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� � . <br /> APPLICA� ION FOR CONSTRU.,TION � <br /> PERMIT <br /> fho Everpreen <br /> CITV OF everett <br /> everett e <br /> BUILDING DEPARTMENT <br /> 259-Beto TO BE COMPLETED IN INK— PLEASE PRINT <br /> OWNEry� MAILADpRE55 GITY ZIP PMONE <br /> J�11 N��t /�z Ccw�RS Rc� 5)wNc.rynish 982�'� 33�/- /943 <br /> TENANT MAILADDRE55 CIiV ZIP PNONE <br /> N�� <br /> •PLMREQORDESIGNER MARFDDRE55 GTY 21P PHONE <br /> de�Sict/� C'ouScc/t'�,vt5 903 /o'`' St /17aKi/reo, 9g2T5 74`S�CGS69 �✓�C,�o <br /> GENER�LC �GTOR MAiLApUFESS CrtY 21P PrpNE M�R�Q��`�CEHSE• <br /> x I 14D <br /> eR;d�a.N Cox�stR�-Tiva C� . IG32 co��.oas (� ,n-oh�,is<� 95sz90 33�/-/9b3 y <br /> MECM1NiC�LCONTR�CTOR MnILA0�9E55 CITY 2iP PrONE LICE65E• <br /> PLUM&NOCANTR�GTOR MAILADDRE55 CITY ZIP PnONE �ICENSE• <br /> 4�hitc Cons t p���nei%�w <br /> GV�SSOF WpRN <br /> �I NEW ❑ MDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOUTION O WJODSTOVE/FRP�INSERT ❑ BUILD�NG RELOCqTION <br /> IENiVIT IMVIIWEMEMOR INTEPIOR REMODf.L ONLY CANTAGT PERSON�Np PMONE NO. <br /> CONTRIiCT Pf110E OF WJRK �� /L/(.�'�O Je� No/t - 33`� - l90 3 <br /> DF9CR1lEWORK�ND90UMEFOpTAGE VOLVEl1 <br /> �16� d <br /> PROPC 4ED VSE OF Sl11LUINa I HEREBV CERTIFV TNAT I HAVE READ AND EIUMINED THIS APPLICATION AND <br /> S/�+QIC F1Q1711'4 ReS;�eNCL KNOWTHESAMETOBETRUEANDCARRECT.ALLPROV�SIONSOFUWSAND <br /> LEWL[CZCRIPiIONOFPR Rtt�SMOWNBELOWORATUCHFOUHCOPIES� ORDINANCESGOVERNINGTHIS7VPEOFWORKWIILBECOMPIETEDWITH <br /> - -1 WHETHER SPECIFIED HEREIN OR NOT.THE GRANiING OF A PERMITDOES NOT <br /> - �OT �`� BiOGK oF t b���ooR �l� hY5 PRESUMETOGIVEAUTNORITVTOVIOLATEOFCANCELTHEPROVISIONSOF <br /> ANV OTHEF STATE OR L<)CFL LAW REGULATING CONSTRUCTION OR TME PER- <br /> FORMANCE OF CONSi HUCTION.THAT i AM AUTMORIZED BV 7HE OWNER OF <br /> THIS PROPERN TO PERFORM THE WORK FOR WHICH APPLIC�TION IS MADE <br /> AN� 1 COMPLV WITH THE STATE CONTRAG?ORS LAW 1827 RCW AND <br /> 296200 WAC. <br /> SGNqTUREOFCONiR CTORORRI�TNORiZEDAGENT O�TE <br /> x /-I-�?'� <br /> PROJKT�D�NE55 qpp�l 5 C17Y BUS!NE55 LiCENSE NO�h0 BUSIHE55 N�ME <br /> L <br /> ►LUM�INO MECMIINICAI <br /> N0. TY�E OF FlIITLIIE OR ITEM FEE NO. TYPE OF EWIPMENT FEE <br /> . . W�TEFCLOSET�TOILEn G � NC—lVHNDLGUNITS—H.P. <br /> � BATMTUB FORCED AIR SYSTEMS—BT.U. M EA — <br /> �J LAVATORYIWASH BASIN) UNIT HEATERS—B.T.U. M ? - <br /> z SHOWEF � � CLOTMESDRVEqS �,j <br /> I KITCMEN SINK6 DISP. VENTILATION FAN ;� ` �� <br /> J DISMWA9MER RANGE HOOD � ` <br /> V.UNDRY TRAV WATER HEATER ' <br /> CLOTHESWASHER WOODSTOVE ? `,.� <br /> URINAL METAL FIREPLACE 8 CHIMNEV �. <br /> DRINKIN6 FOUNTAIN FIpEf'L4;,E INSERT ;� �*` <br /> FLOOA DRAIN HEAT PUMP � ��� �� <br /> � <br /> BACKFLOW PREVENTERS GAS PIPING " `� <br /> ROOFDRAIN9—RAINLEADERS EXHAUSTFAN � �!' <br /> � -,�. <br /> SINK�SERVICE—BAR,ETCJ ,�-�,yQf <br /> ,� <br /> — 7+' <br /> SUBTOTA� S SUBTOTAL S �. <br /> PERAAIT S PERMIT S <br /> TOTAL FEE S � TOTAL FEE Y <br /> FRON�SETB�C� pEnRSETFIRGK SIDESETBRGN PUN M CI(NUMqE1J .- FEE _ 11ECjIPL <br /> /'In �l�./"I ✓�rY"7 � )�'� <br /> YlA•r O�OC�IS./�v� v.i�� � O(L/ <br /> use �or�Ru vecnN*srte FEES VALUATION FEE <br /> • �YES ❑NO <br /> � BUILDING qa � <br /> IYPEOFCANST. OGGUPnNCYGRGUP NOOFOWELLINGl1NIT5 <br /> aILOW�BLE/�CT • � / � � <br /> — �� PLUMBING J <br /> SIZE OF BLOG. NO OF STORIES BSMi. OLG.LOND N� <br /> ZIGI '� / M v MECHANICAI � .-� � <br /> n N � L`2LL <br /> NEI�GHT`LIM�T�TION OTHEF � �` <br /> FlRESPRINNLERSREOU�RED ❑YES t�[I�1 V(/ ,7 <br /> STAT[BUILDING SURCHARGE . <br /> �,°� . <br /> STATEENERGYSURCHARGE I "i <br /> �PPLICATIqNI�cGBY PIANS�PPP.BV , <br /> � PUBLIC WORKS fj � � ,�; � <br /> �V\ � . <br /> TOTAL <br />