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APPLIC�xTIOt�I FOR COI11S'L'Rv�T10N <br /> PERMIT <br /> Ihe Evergroon <br /> CITY OF evciett <br /> �everett � <br /> BUILDING DEPARTMENT <br /> 259•8810 TO BE COMPLETED IN INK-- PLEASE PRINT <br /> OVBIER MAILADDRE55 CILY LP PIIOrvE I <br /> GC�r�i /�ir�e2rcA Ca/1� �j 6�nA�e �3s33 .3'cr�mc yBjz/ (2'a6��5�/-563Z <br /> TEt1ANt MAILAOORE55 CIIY ZIP PHONE <br /> ARCHItECTORDE514NER MAILADORE55 CIIY ZIP P��ONE ' <br /> �I�s>vxi�.o.e//,s���c ��rc.�/irEe:s 38S"S _ Z6'�.rdc u/csr -S'e.�rT�4 q8F79 CZ.X� � z�Z-S�3/U 'i <br /> C[NERALWNTPACLOR n1AtLAD�flE55 CITY ZIP PMONE LiCEN5Ey�3Z�D <br /> �Cr-r�i �''�>c-x:crr C�cH.'P �ma/ G�sq�� da333 ��rnc� �izi (Zo6��/�//-SG3Zt/�ac <br /> MECIIANIGILCONiRRCTOR MAI�AODRE55 QfV 21P PHONE LIGENSE� <br /> PLUM6IN(1C04iRAGTOR M�IUDORESS CIIY ZIP PIIONE LiCENSEs I <br /> � <br /> C�LA,/SSpF WORN <br /> Id NEW ❑ ADOITION ❑ ALTERAiION ❑ REPAIR ❑ DEMOLIiION ❑ WOOUSTOVE/FRPL INSERT ❑ BUILOING RELOCATION �' <br /> TEN�NTIMFPOVEMENTOR^iTEPIORREMO�ELONLY �e�1 J^ GONiACiPER50NnNOP110NEN0 � �. <br /> a �T <br /> CONTRRCiFRICEOFWORK j(-(�, �' �_ , /p�� � C I.. _�_ I /�� _.C��.� 7 � <br /> DESGPIBEWOBKAN�SOUAREFOOtAGEINVOLVEO '7"` -'°�'~�'3�«��6'�v 7 -F <br /> MG�zU �O.f/J7/ZcfC'.r/D('J <br /> PROP09E0 USE OF 9UIl01NG — <br /> I HEREBY CE(771FY THAT I HAVE READ AN D EXAMINED 7HI5 APPLICA710N AND <br /> S/NLCo� �F�'T'��Ly KNOWTHESAMETO�ETRUEANCCORRECTALLPROVISIONSOFLAWSAND <br /> LEGRL OESW IPIION OF PROPERTY�SHOW N BELOW L R ATTACH FOUR COPIE51 ORDI NANCES GOV ERNING i HIS TVPE OF WOF K W I�L BE COMPLETED W ITH <br /> W HETHER SPECI FIED HERcIN OR NOT.TI{E GRANTING OFA PERMIT DOES NO7 <br /> �or 2 e�OCn or O�G�_ST A/'c.�� PR[SUME TO GNE AUTI�JFIIY 70 VIOLATE OR CANCEL 7HE PF70VISIONS OF <br /> ANY OTHEfi S7ATE OR LOCAL LAW REGULATING CONSTRUCTION OR TH E FER� <br /> FORMANCE OF CONS7RUCTION.iHAT I AM AUTHORIZED BY TF{E OWNER OF <br /> _AUD�lYON �rG �'7f6 t' �•J� f- �+� � TF+IS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE <br /> —� PND I C0�4PLY WITH fHE STATE CONTRACTORS LAW 1827 RCW AND <br /> � A -r� '/ 296200 WAC. <br /> </J(✓/s/07CJ•/' ~ �CZO12dG r /� ✓�G✓�S%L'� �C.� SIGNA:UREOfCONiPnCiG�iORAU1110PREDRGENI DRtE <br /> � i x , /��� �/,/� <br /> o�' 7cpiS f%aGr` AS �/�/// <br /> PROJECT���Rl55 �"� 1! <br /> � APP CrlIlI5CRV9U9NE59LICENSE O�NDBOSINESSNAME <br /> ,/�^ r`.�j /�!!iC/'ic� <br /> PLUM8ING MECHAIGICAL <br /> NO. TYPE OF FIXTURE OA ITEM FEE NO 7YPE OF E�UIPMENT FEE <br /> 3 WATERCIOSET(TOILEn j - A/C'-lVHNOLGUNITS-H.P. <br /> BATHTUB � FORCED AIR SYSTE1d5-B.T.U. M EA - <br /> LAVATORY�WASHBASIN) -' UNI7HEATERS-B7.U. M <br /> SHOWEF � �j ' / CLOTFIES DRYERS . _ �� <br /> KITCHEiV S!NK8 DISP. � =. � VENTILATION FAN _ �� <br /> DISH'.�-ASHER ''� — / RANGE HOOD r <br /> LAUNDRV fRFY Wql EFi HEATER (� <br /> / CLOTHES\VASHER ) — WOOD STOVE <br /> URINAL METAL FIREPLACE 8 CHIMNEY <br /> DRINKING FOUNTAIN / FIREPLACE INSERT <br /> FLOOR DRAIN HEAT PUMP <br /> BAGKFLOW PREVENTERS X GAS PIPING -- <br /> ROOF DRAINS-RAINLEADERS E%HAUST FAN <br /> SINK(SERVIC E-OAR,ETG) <br /> SUBTOTAL S � —� _ SUBTOTAL 5 � � (_�� <br /> PEFMIT 5 PERMIT S � <br /> TOTAL FEE 5 �7 �— � TOTAL FEE S � ) <br /> FROMSEtEiACH qEM5E16PGN SIpESEID/.CK PIANCNELNNOMflEO FEE PECEIPTNO. <br /> / <br /> Zo .� _ �q �. S �- �5�6' <br /> USE20NE �otn A VACRlt51iE FEES VALUATIpN FEE <br /> �7 � I G r �'fE5 ❑ NO <br /> � 'w'r'' � L'�UILDING �S4'�CP r�� <br /> ttPEOFCONST OCCUPpNCYGHCUP NO.OFOY/ELUN3UNp5 �_ <br /> 6LLOtlU7LfiACiW I i <br /> �-/,( �3 PLUMBING � � <br /> &2ECF6LDG. NO.OFSTOPIES BSMi. OGGLOAO � <br /> �7 y� ,� ❑ v �, MECHaNICAL � <br /> 9d+ I <br /> 0o HE�f.H11.IMi1RT10N OTHE rI � - p� <br /> 1 4 - x <br /> FItiE5FR14RLC�RE0U1RE0 ❑YES NO R' <br /> � — STATE B ILOING SURCHARGE l <br /> � <br /> STATEENERGYSURCHnqGE �� <br /> APPLtCAT10N�CG BY PUN9 RPPR.OV �;{ <br /> PUBLIC WORKS , -1� �� �. <br /> �� I , <br /> TOTAL r �O �. F�+ <br /> �: <br /> � <br /> �.. . . __., .. .. . . . . . . . . .. . . . . . ._ . _ _ . . <br />