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� r,�,�l <br />APPLICAi'ION FOR CONSTRIi�:T10N <br />PEI�MIT � <br />t�e Everpreen c�eiett <br />CITY OF <br />S' ��- <br />e,verett ENT '�� <br />� ;�� <br />259•8810 TO BE COMPLETED IN INK— PLEASE PRINT <br />�HEq MAIL�OURE55 GI1Y 21P PNONE <br />�'osec,L4�'%.dva �`a�a.are �"ooi So 3rd ��era7f 96ao3 aS9-�690 <br />MCNITECTOR�ESIGNER M�ILADOR[SS CrtV ZIP PIIONE <br />� O$� �� .� t^� ' <br />OENER�LCONTH GTOA M�II�DDRE55 CItY 2iP FMONE LIGENSE• <br />^ S/{ 98�9 s� �9 3-�� �i �Ro�cca��P� <br />are�alt�an l,le -�,•,,.,'�-,s � Pb •�O�.j9% � 4!'L <br />nunuc LILEnSE • <br />FLUMBINOGONIPAGTOF M�II�ODRESS GIfY 21n PNONE LIGCNSE• <br />❑,�ry E pp � EryDpRIO EPiOR�EMO`�EL�ON ON � REPAIR ❑ OEMOLITION Co❑A WOODOSNON019 CP:E NOSER7 ❑ OUILDING FELQCATIO� ' <br />j Lll <br />p r�o <br />CONTRACTPRICEbFWORK � �Atl� 3 J O(Z— ���i� �i�sn�arG =�Zs9- 95��_ i <br />�ord�L e�ocK 3s or <br />PLUMBIN6 <br />KITCHEN SINK <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENI <br />ROOF DRFINS — RAI I <br />'1 FROHiSETB�CN <br />, <br />' U9E20 � <br />; <br />� TVPEOFCCN9T. <br />� �LLOWABLFI�CTUAI <br />! <br />IRVICE — BAR, ETC � <br />SUB TOTAL <br />PERMIT <br />TOTAL FEE <br />RE�R SE1B�Ci <br />l01 �F� <br />- � s� <br />OCCUFANCVOROUP <br />-N �- 3 <br />��.� HO.GFSLORiES BSM <br />r <br />J%s , � " <br />FIPESPRINKLERSREOUIRED 01 <br />IHEREBYCER71FV7HATIHAVEREADANDEXAMINEDTHISAPPLICATIONAND . <br />KNOWTHESAMETOBETRUEANOCORRECT.ALLPROVISIONSOFLAWSANO , <br />ORDINANCES GOVERNING THIS NPE OF WOPK WILL BE COMPLETED WITH �� <br />WHETHERSPECIFIEDHEREINORNOT.THEGRANTINGOFAPERMITDOESNOT 'I <br />PRESUME TO GIVE AUTHORITV TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANYOTHEtiSTATEORLOCALLAWREGULATINGCONSTRUCTIONORTHEPER� '�. <br />FORA7ANCE OF CONSTRUCTION. iHAT I FM AUTHOFIZED BYTHE OWNER OF � <br />THISPROPERNTOPERPORMTHEWORKFORWh11CHAPPLICAT10NI5MADE �� <br />AN� I COMPLY WITH THE STATE CONTRFCTORS LAW iB.27 RCW AND I <br />296200 WAC. �I <br />S�GNPtUP[OfLONt0AG10�ORAU1110R�2[DRGENi D4E <br />MECHANICAL <br />FEE NO. TYPE OF <br />A/C—A/HNDLG UNII <br />__��,.f--ro , <br />VACANLSRE <br />O YE9 �ING <br />UNIT HEATERS — &T.U. <br />CLOTHES DRYERS <br />VENTILATION FAN _ <br />RANGEHOOD <br />WATER IIEATEF <br />WO00 STOVE <br />GAS PIPING <br />EXNAUSTFAN <br />ECK <br />�i�. �� a/�� <br />— H.P. <br />— 6T.U. M <br />M <br />PERMIT <br />TOTAL FEE <br />FEES VALUATION <br />BUILDiNG 3Q n/_Z_ <br />.r„ � <br />PLUMBING <br />MECHANICAL <br />oTHER aa,.�a- <br />STATE BUI�DING SURCHARGE <br />STATE ENEFGI' SURCHARGE <br />PUBUC WORKS <br />TOTAL <br />VG! <br />FEE <br />y04,13 <br />