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�p, 1 <br /> /'� / ' � <br /> APPILICA r'IOE�1 FOR CONSTRUa:T10N i <br /> PERMIT <br /> fho Evergreen i�n•�clt <br /> CITY OF <br /> everett � � <br /> BUILDING DEPARTMENT <br /> 259•8810 1'O BE COMPLETED IN INK— PLEASE PRINT <br /> OWNEP MAIL/D�PE55 CIIY ZIP PHONE <br /> �rn�� +� �::II� os S3il U�/�r�er 1P d4e �'d �U J�c��3 347-383�3 _ ' <br /> TENANT � � � MAllAO�R% GTY ZIP PNONE <br /> ARCNrtEG�OROESIGNER MAIL��ORE55 CIIY 21P PMONE <br /> GPNEPFLGONTP�GTOR MAILADORESS GITY ZIP PHONE LICENSE• <br /> �_'m GITY 2 P VMONE LICENSE <br /> MLCMPNICALCONTRACTOR MULR00NE55 <br /> ll!�2 r,c. C^�,s—F. _ <br /> PWMB�N6CONiPAGTOH MMIPDORE55 CITY 21P PNONE IIGENSE• <br /> ^ i\� /�1 n 1_ � rl <br /> �UGlli� �C�'U111 YIL��� L V <br /> CUSSOF RN <br /> � NEW ❑ ADOITION ❑ ALTERATION ❑ REPAIR ❑ DEMOL�TION ❑ WUODSTOVE/FRPLINSERT ❑ BUILDINGRELOCATION <br /> TENRNL IMPROVEMENi OR INiEH10R REMODEL ONLY J f.OtiIACT PERSON PND PMONE NO <br /> '� �CONTH�Ct PRICE OF WORK ,,1 -- <br /> OCSGf11dE\YOPNANDSOU�AREFOOTr1GEINVO D / <br /> �C�)SP oC�]��f�i—�� t• — <br /> POPOSEOUSEOFpUILDING �— IHEREBI'CERTIFY7HATIHAVEREADANDE%AMINEOtNISA�PLICATIONAND <br /> �Omi� SI 2 � KNOW'HESAMETOBETRUEANDCORRECTALLPROVISIOr;i:OFLAWSAND <br /> IEC�l0E5C.iIPT10YCfPROPENtt�SNOWNBELOWORATTAG��fOURCOPIES� ORDINANCESGOVERNINGTHISTVPEOFWORKVIILLBECOMPLETEDWITH <br /> WHETHER SPECIFI[D M EREIN OR NOT.THE GRAN7ING OF A PERMIT DOES NOT <br /> �1�7�71111� C�� PRESUME70GIVEAUTHORITVTOVIOLATEORCANCELTHEPROVI510NSOF <br /> �oi� BwCK aF ANVOTHERSTATEORIOCALLAWREGULATINGCONSTRUCTIONORTHEPER� <br /> J FORMANCE OF WNSTRUCTION.THAT I AM AU7HORIZC-D BY THE OWNER OF <br /> �TGIJ G_��I- 1�7� F2P�YL�L"`�13 �el,�(�''�� � THISPROPERNTOPERFORMTHEWORKFORWHICHAPPLICATIONISMADE <br /> ANO 1 COMPLY WITH TNE S7ATE CONTRACTOFS LAW 1827 FCW AND <br /> \ 1 296200 W.4C. <br /> (/��f Is�(�/� n'� r� �S �JC�r �I��___ SIG��AIUPEOFCONiMCLORORAUT110R12E0RGENi DAiE <br /> 1 <br /> � l � vds o�' x � , <br /> Ilo�uvnc �r� I s � � li..l ��� Y��1.c -"!- .�`� -4�(— <br /> PROJEGTADORE55 SI 1- �J� IT$('� pppLICANiSC1iYEU51NE55 C¢NSENOANOOUStHESSNAME <br /> 7 �o�;t�o (.Ji2 er ��d e R' .— <br /> PLUMtlING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. 7YPE OF EOUIPMENT FEE <br /> WATERCLOSET�TOILET) _�� __ A/C—A/HN�LGUIJITS—H.P. <br /> � BATHTUB ___� FORCE�:11R SYSTEM;—6T.U. M EA ___ <br /> �. LAVATORVIWASHBASIN� � UNITHEATERS—BT.U. M <br /> SHOWER _� CLO7HESDRYERS � <br /> � KITCHENSINMdDISP. VENTILATIONFAN � <br /> I DISHWASHER _�_ RANGE HOOD <br /> LAUNDRVTR41' �r._ _I_ ��ATERHEATER _ <br /> —� WOOD S70VE � <br /> CLOTHES WASHER _,� __� <br /> URINAL METAL FIREPLACE 8 CHIMNEY _ <br /> DRINKING FOUNTAIN FIREPLACEINSERT <br /> FWOR DRAIN NEAT PUMP <br /> BACKFLOW PREV[NTERS _ GAS PIPIIJG _._ <br /> �;OOF DRAINS—PAINLEADERS EXHAUST FAN <br /> Sii IK�SERVICE—BAR,ETC.) <br /> _ — I <br /> — I� <br /> SUBTOTAL S _� SUBTOTAL S __ ,I <br /> PENMIT S _ PERMIT 5 �, <br /> TOTAL FEE 5 TOTA�FEE 5 <br /> (RONTSEI6ACR PERRSETBACH SIOESELBACN V4NCH//qCKNU.'.!)?LN , FEE /� NECEIPfNO/. � �\ <br /> _J�C__ � � � � � l� /'.J`��/.��-��"✓� ,��L �� f1 /� �l-�� L/ <br /> USEZONE� � LOTAflBT vnr,nNrsrte FEES VALUATION PEE <br /> 6.YE5 CI NO /' /y� <br /> � / BUILDING .sco,�7�{ ��U �LL <br /> TYPEOFC ':9i OCCUPRNGYGROUP NOOFD\YEL4NGUNILS __— (' <br /> p�wwaBLE/ACiunl � p�UMBING JQ <br /> -N 2-3 -- — <br /> sizeoro�oo NOAFSTORIES asmr. occwso MECHANICAL 5 <br /> / 38`� � ..,N — <br /> �iEicH��priorv OTHER •q3�_ <br /> nne scaiNK�eesAeown[o ❑ves `c{No _ SiATE BUILDING SURCNARGE �� . <br /> STATGEN(AGYSWlCMARGE ____,�C �D � <br /> APPLIG4TIONACGBY PUNSAPG0.8Y PUOLICWORKS �J <br /> /._ <br /> `,;'.,��_I� � L.,`I TOTAI. I <br /> � <br /> � <br />