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APPLICATION FOR CONSTRUCTION <br /> PERMIT <br /> /he Everpreen <br /> qTV OF <br /> rvrrcll <br /> everett e <br /> BUILDING DEPAqTMENT <br /> 259•8810 TO BE COMPLETED IN INK- PLEASE PRINT <br /> ��EA MqILqDOFE55 btY ZI PNONE <br /> �# vIU10.1� I,lYlfkl►1S IL � I.��, 51�1?�'� Lr� r'1�_p' -s� � <br /> TENANL MAII p00RE55 CItY ZIP �H N <br /> �RGHRECTOFDESIGNER MAIL�DDRESS CI v ZIP VNONE <br /> GENER�LGONTRALiOF MAiLADDR[55 CRY ilP oHONE UCENS[• <br /> � ir " <br /> MEGNRNICFLCONTR��TON MAILAODPE55 piY ZIP PHON[ <br /> LICENSE� <br /> RUMBINGCONTR�CTOR MAIL�DDRE55 piY ZIP PYpNE LICE4SE• <br /> CL�SSOF WpqN <br /> ❑ NEW ❑ ADDITION ❑ A�TERATION ❑ REPAIR ❑ DEIdOLITION ❑ WOODSTOVE/FRPL INSERT ❑ dUL01NG RELOCATION <br /> TEN�NTIMPROVEMENlORINtER10R REMOpELONLV CONTACTPERSONRNOPNON[NO <br /> fANTR�CT PRiCE 0i WOHK ��� � <br /> DESCRiBE WORK�ND SOU�RE FOOinGE INVOLVED <br /> PROP�SEDIl5C0 B L iNG <br /> I HEREBV CER7IFV?HAT I HAVE READ AND EXAMINED THIS APPUI,qiION AND <br /> KNO W THE SAME TO BE Tr7UE AND CORRECT.ALL PROVISIONS OF LAWS AND <br /> IEG�L0E5CR noHorpaoaeArvrsHowr�eftowoA�rtecNvouaCovies ORDINANCESGOVERNINGTHIS7VPEOFWORKWILLBECOMPLE7EDWITH <br /> � W HETHFR SPECIFIED H EREIN OR NOT.THE GRANTING OFA PERMIT DOES NOT <br /> �or e�ocK oF � PRESUME TO GIVE AUTHORITV TO VIOLATE OR CANCEL THE PROVISIONS OF <br /> ANY OTHEF STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PER� <br /> FOFMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BV THE OWNER OF <br /> THIS PROPEiiN 70 PERFOqM 7HE WORK FOR WHICM APPLICA710N IS MADE <br /> AND I COMPLV WITH THE STATE CONTRACTORS LAW 1827 RCW AND <br /> 296,200 WAC. <br /> SIGNnTUREOFGONiRn�IOROPAp1HpRIZEDAGENi OAtE <br /> PROJEGTADDRE55 C- _r�JLP �A��� / ' � t 1'�� <br /> ��� '\ .� � la /.PPUG�Ni5C1iV8U51N SSLI�ENSENOA 0 USINESSN4ME <br /> � <br /> PLUMPING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF E�UIPMENT FEE <br /> WAT ER CLOSET(TOILEn A/C—NH NDLG UNITS—H.P. <br /> BNTHTUB FORCED Alq SVSTEMS—B.T.U. M EA <br /> LAVATORV�WASHBASIN) UNI7HEATERS—B.7U. M <br /> SHOWER CLO7HE5 DRVERS <br /> KITCHEN SINKB DISP. VENTILA710N FAN <br /> DISHWASHER RANGE NOOD <br /> LAUNDRVTRAY WqTER HEATER <br /> CLOTHES WASHER WOOD STOVE <br /> URINAL METAL FIREPLACE 8 CHIMNEV <br /> DRINKING FOUNTAIN FIREPLACEINSERT <br /> FLOOR DRAIN HEAT PUMP <br /> BACKFLOW PREVENTERS GAS PIPING <br /> ROOF ORAINS—RAI NLEADERS EXHAUST FAN <br /> SINK(SERVICE—BAR,ETC.) <br /> SUBTOTAL S SUBTOTAL 5 <br /> i`ERMIT 5 PERMIT 5 <br /> 707AL FEE S TOTAL FEE 5 <br /> FRONTSETBRGN REnRSETBPCN SIpEOETBACY. PLONCNE I(NUMBEN FEE pECEIPfNO. <br /> �6 �.f a71 � �-I°S � <br /> usczoNe LOi�RE� vnenHrsrte FEES rV,1LUATION FEE <br /> �YES V'fi0 <br /> � ��C, <br /> iYPEOFCONST OGCUPPNCYGROUP NO.OiDWELUNGUNITS BUILDING Ir`�(�� JZ �� <br /> �LLOW�BLF/ L . � <br /> � � � —� — PLUMBING <br /> S2f:OF ULOG. NOAF iORIES BSUT OGG LON� - <br /> / O}Z � _ MECHANICAL <br /> NE�GNTLIMiiqT10N OTHER <br /> riaesrainre�en5aeouwEo ❑YES �o — STA7E BUILDING SURCHARGE � <br /> STATE[NERGY SURCHARGE <br /> APPLICqTION ACC.BY PLANS PPPR 3Y <br /> ._,�� C� ` PUBLIC WORKS <br /> �~ � CAJ TOTAL �G G?/'� <br />