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��H <br />�� � <br />�H[n <br />H�� <br />K n <br />o � <br />�tlH� <br />y <br />Hx <br />O�d <br />��g <br />�I:Y (] <br />t"y� <br />HH <br />gy <br />C]l97N <br />� y � <br />HO�n <br />pppLlCA.ION FOR CONSTRU.:TION <br />PERMIT <br />the Eve�green cwc�rll <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />2�9�8810 TO BE COMPLETED IN INK— PLEASE PRINT <br />M1�AILAUDBE55 GIIY ZiP VHONG <br />OIYNEH . (� � . . L . A l!..� �. Z.-Y .i'>Vi <br />C� <br />�Ufe�SS �5'�.'S'/YS <br />tr ZiP FI�OHE LILENSE� <br />n <br />_o�,���,!>6�� <br />iy ZIP MONE LICENSE• <br />CLPJ+ V r lvvnn <br />❑ NEW A�DITION ❑ PLTERATION ❑ REPAIR DEMOLITION ❑ H'OODSTOVFJFPPLINSERT ❑ BUILOINGRELOCATION <br />TENFNiiMPROVEMENiORINiER10P FEMOOELONLY WNLACTPEASONNNO PNONENO <br />CONtPACTPRiCEOF\VORK ����^' � I`�� LJ �S� � <br />DESGFIBEWOPhANO50UAREFOOiA EINVOWEf�I � <br />�r�� � 17Y1Jn�� i2 � �E--1; �l ���C?',�=- — <br />�p7� OLOCK�L . OF <br />`5G� 1 <br />—PL—U—M�BIN�G <br />NO. I <br />zs�sa u S7`' <br />FI%TURE OR ITEM FEE <br />KI7CHEN SINKB DI: <br />DISHWASHER <br />LAUNDRV TFAV <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTA <br />FLOOR DRAIN <br />BACKFLOW PREVE <br />ROOF DRAINS — R� <br />ewv iceo�nrc _ c <br />pILOWABIEIAGTUAL <br />SUBTOTAL 5 <br />PERAIIT 5 <br />TOTAL FEE 5 <br />'RhARSETBACN SIOESEiOAGN <br />101qq�q WCANLSILE <br />C YES ❑ NO <br />OCGUPANCYGPOIIP NOOFDN'Ellll <br />NO.OFSLORIES BSMi OGGLOAO <br />❑Y <br />❑N <br />HEIGNi IIMITAI <br />❑ YES ❑ NO <br />I HEREBV CEHTIFY THAT I HAVE READ AND E%AMINED TNIS APPLICATION AND <br />KNOW'. HE SA�1E TO BE TRUE AND CORRECT. ALL PROVISIONS OF LA'NS AND <br />ORDINAt10E5 GOVERNING ThIIS TYPE OF WOHK WILL BE COMPLETED W�TH <br />P ESUMETOGIVEAUTHORITVTOV�IOLATEGORCA'NCE�LTHEP OIVISI�ONSOF <br />ANY OTHEF STA7E OP! r1C4L I.FW REGULATING CONSTRUCTION OR 7HE PER� <br />FOAMANf,E OF CONSTRU::TION. THAT I AM AUTHORIZED BV THE OWNER OF <br />THIS PFOPERN TO PERFOfJM THE WORK FOR W HICH APPLICATION IS MADE <br />AVD I COMPLY W�TH THE STA1E CONiRACTORS LAW 1827 R W AND <br />296200 W;,C. �'��8� <br />S�GN�tUREOFCONiPACtOROFAU1110RIZE0AGCNT DAIE <br />X Q��l r%//��;/la�/ �U����(e� �e�e% <br />MECHANICAI <br />iVPE OF EOUIPMENT <br />p�C— NNNDLG UNITS— H.P. <br />FORCEDAIRSYSTEMS—B.T.U. MEA <br />IIUITHFATERS—BT.U. M <br />WA1ER <br />FIR[PLACE <br />HEAT PUMP <br />�AS PIPING <br />CIiIMNEY <br />SUBTOTAL 5 <br />PERMI7 5 <br />TOTALFEE 5 <br />FEF AECEIPTNO. <br />VALUATION FEE <br />BUILDING _ <br />PLUMBING <br />MECHANICAL <br />OTHER � —%�' <br />STATE BUILOING SURCHARGE <br />STATEENEFGVSURCHARGE <br />PUBLIC WORKS <br />TOTAL <br />