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� /^+. !"'1� <br /> � APPLIC.�TION FOR CONSTR��CTION <br /> ! PERMIT <br /> �' rne ererpreen <br /> GTYOF everelt <br /> � �verett e <br /> ' BUILDING DEPARTMENT <br /> I 259•8810 TO BE COMPLETED IN INK— PLEASE PRINT <br /> OWNER MRILPOORE55 GIiY 2iP PHONE <br /> "�,� Craba•,�e., Ceav 31oc '1�t� A�c. t�(G C--�'r 9Y7�os� 33i1- -Z'1 q � <br /> � TEN�NT MAILR�DRE55 CItY 21P PHONE . <br /> . �RCHITECTORDESIONEH � MNIL�DORE55 GIiY ZIP PNONE � <br /> �Z9- 3 �1- `EI <br /> �as�S��S <br /> � OENER�LCONT �C70R MnILROpRESS CIiY ZiP PHONE LICENSE� <br /> AI�Q�•,�ro•� Ctisd�ti �1-e�s 3lo c �lq� h�� KE Evr ��101' 33`f--z�9� <br /> MECM�NI,C�rLCONTRACTOR M�IL�ODItESS C��Y ZIP PIION[ LIGEN$�t n Z i <br /> M�Y�' IQLAERcrr� io <br /> PLUMBINOC NTBACTOR M�ILR:10RE55 CILV 21n PHONE UCEN9E• � <br /> . CL�1590F��� �'� <br /> � � NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLIiION ❑ WOODSTOVE/FRPL INSERT ❑ BUILDING RELOCATION <br /> N�NT IMPROVEMENT OR INTERIOR REMOUE�ONLY CONiFf,T PENSON RND PIIO1NE NC. <br /> � CONTRACT PRIGE OF WORk � � ��2 � "'� ��� �� �`�� • � � <br /> ' DE9CPIBEWORIt�N�30UAqEFOOTRGEINVO D <br /> Q��� �� _ <br /> �. VROP09EUU9EOFBUILDINO IHEREBVCERTIFYTHATIHAVEREADANDEXAMINEDTHISAP('LICATIONAND � <br /> : S � � KNOWTHESAMETOBETRUEANDCORRECT.AILPROVI510NSOFLAWSAND '� <br /> LEWLDESCNIPTION OF PROPERTYISNOWN BELOW ORATUCH FOURCOPIE51 ORDINANCES GOVERNING THIS NPE OF WORK WILL BE COMPLETED WITH �. <br /> � WHETH ER SPECIFIED HEREIN OR NOT.THE GRANTING OF A PERMIT DOES NOT <br /> , PRESUME TO G�VE AUTHORI7V TO VIOLATE OR CANCEL THE PROVISIONS OF 'I <br /> Lor a�oGK_ or AN1'OTHERSTATEORLOCALLAWREGULATINGCONSTRUCTIONORTHEPER� <br /> FORMANCE OF CONSTRUCTICN.THAT 1 AM AUTHORIZED BYTHE OWNER OF i <br /> . ^ TIIISPROPE 7YTOPERFORMTHEWORKPORWHICHAPPLICATIONISMADE ��. <br /> � T���� AND I CO Y WITH 7HE S1A7E CONTRACTORS LAW 1827 RCW AND � <br /> � 296.200 WA � <br /> — SIC+NRTUAEOf NtRAC10RORAU1110RREDAGENi 1 �AiE . <br /> 1 <br /> 3G- z9 -o�j — 3—b53 -ooct X _ i��� <br /> PROJECTA�ORESS qPPLICA ISGIiYB SiNESSLICEN5EN0. NDBUSINESSNA E <br /> . PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> • WATERCLOSET(TOILEn A/C–A/HNDLGUNITS–H.P. _ <br /> BATHTUB FORCED AIR SVSTEMS–B.T.U. M E0. <br /> . LAVATURYIWAStIBASIN) '� UNITHEATERS–B.T.U. M <br /> � SHOWER � CLOTHES DRYERS <br /> KITCHEN SINKS DISP. — VENTILAT�ON FAN '. <br /> DISHWASHER � RANGE HOOD �. <br /> �� LAUNORVTRAY WATERHEATER � <br /> � CLOTHES WASHER — WOOD STOVE <br /> URINAL METAL FIREPLACc 8 CHIMNEV <br /> DRINKINO FOUNTAIN FIREPLACE INSERT <br /> FLOOR DRAIN HEAT PUMP � <br /> ! BACKPLOW PREVENTERS C�AS PIPING <br /> ROOF DFiAINS–RAINLEADERS EXHAUST FAN <br /> ' SINK(SERVICE–BAR,ETC.) <br /> SUBTOTAL S SUBTOTAL 8 <br /> ' PERMIT S PERMIT S <br /> TOTAL FEE S TOTAL FEE 3 <br /> FNONTSET&1CN REPRSETBRCK SIDE' 3ACR �_ PUNCHE���O� FE _ "� �C NECEIPTN_ O._ _ � <br /> � j�lv UJ rY��/ <br /> '7/1 � 3p '� o l.–CD <br /> lilJ <br /> USEzoNe LOTARFA Vr1CANTSItE FEES VAlUAT10N FEE <br /> � I`�/�,� '�pES f] ND <br /> "' G•� �Y' BUILDING _�/..'�l <br /> TYPEOFCANST. OCCUPANCYGROUP NOOFDWELLINGUNITS <br /> ALLOWABLE/ACTUAL I P�UMBING <br /> �-3 <br /> BIZEOF6LD0. NO.OFSTORIES BSMT. OCGlOAD <br /> /Q ` I ❑r _ MECHANICAL _ <br /> N <br /> 3y9 HEIGHiLIMITRTION OTHER — <br /> �f�i <br /> FIRE9PpINKlER5RE0U:qED ❑YES �CYlO "'�/ STATE B ILDING SUFiCHARGE <br /> . STATEENERGYSURCHARGE <br /> APPLICATIONAGGBY PLRNSAPGR.BY � <br /> PUBLIC WORKS <br /> ��� TOTAL <br /> �G�J s <br /> � ..�:�gz•. :.;,,. . ...... . � . ., . . .. .. . _, ..�. � :::, . � - . . <br />