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, i_ � ,� <br /> APPLICATION �OR CONSTRUC'i'ION <br /> PERMIT <br /> Ine Evergreen everetl <br /> CITY OF � <br /> everett <br /> BUILDING DEPARTMENT <br /> 259-8810 TO BE COMPLETED IN INK— PLEASE PRINT <br /> OWHEfl IAAILADOPE55 CIIY ZIP PIIONE <br /> � u�,�,�, ,�,.c,�.��— 7ai s— a=.N,f� v�r �v�ur� _ 3s3--0 8 is- <br /> TENANT MAILFODPE55 GiIY ZIP PNONE <br /> AHCHITECTORpE51GNEF MAILA�OFE55 CItY 21P PHONE <br /> GENERAL GNTRACTOF MAIL�DDRE55 G�Y ZIP t+ �f�P��ONE LIGE SE+ <br /> r�cP J'3 o�Hyf 3' <br /> �D 2�/2 sOu�Y� 3GJ�.T /S�SIo� tiSnr o%y /�/-�dD /7�J�✓ �,n 2 `S i 36k/F <br /> MECH�NICAL GONTPACiOR IAR�I AOUPESS / CILY Z P PMONE UCENSE♦ <br /> YLUMBINaGONTR�LTON MN�ADORES� CItY IIP P��ONE UCENSE� <br /> G1A550F WORK <br /> ❑ NEW ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ N'OODSTOVFJFRPL INSERT ❑ BUILDING fiELOCATION <br /> TENANiIMP00VEMENTONINiEPIORREMODELONLY GON1ACtPEB50NANDP110NEN0. /S"� <br /> - / ' / notl <br /> CONIP CTPRICEyO�fWOPIC �7 ��CJU i OF��1/ � /(�)�C ���0!✓�L�G` ���.I Z S-/Z- <br /> ��.2�W/�t!/�/uT/Oi✓Jnc i�+vo/VL�C(� /`I>L <br /> PHOPOSEO USE OF BUILPINa I HEREBV CERTIFY THAT I HAVE READ AND EXAMI N ED 7HIS APPLICATION AND <br /> ^%{-i/J KNOW THE SAME TO BE TRUE AND CORREC7.ALI_pROVISIONS OF LhWS AND <br /> /1 f� i ORDINANCES GOVERNING THIS T`r'Pt OF WORH WILL BE COMPLETED WITH <br /> LEGRLOESGRIF110NOFPROPEPTYISHOWNBELOWORRTTr1GMFOURCOPIES� WHE7HERSFECIPIEDHEREINORNO7.THEGRANTINGOFAPERMITDOESNOT <br /> PRESUME TO GIVE AUTHORiN 70 VIOLA7E OR CFNCEL 7HE PROVISIONS OF <br /> �ot e�ocK ov ANVOTHERSTATEOP.LOCALLAWREGULA7INGCONSTRUCTIONORTHEPER- <br /> � FORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED 6Y THE OWNE(i OF <br /> ` THIS PROPERN TO PERFORM THE WORK FOR W HICH APPLIi.ATION IS MADE <br /> FND I COMPLY WITH THE STATE CONTRACTORS LAW 18.27 RCW AND <br /> 296200 WAC. <br /> �/-� pAn �C13 •/y ��QS��� � O�O� SIGNRi11RE �CONLRACiD ORAVii�OR2EDAGENi ORTE <br /> / /lK.. .✓% y (�S�' - <br /> —r- <br /> X s, � � — <br /> PROJECTADDRE55 nPP LA�� ��11'BUSiNC55LiCENS[NO.ANDB WES NAME <br /> 10� �5 �utni iar � <br /> PLUMBING ME�HANIJAL <br /> NO. TYPE OF FI%TUPE OR ITEM FEE NO. TYf'E OF EOUIPMENT FEE <br /> WATER CLOSET(TOILE7) h'C-A/HNDLG UN ITS-H.P. <br /> BATHTUB FORCED AIR SYSTEMS-B.T.U. M EA <br /> LAVATORYIWASHEASINI UNITHEA7ENS-B.T.U. M <br /> SH WER CLO7HES DRYERS � � <br /> TCHEN SINKB DISP. r� "= 4ENTILATION FAN � � <br /> DISHWASHER �l - � PANGE HOOU � �- � <br /> ,� � LAUNDRYTRAY � - WA7ER HEAT[R �� <br /> � CLOTHES WASHER �__ WOOD STOVE <br /> URINAL tdETAL FIFEPLACE 8 CHIMNEY <br /> " DRINKING FOUNTAIN FIREPLACEINSER7 <br /> FLOORDRAIN HEA7PUMP <br /> BACKFLOW PREVENTERS GAS PIPING _ _ <br /> ROOF DRAINS-RAINLEADEFS E%HAUST FAN — <br /> SINK(SERVICE-BAR,ETQ) <br /> i <br /> � _ <br /> SUBTOTAL 5 �l � SUBiOTAL `� _ <br /> PERh11T S - PERMIT g ' <br /> ' TOTAI FEE 5 --��' ��� TOTAL FEE 5 �, , "- <br /> �, FflONTSETBNGN PE�IRSET9nCN 5i0[SEIBn� PUHCNEI'RNUMOER FE���n� PECEIPfNO. <br /> � Zo � � � .S -i <br /> 'i usezoNe IOtARER �AcaHrsire FEES VALUATION FEE <br /> ❑ res Dao <br /> j' — � � euaoinc 3/ 8�7. .;��%7 � <br /> 1YPE0 GONST. OGWPANGYGROUP NO.OFDSVELLINGUNItS <br /> ALLOW�BLE/q{�yE}. �_3 � PLUMBING _ <br /> Y, � <br /> SIZEOFBL�O. MO.OFSiORIES OSMT. OLGLOAO MECHANICAL � —� <br /> ❑V __ — <br /> � SSZ _ <br /> ., S,3 MEIGNILIMIL?noN OTHER <br /> j FIRESPRIrr�C��A�EOl1IRE0 ❑ves !�o � STATE BUILDING SURCHARGE r� <br /> 1 <br /> t STATE ENERGV Sl1RCHARGE <br /> � APPUCAIIONAGG6Y PLANSNPPRBY ,� � <br /> PU6JC WOHKS <br /> � �� � �-� � ' <br /> TOTAL � <br /> i <br /> � ; ��`J�G'�' <br /> ;� _ <br /> ��� — �-�� <br />