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� � <br /> APPLICATION FOR CONSTRUCTION PERMIT <br /> Ihe Evergreen everett <br /> CITY OF � <br /> everett <br /> BUILDING DEPARTMENT <br /> 259-8810 TO BE COMPLETED IN INK—PLEASE PRINT <br /> I 1 DEMOUTION 1 I COMBINATION JQ BUILDING I I MECHANICAL I I PLUMBING C 1 SIGN <br /> OWNER M LpDORE55 CIIY 21P PIIONE <br /> IVFREtr PARKS �, �}Ec. p�PT �3eoz �vervroR� , FVIEK�Tf 9azol zs�- 0300 <br /> iENnNr IA�I��p�RESS cnv zm rnor+F. <br /> '1/��L <br /> MCIIRECTORDES�GNEfI M�ILd00R[55 �IIY 21P pIfONE �'�� <br /> �I1J�q�(,�OD /3EG0J(D 6// 5 NNII�/�Tf /1 VE E. 5��rr�t, 9 g)E2 3 Z S- 79�9 <br /> GENERAICONTMC100 MAII.�DDIlESS CIIY ZIP PIIONE UGENSEI ' <br /> ' 't <br /> o/f�No lo.�sTRulrre.Y. :rr�',. <br /> MEC11qNIG�LCONiPAQOR MNI�OD(iESS CItY 21P PIIOIlE LIGENSE� <br /> h r�r� M�i�. �r�r« �,r ��i e y :'-,,. <br /> rwMniNacomm�cron Mm�noon�ss cnr zm ruour Uf.CNSF.1 <br /> '�JT/3Tlf /rl�Lf�, l� // <br /> C1A550F WOPK <br /> .,:Y'T.,.-. <br /> �x NEW I l ADDITION I I ALTERATION I I REPAIR I I �EMOLITION I I WOOOSTOVE/FfiPL INSERT I I BUILDING RELC�CATION ��.�•l <br /> iCN�Ni IMPROVEh1ENi OR R1i[�R REMODEL ONLV COHI�Ct PCfI50N�NO PIIONE NV. �,, <br /> cor�TnncrPaiceorwonK: //D oA0 _ �• G�Gr ��(�l L�/l�i� - '2 j°) - C�j017 �' <br /> s rc :ro r i�• lllrZ j� � <br /> :� <br /> —F���e� • 320o s,F— <br /> �noroseouseoromion+c I HEREBY CcRTIFY THAT I HAVE READ AND E%AMINED THIS ��.��,;. <br /> , __ROwJ/(�/lr sHEG6 � sfiRAkL APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECL ALL '� '��� � <br /> � �ea��uescnirtroNorvnorenrr�srwwNoe�owonnnna�rouncori�si PROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTYPEOF -' �d' <br /> : WORK WILL BE COMPIETED WITH WHETHFR SPECIFIED HEREIN OR <br /> �or o�ocK oF NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AUTNORITV TO VIOLATE OR CANCEL TI1E PROVISIONS OF ANV J <br /> � W, ��L � s �[a J�, Z.'�)� /3 . r7�', u�n1� OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OH THE ,";�. <br /> . PERFORAIANCE OF CONSTRUCTION.THAT I AM AUiHORIZEO BY THE � <br /> OWNER O� TfilS PROPERiY TO PERFOfiM THE WOfiK FOR WHICH <br /> ' APPLICATION IS MADE AND I COMPLY WITH TNE STATE �. ���t�' <br /> CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. 'L;'!�� <br /> I sicnnrunEorcorannc�o onnunwnizeonceui onre � �-�� <br /> I',7� ���--�-`^K�..,C �.fJ,� . X ��i/ �li'�1 u� '///.'Z 2`)//J.�7 _ - <br /> � PROJ TAODRE55 w _,� —� <br /> � �OO MT��SG �p� `C� A�PLIG�Ni5C17V0USM[SSI.ICENSEHO.�NDDUSINESSN�ME - <br /> ± PLUMBING MECHANICAL <br /> � NO. TYPE OF FIXTURE OR ITEM PEE NO. TYFE OF E�UIPMENT FEE � <br /> ' WATER CLOSET(TOILET) _ i A/C—A/HNOLG UNITS—H.P. i ^;"1 <br /> BATHTUB ' FOHCEDAIf1SVS1[MS�-�J�.U. M E.A ��;�C� <br /> � LAVATORY(WASH BASM) —; UNIT HEATERS—O.T.U. M � � - . <br /> ".i <br /> SHOWER � CLOTHESDRYERS —�— <br /> KITCHEN SINK 8 DISP VENTILATION FAN ; y�' ,'' <br /> DISHWASHER � RANGE HOOD , ' +�� <br /> •..�. <br /> LAUNDRY TRAY ' WATER HEATER '� 'i <br /> CLOTHESWASHER —� WOODSTOVE � ' '~ <br /> URINAL � M[TAL FIREPLACE 8 CHIMNEY --�— - "'S <br /> DRINKING FOUNTAIN i FIREPLACE INS[fiT ' �tiv.`��. <br /> FLOOR DRAIN HEAT PUMP �— ,�•i,,. <br /> i <br /> y BACKFLOW PREVENTERS ; GAS PIPING ' <br /> —�— <br /> ROOF DRAINS—RAWLEADERS �— E%HAUST FAN � <br /> SINK(SERVICE—BAR,ETC.) ; � �,;� <br /> � � .,5; <br /> — _,— <br /> , � :. <br /> — — �— — �:`4�7 <br /> � <br /> A — � _ � <br /> —� —�-_ <br /> LL � ' �• <br /> ' �y SUB TOTAL $ ' SUB TOTAL $ ';�� <br /> -� PERMIT $ i— I'ERMIT $ i ':y� <br /> "i� T07AL�EE $ ' TOTAIF[E $ � {1 <br /> � ryFRON75ET04CN IlE�P5EIBACN SI�ESEIpr1GK P14NC11[CK UMOE11 �[[ R[CEIPiNO. '�,!'�� <br /> I <br /> � G� �c j� a� �! — :�`' <br /> USE]ONE '�- �oT nncn vncnm sne EES VALUATION FEE �"'�- <br /> VMD/�N LO�SL�f ; I VES X NO �'— �i <br /> �UILDING Gi �, Op0 1 ��` � <br /> tVPF Of C NS.�IlOWAOI[ 7YPE 01 LONSI.�CIU�I ��^�^cr un m mvlLLmr.mins —�-- ����.J�1 i�.; <br /> 2 PWMOING � '�� <br /> i <br /> SIZEOFBLDG. NO.OfSiORIEF 0�5[VENL —� <br /> MECI IANICAL i <br /> 3aoo s�,FT. oN� fJ YES �C No -- ; <br /> occurnncv�ono rmesrnNKiensneoo ueiciaurnirnrioN �T���� �'> IL�,:i � i•.L�6`� '1�1 )� `Y� <br /> � I 1 YES YJS.NO StATE�UILDING SUf1CHAHGE � <br /> nensa+ronsrnwHi[ns — ' _ - <br /> —T— <br /> S7AiEEN6RGV5URCHppG[ � <br /> nrrucnvor�nCc.Bv PLA SAPPROVEOBY CIiYOFEVERETT puoucwonKs � <br /> �`/✓�/ � TAX CODE SL3105 �ora� • ; ,L� '/, <br />