> � <br />