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APPB.IG�i1'IOPI F�R COf�S'fE'3�'JGTION <br /> P�i�MIT <br /> fhe Evergreen ��i,�i,�� <br /> pTY OF <br /> everett � <br /> BUILDING DEPARTM NT <br /> 259• ig/' � � TO BE COMP ''T D IN INI — PLEASF�,PRINT <br /> hG� J ✓P.� ? <br /> ��"�i� 7� MAILA pR 55 U Y S � 1 f IONE <br /> TENANT M1IPLL�DORE55 GIY l.IP PNONE <br /> ARCHItEQORDESIGNER MRILA��BE55 Li1V ZIP iNONE <br /> G[!lERALCONiPACTOR MAILPOORE55 CIiV ZIP PHONE UCENSE� <br /> IdE�HnNIC/LCONiRAGiOB MAILAOOi1E55 QtY ZIV PHONE LIGENSE• <br /> PlUtA01NaCONTPACTOF MAIL'+O�RE55 CitY ZiP PnONE LIGENSE+' <br /> GL�.SS OF WOPR ,�, � <br /> ❑ NEW ❑ ADDITION ❑ ALTERATION ❑ (7EPAl{7 1ld�DEMOLITION ❑ WOODSTOVE/FRPIINSEliT ❑ BUIIDWGR[LOCATION <br /> TEN�NT IMPROVEMENT OR INi[RIOR REAIOOEL ONLY CONi�Lt VGRSON ANO P110N[NO. <br /> COHTRACTPRICEOfVIORK: — — <br /> DESCNIBE WORN ANO SOUAR[FWiAGE INVOWEO <br /> PROPOSED JSE OF BUILDINO I HEF EBY CERTIFY THAT I HAVE fiEAD AND E%AMIN ED THIS APPLICATION AND <br /> KNOVJ THE SAh1E TO B[TaUE AND CORRECT.ALL PROVISIONS OF LAW S AND <br /> IEGALDESGflIPiIONOFPpOPERtt�SHOWNpELO1YORATTRCNF uecovies� ORDINANCESGOVE�7NING7HISTYPEOFWOFKWILLBECOMPL[TEDNJI7H <br /> � � �� � l� WhIETNERSPECIFIEDHEREINORNOT.THEGRaNTINGOFAPERMITDOESNOT <br /> �� � PRESUIdETOGIVEAUTNOf7ITYTOVIOLATEOP.�:ANCELTHEPFOV1510N50P <br /> IOT�TBLOCN OF ��1� � ANYOTHERSTATEORLOCALLAWREGULATINGCONSTRUCTIONORTHEPER� <br /> fOFMANCE OF CONS�HUCTION.7HAT I AM AUTHORIZED BY THE OWNER OF <br /> THIS PROPER7Y TO PERFORM THE WORK FOR WHICH APPLICATION IS MAOE <br /> ANO I COMPLY WITH THE S1ATE CON�fRACTORS LAW 1827 fiCW AND <br /> 296.200 WAQ 60 <br /> S�GNAtI1RE CONiRnCIDfIOR NIIORIZEOAGENI OAiE �' �—,�^o � <br /> /� // �y�, �_��,���f X�,�� ���� <br /> PFOJECT AO�PE55 APp��CRY B CILY BU9NESS IICENSE NO AN�6USING55 NAME <br /> PLUM9ING MECHA�'ICAL <br /> NO. TYPE OF FIXTUF�OR ITEM FEE NO. IYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILEq NC—A/HNDLG UNITS—H.P. _ <br /> BATHTUB FORCED AIF SYSTEMS—B.T.U. M EA _ <br /> LAVATORY(WASHBASIN) UNITIIEATERS—B.T.U. M <br /> SHOWER CLOTHES DFYE�S _ <br /> KITCHEN SINK 8 DISP. -- VENTILATION FAN � <br /> DISHWASHER RANGE HOOD <br /> LAUNDRYTRAY WA7ER HEATER ___ <br /> CIOTHES WASHER WOOD STOVE <br /> URINAL METAL FIREPLACE 8 CHIMNEY _ ____ <br /> DRINKING FOUNTAIM FIF[PLACEINSERT <br /> F�OOR DRAIN HEAT PUMP _ <br /> BACKFLOW PREVENTERS GAS PIPING _. ° <br /> ROOFDFAINS—RAINLEADERS E%HAUSTFAN __ - <br /> � <br /> SI NK(5 ERVICE—BP q,ETC.) -- <br /> � <br /> SUBTOTAL S SU8T07AL 5 _ � <br /> ' PERMIT S PERMIT S _ <br /> TOTAL FEE 5 TOTAL FEE 5 r:+ <br /> I FRONTSEipACH REARSETBACN S�OESEtpAGN PIANCMELKNUM0E11 F[E PECEIPTNO. � <br /> b5[2oNe wtMEn V4CANiSIIE �EEg VALUATION FEE � <br /> ❑ YES ❑NO <br /> BUILDING �a <br /> T'PEOFWNSi, OCGUFANGYGBOUP NOOFOWELLINOUNiiS ---�-- ------- --- <br /> A�LOWABL[/AGTWL P�UMOING <br /> SIZE OF OL00. NO Of SiON[5 �SMi. OCG LOAO <br /> ��Y MECHANICAL <br /> u i� --___— — —�_ <br /> MEIG111 LIMItAt10N OTHER �� <br /> FIFESPRINKlER5RE0UIREP ❑YES ❑ NO STATEBUILOINGSUPCHARGE . <br /> STATE EN@flGY SURCHARGE _ _ � <br /> APPL'CFiiONACC.OY PLANSAPFF.OY — — — E <br /> PUBLIG WORKS � <br /> TOTAL �� <br />