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� � � <br />I� � r�1i <br />9H(~/� <br />4 xs <br />yZH <br />K o <br />H �f <br />"�tl N 'il <br />yf/�H <br />[�7 O � <br />OH� <br />H�g <br />�v n <br />zH� <br />�yx <br />HH <br />g �' <br />C] t7 y <br />��[r:7 <br />HO(yi� <br />� <br />1 <br />I '_ � <br />� 1 <br />A�PPLICt�. i IQPI F�UR COPISTF�4.oT10N <br />PERMIT <br />r.r���i� <br />tho Evergreen 0 <br />CITV OF � <br />everett <br />BUILDING DEPARTMENT <br />259-edio TO BE COMPLETED IN INK— PLEASE PRINT <br />Glir 11P rMONE <br />OIVNCR . MPILNOVFE55 .1 _ / )G -(..' �/ �� ' L/ <br />J � d /�� �. �l P ��' : ��,�0 � cl./ _ _ <br /><-7-'�G,'(-'ti / _i i1 ��Zc��i ' �'" < c <br />�� I�� �' 1 �� GIIY ZIP PHONE <br />iENFM / ��AILP�ORE55 <br />.� % i-�� - - <br />ANCNIiELT OF DESIGNER <br />MPIL�DOAE55 GlY ZIP PNONE <br />,'�liiv /�f �/? l.�r/4�V✓2_ z�v <br />/ PIIONE IICEN$[ • <br />GENRAICONiPALTOP' / 6 MA�LA�DRE551 �/�/�j/��jrr�/�-QV?�[..� �r0%Z- FI (�c-t , <br />C_7���TC.n /.:�i.v7r-(, O i<<� � /�'II�F�✓�/'� �'v < �'/7� /� // P"� /Gv oNe�Y7-roL / �ee seli .i;� <br />r <br />C11Y qp VMONE LICENSE • <br />PLIIMpINGCONiRALTOP MPILROORE55 <br />❑ NE\V ❑ ADDI710N ❑ A�TERAT�ON ❑ REPAIR <br />I'ca�ol�s� <br />wr '''J i`/e�ocK ��5' ov I� - f� � <br />vFaec*nooaess ��r,�. , ?;�%�/Cc'rc•(�<-i � ,"�"C. <br />� � f i, < . _.� r-f _ c�• � '- Ga�� � " I <br />PLUM9ING <br />NO. TYPEOFFI%TUREORITEM <br />WATEfl CLOSET �TOILEn <br />BATNTUB _ <br />LAVATORV IWASH BASINI <br />SHOWER <br />KITCHEN SINKB DISP. <br />DISHWASHER <br />LAUNDRVTRAY <br />CLOTHES WASHER <br />URINAI <br />DRINKING FOUNTAIN <br />ROOF DRAINS- RAINLEADERS <br />SINK �SERVICE - BAR, ETC � <br />SUBTOTAL 5 <br />PERMIT 5 <br />TOTAL FEE 5 <br />ri ? <br />L�PG <br />DEMOLITION ❑ \YOODSTOVE/FRPL INSERT ❑ BUILOING REIOCNTION <br />CO4IPGT PEfi50N NO PHONC NO �; L/�� C/ <br />�.�. �%<J t �� �� � <br />� YES ❑ NO <br /></�'x !i7 <br />OCCUPAKGYGPOUP NO OFOWELUI <br />a <br />NO OF SiORIES BSMT. OGL LO�D <br />ur <br />c �+ <br />NCiG11iLIMIiA1 <br />REOUtRE� ❑ YES ❑ NO <br />I HER[BY CERTIFYTHATI HAVE READ AND E%AIdINEDTHIS APPLICATION AND <br />KIJOW THE SAME TO BE iRUC AND CORRECT. ALL PROVISIONS OF LAW S ANO <br />OROINANCES GOVEfiNING THIS NPE OF WOFK N'I�l BE COMPLETEO 1NIiH <br />PRESUh1E TO G VEEADUTNORIIN TOOOLA EGOR CANCE�L TA1[EPROV SI�ONS OF <br />ANV OTHER STATL OR LOCAL LAIV REGULATING CONSTFUCTION OR TNE PEi±� <br />F0171.1ANC[ OF CONSTRUCTION. THAT I AM AUTHORIZED BY?HE OWNER OF <br />THIS PnOPERN TO PERFORA� THE WONK FOR WHICH APPUCATION IS h1ADE <br />AND I COIdPLY �vITH THE STATE C/ONTRACTORS LAIY 1827 RCW AND <br />296.2�� WAC./ [ � (�- ;=��� <br />sieNAiIIFf O�.�OMRPCLpAyIRaUiNrylle{ubGENi DFiC � I` l J <br />13 <br />MECHANICAL <br />No. naeoF <br />A/C- A/HN�LG UN❑ <br />FORCED AIR SYSTEh <br />❑N IT HEATERS - B.T. <br />VENTILAiION FAN <br />RANGEHOO� <br />WATER HEATER <br />METAI FIREPLACE 8 <br />FIREPLACE INSERT <br />HEATPUMP <br />GAS PIPING <br />E%HAUSTFAN <br />OUIPMENT FEE <br />- H.R _ <br />- B.T.U. M EA _ <br />M <br />SUBTOT�L 5 _ <br />PEPh11T S <br />TOTALFEE 5 <br />FEE PEC[IPTNO. <br />VALUATION FEE <br />BUILDING <br />PLUMBING <br />MECHANICAL <br />OTHER <br />STATE BUILDING SUFCNARGE <br />STA7EENERGVSURCHAFGE <br />PUBLIC WORKS <br />TOTAL <br />