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, <br /> APPLICw:'fION FOR CONSTRI.�:T10N <br /> PERMIT <br /> the Everpreen rvcrelt <br /> CITY OF O <br /> everett � <br /> BUtLDING DEPARTMENT <br /> 259-By10 TO BE COMPLETED IN INK— PLEASE PRINT <br /> OrYNER MAILPDDRE55 CILY ZI{` PIIONE <br /> ' %� S7F�e ,y,+,�e�J a�,�,t �-�a�c,escN /�-vc: Ev�e� 98ao3 353- 86Gs <br /> TEN�NT MRILAOORf55 GIiV ZIP PHONE <br /> �PCHITECTOdDE51pNEP MAll�00f�E55 CIIY IIP PIIONE <br /> � pENEHA�GONiP�GiOR MAIL/.ODRESS LiTY ZIP FMONE LICENSEa <br /> � 0(. /"F.IC <br /> MECMANIC�IGONiMCiOR MAIL�UDRE55 GITY 21P PNONE 4GENSE� <br /> 1 <br /> PLUMBMpGON1RAC10N MARROpRE55 GiY ZIP PHONE LICENSE• <br /> � <br /> ClASS OF WORK <br /> ❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPLINSERT L� BUILDINGRELOCATION <br /> iEN�NT IMiP�4EMENi OR INTERIOR REMO�EL ONIY CON1ACi PEPSON ANO PIIONE N0. <br /> � CONiPRCTPR:CEOFWOfiK <br /> pF,SCRlOE WOlIN�Np SOU�HE i001AGE INVOLV[D <br /> � I �NSTNLL /�E(�ET STO�E — �p <br /> � — <br /> VROPOSED USE OF BUIIDING I H[REBY CERTIFY THA71 HnVE READ AND EXAMINED THIS APPLICATION AND <br /> �( S ��� �« ,Gy �We�N(. KNOWTHESAMETOB[TRUEANOCORRECT.ALLPROVISIONSOFLAW: AND <br /> LEG�L UESCRIPIION UF PROPERiY�SMOWN 9ELOW OR RTUCN F011R GOPIE51 OFD W LNCES GOVERNING THIS NPE OF WOFK WILL BE COMPLETED WITH <br /> � � WHE7HERSPECIFIEOHEREINORNOT.THEGRANTINGOFAPERMI7DOESNOT <br /> i PRESUIdE TO GIVE AUTHORI7Y 70 VIOLAiE OR CANCEL THE PROVISIONS OF <br /> �or B�ocn oF ANVOTHERSTATEORLOCALIAWREGULAiINGCONSTRUCTIONORTHEPER� <br /> FORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BYTHE OWNER OF <br /> j THIS PflOPERN TO PERFORM THE WORK fOR W HICH APPLICATIGN IS MAOE <br /> AND I COMPLY WITH THE STATE CONTRACTORS LAW 7827 RCW AN7 <br /> 296200 WAC. <br /> i $IGNATUf1EOFCON1RRCi0fiORAUi110RIZEDPGENT DRTE <br /> � � <br /> ? IPROJEGi�DORE55 qPPUCR115CIiYBU51NE55LICENSENO.PN091�51NE55N�ME <br /> + � �.s�,3a �-r+c,Eso,v e ,�de�.tr— <br /> � PLUMBING MECHANICAL <br /> � NO. TYPE OF FI%TURE OH ITEM FEE NO. TYPE OF E�UIPMENT FEE <br /> WATER CLOSEf(TOILEn A/C—A/HNDLG UNITS—H.P. <br /> BATHTUB FOFiCED AIR SVSTEMS—B.T.U. M EA <br /> 1 LAVATORVIWASHBASiN) — UNITHEATERS—B.T.U. M — — <br /> SHOWER CLOTHES ORYERS _� <br /> I KITCHEN SINKB DISP. VENTILATION FAN _ <br /> i DISHWASHER _ R�NGEHOOD <br /> � LAUNDRYTRAY WA7ER HEAiER <br /> � _ CLOTHES WASHER —— �'✓OOD STOVE — <br /> URINAL i.1E7AL FIREPLACE 6 CHIMNEV <br /> I DRINKING FOU�IThIN FIREPLACE INSERT _ <br /> —� <br /> i _ PL90R DRAIN _ HEAT PUMP <br /> i BACKFLOW PREVENTERS GAS PIPING <br /> � ROOFORAINS—RAINLEA�ERS EXHAUSTFAN �v� <br /> �� SINKISEFVICE—BAR,ETQ) I - ��� LdJ <br /> + — ' <br /> I <br /> I — _ — <br /> � _-- <br /> 1 — - — <br /> , <br /> � -- <br /> I SUBTOTAL S SUBTOTAL S <br /> PERMIT $ PERMIT S <br /> ; TOTAL FEE S iOTAL FEE S <br /> ' FflONiSEiOACR PEARSEiBAGK SIDESEipAGN PUNLMELNNUMOEO FEE HELEIPNO. <br /> 1 <br /> " usezone totane� WC�NTSIIE FEES VALUATION FEE <br /> � ❑YES n rvo <br /> + BUILDING <br /> 1VPEOFCONSi. OGCIIPANGYGROUP NO.OFOWELlINOUNITS — <br /> • A�LOW�BLE/�CfUQ <br /> i PLUMBING <br /> S�.EOFOL�O. NOAFSTONIES BSMi. OLGLOAD �)'� <br /> � ❑r MECHANICAL L A 1 <br /> ❑N – - <br /> 1 <br /> i <br /> IIEIGNIUMItAiION O7HER <br /> ( iIRESPRINNLERSREOUIREO ❑YES ❑NO STATE BUILDING SURCHAFiGE <br /> j STA7E ENERGY SURCHARGE <br /> 1 APP4CAl10N�CC�Y PUN9�F�'dBY <br /> � PUBLIC Y�ORNS <br /> � � TOTAL <br /> i <br /> i <br />