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APPLICAi ION FOR CONSTRIl..T10N <br />PERMIT <br />Ihe Everpreen everett <br />CITY OF <br />everett e <br />BUILDING DEPARTMENT <br />259-eAto TO BE COMPLETED IN INK — PLEASE PRINT <br />OWNER MAIL>OORE55 CITY ZiP �,2C �MONE <br />Ni1�uGY blU1LLLArvI �lo,VcuX �zas_sa"'��P.S.rv= E�✓�.eFrT �v� 3 jS3�6z%3 <br />iEN�NT MRIL��ORE55 CIfY 21P PIIONE <br />/�Qo«Sio,V DfSrsiV 2zu/ �cu.l�o-�_ �.�t`_�E.I.i—�1�+�8Zo''� 3�-y-3Zo("� <br />ARCNITECTOfl0E51GNER M�IL�DDRESS CIiY ZIP PHGNE <br />TNoxt. �►oNsr�eucr�o� -Z'f_�5=�£S1� <br />QENEfl�LLONTPACTOR M�ILA�ORESS CItY 21P PI�ONE LICENSE• <br />fi'Q0N ����Trc �No�ro��s� <br />MECH�NICALCONTPACTOR M�ILR��RE55 CIiY 21P YMONE IILENSE• <br />PLUMBIN6CONTRACTOH MAI�NOONE55 LITV ZIP �MONE IICENSE• <br />❑ NEW � AODITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVEJFRPL INSERT ❑ BLIILDING RELOCATION <br />CANTMCTPRICEOFWORK JT /7" <br />OESCRIBE WONN FNO SOUARE FOOTRGE I <br />� I6/� � <br />pqppp— $�OF ILDI <br />Su rU a20 O <br />LEAIIL DESCHIPTION OF VflOYERtt ISHOV <br />LOT BLOCN OF <br />1WLl�l I�VVnWa ' <br />Z3S S�'�`=' <br />PLUMBINO <br />MC. T'PE OF <br />WATER CLOSET (T( <br />BATHTUB <br />LAVATORVIWASHI <br />SHOWER <br />KITCHEN SINK 8 D <br />S. /,�I • <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />ROOF DRAINS— RAINLEADERS <br />SINK (SERVICE — BAR, ETC.) <br />SUBTOTAL <br />PERMIT <br />TOTALFEE <br />FFONTSET9ACK flEAqSETB�GK � <br />LS � " ` _ <br />C.J <br />�USEZ01 � LOTPREA <br />ttPE OF GOHST. OCC'IPANCY GflpUP <br />�ILOW�BLE A TU�L <br />SREOFB�C�-� NO.�pTORIE n N <br />I In <br />FIPE <br />❑ ves � <br />r I' <br />�$ <br />SIDESETBAC✓. ' <br />7, S <br />VPCANT SIiE <br />❑ VES ❑ NO <br />/V <br />I HEREBV CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND <br />KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS AND <br />ORDINANCES GOVERNING THIS TYPE OF WORK WILI BE COMPLETED WITH <br />WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OFA PERMIT DOES NOT <br />PRESUME TO GIVE AUTHORITV TO VIC-LATE Ofl CANCEL THE PFOVISIONS OF <br />ANY OTHER STA7E OR LOCAL LAW REGULATING CONSTRUCTION GR THE PER• <br />FORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE OWNER OF <br />�HIS PROPERTY TO PERFOPM THE WORK FOR WHICH APPLICATION IS MADE <br />AND I COMPLY WITH THE STATE GONTRACTORS LAW 1827 RCW AND <br />296.200 WAC. <br />SI�NqiUREOFCONIRPQOaORA�IMORiZEOAGENT DRTE <br />I 1 <br />APPII� GPNTSLiTYBO_-_�NOA �BUSiNE55NAME <br />MECHANICAL <br />NO. TYPEOFEOUIPMENT <br />A/C — A/HNDLG UNITS— H.P. <br />FOR�ED AIR SYSTEMS— B.T.U. M EA <br />11NITHEATERS—B.T.II M <br />RANG[HOOD <br />WATER HEATER <br />WOOD STOVE <br />METAL FIREPLACE 8 CHIMNEV <br />FIREPLACEINSERT <br />HEAT PUMP <br />GAS PIPING <br />E%HAUST FAN _ <br />SUBTO7AL S <br />PERMIT S <br />TOTAL FEE 5 <br />rti fp� C l� FE�. _� ��C•�_ PE i <br />. � (r- n <br />FEES VALUATION <br />BUILDING CJ+� �,� % SL IS <br />PLUMBING <br />MECHANICAL <br />OTHEfl �iQ�f -�'I(� �'• <br />STATE dU1LDING SUFCHARGE <br />SiPTE ENERGY SURCHARGE <br />PUBLIC WORKS <br />TOTAL <br />a <br />a <br />