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APPLIC..f10N FOR CONSTRI.CTION <br /> PERMIT <br /> fhe Everpreen ����«�� <br /> CITY OF O <br /> everett <br /> BUILDINCa DEPARTMENT <br /> 259•8Bi0 TO BE COMPLETED IN INK— PLEASE PRINT <br /> OWNER MAILPODPE55 GtV 21P PNONE <br /> �'-,2v6 �, �4�K 2�2o vitz� r� �rFP� `�'�'/�! 2.�1�a�'a57 -- <br /> �H�� MAILPO�RE55 UiT 21P MONE <br /> ARGNrtEGT OR DESIGNER <br /> MAIL���PE55 CITv ZIP PMONE <br /> GENEPALGONipAGiOR <br /> MAILAD�RE55 C�TY ZIP PHONE LIGENS[• <br /> D� 1.IAIL ADDHE55 GITV ZIP PNONE LICENSE• <br /> MECMANILALGONTR�GTOR <br /> PLUMBIHG GONTnsLTOP <br /> M�IL AO�RE55 G�TY ZIP FNONE LICENS[� <br /> CLNSS OF WJRK �7�. <br /> ❑ NEW ❑ AODITION ❑ ALTERAiION t,q FEPAIR ❑ DEMOLITION ❑ \YOOOSTOVE/fRPLINSERT ❑ BUILDINGRELOCAiION <br /> TEN�NT IMPROVEMENi OR INTERIOP REMODEL ONLY CANTPQ P[PSON PN01 NONE NO <br /> CONiRAGTPRICEOFWORK IIQ�-/� �� � ��'XK — <br /> DESGRIBEWORK<NDSOUAAEFOOiRGEi•vvr�vs �C� I'� <br /> �r-QcY'�F �t�I.O �V� � � ` ---- <br /> PROPOSEO USE OF B�ROING I HEPEBY CERLr'!THAT I HAVE REA�AND E%AM W ED THIS APPLICATION AND <br /> ��I���� KNON:THE SA'n'E TO BE TRUE AND COF7RECT.ALL PROVISIONS OF LAWS AND <br /> OR�INANCES GOVERNING THIS TVPE OF WORK WIIL BE COMPLEIED WIiH <br /> 1EG0.0E5CRIPTIONOfC��JPENTYISHpWNBELOWORATTPGNFOURLOPIE51 WHETHERSPEGFIEDHEREINORNOT.THEGRANTINGOFAPERMITDOESNOT <br /> PRESUME TO GIVE AUTHORITV t0 VIOLATE OR CANCEL THE PROVISIONS OF <br /> �Or Block oF POAMANCE OF CONSTqUCTION THAT�I AMIINU HORIZEO BVIOTHEOOWNER OF <br /> ANIDPROOMP YTWP�I�T�NE STATE CONTRACTORSM qWL�BZT�OR�AND <br /> 296200 WAC. <br /> SiGNAiUA[O�CON1RnCi0n On hU1Y0R2E�AGEN1 041[ <br /> — � y��""— �� <br /> PROJEGT�OOR[55 AG LIL NtSQTYpU51NE55UC NSE40 nNOBUSIN65NAME <br /> a i � — <br /> PLUMBING MECXIINICAL <br /> NO. T'oE OF FI%TURE OR�TEM <br /> FEE NO. TYPEOFEOUIPMENT FEE <br /> WATER CLOSET(TOILEn A/C—A/HNDLG UNI75—H.P. <br /> BATHTUB FORCED AIR SYSTEMS—BT.U. M EA __ <br /> LAVA70RY(WASH BASINI UNIT HFATERS—B.T.U. M __ <br /> SHOWER CLOTHES DRVERS — <br /> KI7CHEN SINKB DISP. VEN7ILATION FAN <br /> DISHWASHER AANGE HOOD <br /> LAUNDRYTRAY <br /> WATER HEATER <br /> CLOTHES WASHER WOOD STOVE <br /> ME1AL FIREPLACE 8 CHIMNEV <br /> URINAL — — <br /> DRINKING FOUNTAIN FIREPLACEINSERT <br /> FLOOR DRAIN HEAT PUMP — <br /> BACKFLOW PREVENTER� GAS PIPING — <br /> ROOF DRAINS—RAINLEADERS _ E%HAUST FAN . — <br /> SINK(SERVICE—BAR,ETC.) <br /> SUBTOTAL S SUBTOTAL S _ <br /> � PERMIT $ P[RMIT g __ <br /> TOTAL FEE S TOTAL FEE g <br /> FFONT 5[T84CN REAR SEIBALK 510[SETBACN <br /> PLANCNECRNUMBEN FEE PECEIPTNO. <br /> usezoHe �ornae� V�GANTSIiE FEES VALUATION FEE <br /> C YES ❑ NO <br /> BUILDING <br /> T/�EOFCANST. OGWPAHCYGROl1P NOOFDR'ELIMGUNITS <br /> auOvuatErnctu�� PLUMBING <br /> saEoreioc. r+o.orsronits asMr. occ�o�o MECHANICAL <br /> cr — <br /> CN <br /> HEIGHTLIMITATION OTHER <br /> FIRE SPPINNLERSREOUIPED ❑YES ❑ �0 STATE BUILDING SURCHARGE _ <br /> S7ATE ENERGV SURCHARGE <br /> APRIUTIONPCC.BY PLRNSPPPRBV PU6LIC�YORKS <br /> TOTAL <br />