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^ � <br />APPLICE+�ION FOR CONSTRI.��T10N <br />PERIIAIT <br />fhe Evergreen evcrett <br />CITY OF <br />everett e <br />BUILDING DEPARTMENT <br />259-8810 TO BE COMPLETED IN INK— PLEASE PRINT <br />OWNER MAILPD�RE55 CILY ZIP PMONE <br />TD BE. RE��eo - <br />ARCMRECTOPOESIGNEP AfAILPODRE55 / CILY 21P PMONE <br />GENEfiALCUNiRF�OR �NGL°LSD/JMni�on���� —Y�^' ����L/ / �0�� PHONE ��—LL/ IICE� <br />MECHRNICRLC NiP4CTOR MAILPDDRESS C�TY ZIP PNONE ULENSEs <br />PLUMBINGGONTNAGTO�� �+^I��S`+ CIIY L' PMONE UGENSE• <br />:,�L�,/SS OF N'ORK <br />lN NEW ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOOUSiOVE/FPPlINSERT ❑ BUILDINGRELOCATION <br />GONTR�CT PRICE OF <br />'__'_____..... _ _ . . <br />J..�- Ji "7 ,, <br />LOT �� OLOCN � - �l OF ��— <br />i�n-�, :; <br />= f.� �i, � <br />PLUMBING <br />10. TYPEOFFIXTURE <br />WATER CLOSET ITOILET) <br />BATHTUB <br />LAVA70RV (WASH BASIN) <br />SHOWER <br />� KI7CHEN SINKB DISP. <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR ORAIN <br />BACKFLOW PREVENTERS <br />ROOF DRAINS — RAINLEAU <br />au¢ iccu�nrc _ weo crci <br />SUBiOTAL s <br />PERMIT g _ <br />TOTAL FEE g <br />FPOf1iSEi84CN PEARSETBACK SI�E51 <br />i ��i <br />USEZONFFF���...,,, LOT�AEA VACAH <br />��^'� �� � Y[5 <br />v <br />TVOEOFGONST. OCCU!'ANLYGROUP NOOF <br />AILOWABLE/PGII14-- <br />�L.-/`i �' -3 <br />Si2EOFBLDG. NOOFSTpPiES &SMT. OGGLi <br />s Y � `� <br />- &O lbA�H4v � 3.�9�� /O��L ��eic�r <br />.IqESPRINNlERSREOIIIFED ❑V[5 ywu � <br />1,� i <br />b O <br />.� 0 <br />iELLING UNI15 <br />2 <br />.�- <br />MllAiION <br />� / <br />� 3 ��75 <br />IHLREBYCERTIFY7HA71 �AVEFEADAND[%AMINEDTHISAPPLICATIONAND <br />KNOW THE SAME TO BE TRUE AN ] CORRECT. AlL PROVISIONS OF LAWS ANO <br />OR�INANCES GOVERNING 7HIS'•YPE OF WORK WILL BE COMPLETED WITH <br />W HETHER SPECIFIED H EREIN OR NO7. THE GRANTING OFA PEFMIT OOES N01 <br />PRESUMETOGIVEAUTHORIttTO /IOLATEORCANCELTHEPFOVISIONSOF� <br />ANY OTHER STATE Oli LOCAL LAW R 2GULATING CONS7RUC710N OR THE PEF- <br />FORMANCE Of CONSTRUCTION. TH 1T I AM AUTHORIZED BV THE OWNER OF <br />THIS PROPERTV TO PERFOPM THE V:ORK FOR WHICH APPLICATION IS MACE <br />AND I COMPLY WITH THE STA7E �:ONTRACTORS LAW 18.27 RCW DP'D <br />296200 WAC. <br />SIGN F�ON1RAGip/R/OF:\/UiNOPIZEOt]ENT OAiE <br />%! Qd <br />X Y �'��O! <br />! <br />qPPLiCANI IIYOUSMESSLI [NSENOAN�DUSNFSSNFME <br />MECHANICAL <br />TYPE OF EOUIPMENT <br />A/C — NHNDLG UNITS— M.P. <br />FORCED AIR SVSTEA'S— 6T.U. <br />UNITHEAfERS—BT.U. M <br />CLOTHES ORYEPS <br />VENTILATION FAN <br />RANGEI100D <br />WATER HEATER <br />WOOD STOVE <br />METAL FIREPLACE 8 CHIMNEY <br />HEAT PUh <br />GAS PIPI� <br />EXHAUST <br />SUB TOTAI <br />PERMIT <br />TOTAL FEE <br />� 7��{�1 <br />�> <br />FEES VALUATION <br />aui�oiNc �� 99y <br />PLUMBING <br />MECHANICAI <br />OTHER i ,' i I' <br />I <br />STATE BUILDING SURCHARGE <br />STATE ENERGV SURCHARGE <br />PUBLIC WORKS <br />TOTAL <br />Fee <br />5 7 � <br />5 � <br />S �"/ <br />ECEIPf NO. <br />. � � <br />c� : "� �� � <br />FE: <br />=�r�2,^ � <br />.I � i�l <br />l i ' � f <br />�/ <br />�� 7 '/, : <br />�`� <br />'"�ll"I ' �� > <br />