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/!►PPLeCL►r'IAI�! �OFi �Oh1STF34s.:TiO�'a <br /> PE�?�91T <br /> Inc Evorgreen ""'��'�� <br /> CiTY OF <br /> everett <br /> BUILDING DEPARTMENT <br /> 259�8650 TO RE COMPLETE6 IN INK- PLEASE PRItvT <br /> ov.rer+ } uni�r.00eess arv zm nrorrv- <br /> 50�� 5c,�st=i �.nwt �v�T 9820?, z5f�-zZ•z•7 <br /> F>��z �1 �3—._- - <br /> iEN/JIT L MAILADDliE55 CiiY ZIP PMCN[ <br /> >.lI >:..�s c ���c� 7'L�;:.�n,Er ��u, k� �13v�2u��r� h7 _ ;z? _757 -��68� <br /> AIiCHIiECiOP� I:AISPpDREiS y� CIiY ZIP PMONE <br /> yo� �.yEr>��i1c��-J�r I �KD �r�z�rl `��ic�3 _�9�IL -- <br /> �+r - MAILAOOPE55 GiTV ZIP PNONE UCEY`_f= <br /> GENEP:LGGNTFAG OR n <br /> [.�`7. x �Gl,� �TMt �Ec( II,G'f(V'. EvG'Q.�- arr— zio vnoNe uce��::,.,� . ._ <br /> �i-1 rnECNAiiica�c *rucrca r.ua.00nEss <br /> I 9Hi/� � l <br /> C �: �,y M� 1�-. � 1.Jo k�CJM Yc� -- <br /> H ',' � °W1.101NGCOYi ACiOP IAPIUL�RE55 CIiY ZIP PNONE ULENSC- <br /> � z� <br /> � ,�z '��� i i>cx��� - _ _ <br /> O �� OA550*WORN <br /> y ~ � E-j�MElJ ❑ AD�I?ION ❑ ALTFRATION ❑ REPAIR ❑ DFMOLIiION ❑ WOODSTOVE/FPPLINSERT ❑ BUILOINGOELOCATVJN _ <br /> !n H <br /> � H [� 1FJIAhiniPRP/EMENT4NINiCP'�ORPEIAUCE'_ONLr �/y j� LONi+ClPlFSONPNOPHJNENO <br /> .'I� `l'i_� }�� 0 /� �O�w� —.._ __ <br /> .:�] QC, a)N1FGLiPRIGEOfV:09�. , } _ — — <br /> ht� 0'i5(A13EViOPR4ND5CV�REfOOiFGEINVCLV6D <br /> v oo ��u k�s�llEr._tf, E`��� +i5e 3;Y-:�mz�c. - - - --- <br /> H G:O ��pK,�DUSEofow�n�NG IHEflEBYCERTIFVTHATIyA�eREADANOE>.AMWEDIHISAPFLICA�IONFNC <br /> �� � <br /> H � ���G ' D�N�� KNOW'HESFMETOBEiPUEANDCCFRECLALLPROVISIpN50FLFW5AND <br /> a y�, � GRDINANCES GO�'ERNING THI,^-.T�T-E OF V70RK N'ILl BE C01dPLETED WITH <br /> u,,;..qcscaivnovovvaoPEatt�sNowNeetowoar,T*ncHvouacov�esi yyHEiNERSPEGFIEUHEREINOHNOt.iHE�FANTINGOFn�=P�dI700ESN0T <br /> ['" 1yy / � PRESUh7E�fOGIVEFUTHORITVTOVIOLAT50RCPNCELTHEPFOVI5IUN$pf <br /> �i2 ' L!1"_ 1"v� �4i, <br /> � y i, � 81�K �F I ! J V�� I� pNYOTHERSTATEOHLOCALI.AWSEGULATIIaGCON5iRllGiIO�JORTHEPFr7� <br /> r � � FORIdANGE OF CONSTRUCTION.THAT I AM AUTH05�ZED�'I1'HG OWNER O� <br /> � �� THIS PROPERTV TO PERFCRIA THE WORK FOR WHIL'H FFFLIC`TION IS M17A7E <br /> � �� _ _ AN� 1 CO��PLY WIT4 THE STAiE CONTRACTORS L::?t ' ] RCl'J ANO <br /> 296 2001VAC <br /> vemau�:e��ro.�:mcerc::r,i.:,uniouizm:.aer�r c;.�c <br /> H O C/� _ -I p ' �� -/ <br /> — ,r�'9'���.��,'���Us�tncn- --- <br /> vaode-�nonae-s ��s� � ms�ue uc e�+o os�snae -. ... <br /> � "� >> � rti ����, ���� <br /> � , <br /> PLUiABING MECHANICAL � <br /> NG. TYPEOFFIXTUREOPITEM FEE NQ. TYPEOFEOUIPMENT FEE <br /> '>� WAIERCLOSETQOiLET1 ____ ___�'" _ _ NC-A/HNDLGUNITS-HP _ _ ______,._ __ <br /> FORCED AIR SYSiE1dS-B.T.U. M EA <br /> I a / BATMTUB -_— ' _-.- �.� _- _ _ _. _— _- _ ___ .- _. <br /> LAJATORYIWASHBASIN� ��. UNITHEATERS-BT.U. M __ _ <br /> I SHLWER �-j _ __I _. CLOTHESDRVERS � i - <br /> "-� s KITGHEN SINKd DISR .i � VEN7ILATION FAN _ ' ^�� <br /> � �'� a�' DISHWASHER _J`"7 �__L RANGEHOOD _ __i- =1�,' <br /> I LAUNDRYTRAV �� - �_ WATEPHEATER___ '___ ' _ <br /> _ � CLOTHESWASHER - WOO�STOVE _ _ _ <br /> II �' UPINP.L __ _ M_TALFIREPLACEBCHIMNEY . . -7' <br /> � � DRINM.WG FOUNTAW __ / PIREPLACE INSEAT __ ��� r � <br /> FLOORDRAIN __ _NEATPUMP _ -___ <br /> BACKFLOW PREVENTERS o%S PIPING ___ <br /> 9�� .-.� ROOF DRAINS-RA��NLEA�ERS _ E%HAUST FAN _ <br /> SINK�SERVICE-BAR,ETC.) _ _ __--- — -- <br /> ...:.b,� - �- -' SUBTOTAL 5 -' '__ SCBTOTAL — 5 __Z'� ���� <br /> ---�-- P[RId1T S -' _ _ PERMIT ___ 5 " � _ <br /> TOTAL FEE S �' � 10TAL FEL 5 .`.- ��' ��'� � <br /> ��.. FRONISLTCFC✓ l�UP9EtPnCA S�ESGI�AGK PIANGN(CNNUMBEfl FE[ i�_"� RECEIPiNO. <br /> _ � � l � � � . �r� ._���� � '�).�Q� � �.—� <br /> � 1 � . '`,'' <br /> usEzor+e �ornntn 8��� �Acnr�rsnc FEES VALUATION FEF. <br /> .rj - ' ��� �/res '.�r�o <br /> K BUILDING � i �� ��� c_�� <br /> ttp[OFCANSL OCCUPTNLYGRCtIP NOOfOWELUN0UN115 — — -- ��-' � - —�- <br /> ALLOWABIE/ACIUAL � �� � <br /> �-j, Q�^ I PLUA�DING _ l� . _ <br /> sizeor o�oc r.o o�.iu�iis osvr occ�wo ��L <br /> 1�0185F �3' I xti �(pr MecHnNicn� —— - •_) � l'i, <br /> 57� $� /A ��,o� NCiGMtL11.11iALiON OTNER ____ ` ,�_ <br /> �+rT �'/ � <br /> i <br /> r,c� s�eimn�ensneowaeo ❑res ,rpo _ SiATE BUILOING SURCHARGE � ` � <br /> STATEENER(.YSURCHARGE � � �� <br />'��L • . -w110NACG�Y PLANB�PPf�pY , ' � <br /> . � �� PUBLICWOFHS \ � <br /> �� � _' -- ""� � .1 <br /> /.r�C_. TOTAL � I���: � �.: � �) <br />