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APPLICATII�.� FOR CONSTRUCT �N PERMIT everett <br /> fhe Everpreen TO BE COMPLETED IN INK—PLEASE PRINT � <br /> CITV OF <br /> everett HEAl1NG SYSTEM: U GAS ELECTRIC U ____ _ <br /> BUILDING DEPAFiTMENT I------ � � <br /> 259-BB10 <br /> i I DEMOLITION � i COMBINATIOf � BUILDING i �MECHANICAL i ' PLUMBING ; i SIGN <br /> ,�O NER /AIAIL FII0FrES5 —�� ''-- LII`Y/�-----ZIP PIIONE C; q <br /> ,»�%!,/ 7�42.�'T �.1�C%��� �� �!`� �'! /� � ������ �i c��E% ✓�! - ,S✓��/ <br /> TEN�NT MAl1.A�ORESS LITY 21P PHONE <br /> ARCMITECTOR�ESIGNEH MAII AO�RES� LITY 21P MIONE <br /> s�,.� .� <br /> GENE(i�LCONTPACTOfl MAILAODRESS CITY ZIP PI101lE UCENSEI <br /> % <br /> SC/� ,�, <br /> MELHANICALCONTRACIOR MAl1.A00RE55 CIfV ZIP PIIONE IILENSEI � .��, <br /> PIIIMBINGCONTRACTOR MAILADDRESS CITY 2IP PHONE LICENSE/ <br /> CUSS OF WONK -;! <br /> I I NEW I I ADDITION :�ALTERATION i i REPAIR . I DEMOLITION I i WOODSTOVE/FRPL INSERT � i BWLD�NG RELOCATION <br /> COt�IAf.I P6PSON�ND PIIONE I!O ' <br /> GONTR�GT PRICE OF WORN '�(�/U ' ���� <br /> D[SCRIBE WORK ANO SOU�flE FOOIAGE INV`OL/VEfI <br /> �7S1 �6'� C�7a�/<.�S�:f�l1���e/ '/f �'lla.�a—.-+�[�� :�.r}. <br /> PROPOSEDUSEOFUl1Il01N/C � � � I HEREBY CERTIFY THAT I HAVE READ AND E%AMINED THIS ��� <br /> C i.�C �!' -/A.n � /�i /-_�f "�' /%� � APPLICATION AND KNOW THE SAME TO 8E TRUE AND CORRECL ALL �� <br /> LEWL DE IPTbN OF PPOPERTY ISII( N OELOW OR ATIRCR POIIR f, iesi PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> � / �/ � ,/ WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR �41�. <br /> �or� A�ocK •>(• Ic+ oF ✓/•9�L c�l /--dl,i!L� NOT. THE GRANTWG OF A PERMIT DOES N0T PRESUME TO GIVE � - <br /> AUTHORITY TO VIOLATE OR CANCEL THE PflOVISIONS OF ANY �s' <br /> �� �� n� OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFOFMANCE OF CONSTRUCTION.THAT I AM AUTHOflIZED BY TFIE <br /> OWNER OF THIS PROPERTY TO PEHfORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE . <br /> � CONTRACTO LAW 18.27 RCW AND 296200 WAC. . <br /> SIGN4il1HEOF �iR�CTOHORAUt110NIZED�GENT DATE <br /> X 'I� .��, <br /> , <br /> PPPIECT�DDRES l�� � L ' C�C`�! � /_ ��^�/ . ��'�. <br /> n / ` � PPL ANISGI lIIISIIlE.SI.ICENSEKD �NOOIISINESSNAAIE 4 <br /> �.� <br /> V . i ' � ' ' .,� <br /> PLUNBING M CHANICAL � } <br /> NO. TYPE OF FI%TURE OR ITEM FEt NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOII.ET) A/C-A�HNDLG UNITS--H.P. � _ . <br /> BATHTU� ' FORCED AIR S`.'STEMS-B.T.U. M E.A_ ; � <br /> LAVATORY(WASH BASIN) —�—��-� UNIT FIEATERS-B.T.U. M � <br /> - --- —•—' ._ -----.— <br /> — � CLOTHES DRYERS <br /> SHOWER �— — ----' -- : ' <br /> KITCHEN S�NK 8 DISP __.__T_ VENTILATION FAN __� , <br /> DISHWASHER � RANGE HOOD . <br /> LAUNDRY TRAY ' WATER HEATER _ � <br /> CLOTHES WASHER —�_ N,�OOD STOVE � ���� <br /> URINAL ' METAL FIREPLACE 8 CHIMNEV _ ! <br /> DRINKING FOUNTAIN i FIREPLACE INSERT _�_ <br /> —r— HEAT PUMP <br /> FIOOR DRAIN ,__�__ _ ____. -- � <br /> BACKFLOW PREVENTERS ; GAS PIPING <br /> ROOF DRAINS-RAINLEADERS --��_- EXHAUST FAN __ � <br /> SINK(SERVICE-BAR, ETC.) � ' ' <br /> — -- --�— — � <br /> � ' <br /> _ ____ T <br /> �_ __- ____- i T <br /> ---T <br /> I � <br /> SU�TOTAL $ ; SUB TOTAL $ ' <br /> PERMIT £ �—_ PERMIT $ � <br /> --`— TOTAL FEE $ ' <br /> TOTAL FEE 5 , <br /> FOR OFFICE USE ONLY: <br /> FRONTSETOnCK R[aN5E70aCK 511)ESEIOnCH �'IA�lCII&CRtIUl.10CP RE fiFCEIPTNO <br /> lISE20NE IOTAR[A VACANTSIiE FEES VALUATION FEE <br /> � � <br /> — --------- --.-_._-- <br /> UUILDING C.��O / S � �>n <br /> IYFF Of CONIS Pl10WAlllE 1VP[OI CON51 Af.I11A1 ori.ureum i.n a�muuru;uxn5 �—'-------" ' - . ..------- ---- <br /> �h010� PLUMBWG i <br /> SC-�1 ---�-�J - �-3 ...--�-- ----�-- <br /> SIZEOFBLOG NOOFS70RIE5 OASEAI[f!T ��ECi/ANICAI. � <br /> �_ <br /> �v C� � � - MDITIONALPLANCH@CK `J i7 S <br /> OCCUPANCYLOND FIRBSPRNKLEfiSflGO'0 IIEIGIITlII.117ATlOt! _ � <br /> __ 1 <br /> u, OTHER ; <br /> ,- <br /> REA50 FORSPRINNI.ERS <br /> STATE DUII.DING SURCHARGE �, ;Sa <br /> i <br /> INT�KEBY PIANSAPPROV[DNY CITYOFEVcRETT PUBLICWORHS i <br /> � /J� LOCAL SALES <br /> �/ ���,�� TAX COOE IS 3105 TOTA� � q ; ,� Y <br />