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`� <br /> 1 - <br /> � !� <br /> �' APPLICAYION FOR CONSTR4�T�^!�l <br /> PEF3MIT <br /> Iha Evorgreen i�`,������� <br /> CITY OF 0 <br /> everett � <br /> BUILUING DEPARTMENT <br /> 259•8810 TO BE COP/IPLETED IN INK— PLEASE PRINT <br /> O'NNE��� �////`/`/�I.IAIL P�flE�lL1L�C.��SJLl�—�./`O/ 1'110NE -- <br /> TEWNANi MAiLnDORE55 Cilv Iiv P��ONE <br /> �NGMrtECiOBDE5IGNEF MAI�Ap�BE55 GI1V ZIP PHONE �� <br /> GENEN�LGONiR?.TOR MnIIPODPERS Ci1Y ZIP PIIOqE JCENSE• <br /> MEClIRNICA�GONIRRLTOH MNLAOURESS CIiY IIP PIIONE UCENSE• <br /> PLUMBINGCONiflALiO AIAIL�OORESS GIIY IIP PIIONE LICENSE• <br /> 4,=/�' <br /> cwss oF vronv <br /> � NE\V ❑ ADDITION ❑ AITERATIDN ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL INSERT ❑ BUILDING RELOCATION <br /> TENANT IMPPOVEMENi O�INiE�RIOB REM�O��EL�NLV CON1ACi PElI50N AND PIIONE NO <br /> �/CQNTFACTPRiCEOF W0lIM %���.fFJ.���c�_(/By_��� <br /> SGRIBEWOflNM�DSaUAREfOO1XGElrlvo�veo / <br /> PFOPOSED USE OF BIlIL01NG I NEREBY CEfiTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND <br /> " KNOW THE SAME TO 6E Tr7UE AND CORRECT.ALL PROVIS�ONS OF LAWS AND <br /> LEG�LUEGNFiIONUfPROPERLY�SMOWNOELOWOf1AiiAGMFGUfIGOPI[51 ��DINANCESGOVERNINGTHISTYPEOFWORKWILLBECOMPLETEDWITH <br /> WHE7HERSPECIFIEDhIEREiNORNOT.THEGRAN fINGOFAPERMITOGESNOT <br /> PRESUME TO GIVE AUTHORITV TQ VIOLATE OR CANCEL THE PROVISIONS OF <br /> LOi o�OLrc oF - pNYOTHERSTATE017LOCALLAWREGULt.T{NGCONSTRUCTIONOFTHEPER- <br /> FORM1I�NCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE OWNER OF <br /> THIS L'ROPERTY TO PE(iFORM THE WORK FOR WH!CH APPLICATION IS MADE <br /> AND I COIdPLV W1T4 THE S7AiE CONTfiACTORS LAW 1827 RCW AND <br /> 29C. p0 WnC <br /> siu� tuncorco�+inncronai�nuuionizconccrrt DNIE <br /> r. . � / <br /> PROJECiADORESS - - '- �(�����.---� _ ) l` �'�- <br /> pPPLICAtlti 'iYlU51N1'.till r�5 NUANDOl151NLS5N�ME <br /> 7���Z ��'l�i�)'�"1'� <br /> PLUMBING �— MECHANICAL <br /> NO. TYPE OF FIXTURE OH ITEM FEE NO. TYAE OF EOUIPMENT FEE <br /> WA7ER CLOSET�TOILEp WC—NHNDLG UNI7S—H.P. <br /> BATHTUB FORCED AIR S'/STEMS—BT.U. Id EA <br /> LAVATORYIWASHBASIN) UNITHEATERS—B7.U. M <br /> SNOWER CLOTHES DFYERS <br /> KITCHEN SINK 8 DISP. VENTILATION FAN <br /> DISHWASHER RANGE HOOD � <br /> LAUNDRY TflAY WATEN HE,'1TER <br /> CLOTHES WASHEF WOOU STOVE <br /> URINAL ME7AL PIREPLACE 8 CHIMNEY <br /> �IiINKINGFOUNTAW = FIREPIACEMSERT <br /> FLOORDRAIN HEAiPUMP <br /> BACKFLOW PREVENTERS GAS PIPING �_7 <br /> FOOF DHP.INS—RAMLE40ERS EXHAU57 FAN <br /> SINK�SERVICE—BAR,ETC.) <br /> _ � <br /> SUB TOTAL 5 SUB TO7AL 5 �L�� <br /> PERMIT 5 -- - ___ _ PEfiMIT__ 5 �� � 1 <br /> TOTAL FEE 5 TOTAL fE[ S �% ) <br /> fRONi5ET0ACK PENBSEiBACK 5�0[SEtOAGK VIPNCHECNNUM�[0 FEE flECE1PTN0. <br /> USEZONE IOiAHE� VAUNLSpE FEES VALU(QION FEE <br /> I)Y[5 f1NO <br /> BUILDING <br /> ttPEOfCONST OLGUI'�NCYGROt1P NOOFDWELL�NGUNItS ------ — <br /> ALLJWA9lE/ACTURL <br /> PLUMBING <br /> �saeoveioc. uoorsror+ies osur. occweo <br /> u r MECHANICAL ( �i �� <br /> Il N -- -- <br /> r�ero�aurniunor� OTH[R <br /> lIRE$PRINY,LERS R[OUIREO ❑Y[S ❑eo _ STATE BUILDING SURCHARGE <br /> STATE ENFRGY SUFCHARGE <br /> nra�•,ar;o���r ruNsnrrnor - <br /> PU9LIC WORNS <br /> rorai <br />