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� APPLICATIGA FOR CONSTRUCT�N PERMIT ; <br /> everett <br /> tlm fvergreen � <br /> CITV OF <br /> ��� eve rett � <br /> BUILDING DEPARTMENT TO BE COMPLETED IN INK—PLEASE PRINT <br /> 259-8810 <br /> ; y� � n DEMOLITION COMBINATION x BUILDING MECHANICAL PLUMBING SIGN 'I <br /> ti 0 ER MAILRDDRESS CITY ZIP PHONE <br /> y �� i��ll �d� cPrk) 19ias Nu�tl,c�t..k r�., .;.,:� rw ��l�ll v8o�� Nk3 -yc3l� _ <br /> K n TENANT n M�FIL�AO�ORE—SS CITY ZIP PHONE <br /> Q'�.� �NnWI�S 1`22r1' ��F�,.i,n ���'�IhfY 5� �.t�,�- � r✓C%C� �1�3�7�� ' <br /> .ti y� RRCHItEGTOR0E51GNEfl M L S CRV ZIP PHONE <br /> r7 x 5w��so.,: 1�s. ,v 3rn 5. ��e,r� �.�os C! Gi'o.v C/�- 9.�na o L•!�( S7%-�N�S'3 <br /> � GENERALCONTFACTOR�,Mg;knMAILP00RESS LIT ZIP PHONE UCENSEa i <br /> -�i�� ��'� C,^�1����,relo e.,f �2`bo�l ll��in'�� Sc �x(�✓-r `l52oc lc�f/-o�9� osPRrr-DLl52Mbt/ <br /> MECH�CA CONTRACTO MAILA��RE55 CITV 21P PHONE IICENSEe <br /> L�� (9 <br /> �y� PLUMBINGCONTflAGTOR MAILADDRESS CITY ZIP PHONE LICENSEI — <br /> �y CLFSSCFWOPK <br /> Sy7yH �NEW C' ADDITION i�! ALTERATION � �. HEPAIF �.�.! DEMOUTION �..� WOODSTOVBFRPLINSERT i.l BUILDINGRELOCATION <br /> "�y TENANTIMPROVEIAENTOPINTERIORRE�d00ELONLY CONTACTPERSONANDPHONENO. <br /> � � / ` � <br /> CONTRACTPRICEOFWORK: �U <br /> y DESGRIBE WOFKANO SOUA\FE FOOTFGE V(�OLVED <br /> H�C/J �`�j��5� �NSIS� ,�/OWtN: i I�17/i �7.(�ot7 �N tK`S��'v� <br /> PROPOSEDUSEOFBUILOING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS � <br /> S+r` � ,,��C2 APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL ' <br /> - � LEGALDESCRIPIONOFPPOPEFTYISNOWNUELOWORRTiACHFOURGOPiES) PROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTYPEOF <br /> WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> �or o�ocK oc NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE � <br /> �.,�p : ,� AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANV <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTIG:J OR THE <br /> �t ` .. � PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY TF:'� <br /> OVJNER OF THIS PROPEFTY TO PERFORM THE WOFK FOR WHICF <br /> ;iy -�. .. APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> 5 . ,,,. . CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br /> SIGNA EUG4 RACTORORRUiHORIjED ENT DATE <br /> X ����n� 3/���� <br /> ly /}rT S1N� un. USn'Y� �Je�o�rie�,� I�✓(� <br /> PROE T D RESS S `c`�.�,�v� !J.�.� ..L . t �� I '. <br /> (. APPUCANTSGITYBt15ME55LIGEN5EN0.hND905ME NAME <br /> .� iv�� s� �,.i.t N <br /> � 1 PLUMBING MECHANICAL <br /> N0. TYPE OF FI%TllRE OR ITEM FEE N0. TYPE OF EOUIPMENT FEE <br />. '�� WATER CLOSET(TOILET) A/C�A/HNDLG UNITS—H.P. <br /> � BATHTUB ; FORCED AIR SYS'fEMS—B.T.U. M E.A. ' <br /> ' 1 � LAVATORY(WASH BASIN) � UNIT HEATERS—B.T.U. M � <br /> 1 ' SHOY:ER � f,LOTHES DFYERS <br /> � KITCHEN SINK.6-'DIS� VENTILATION FAN <br /> � DISHWASHEF iiANOEH00D u�`� Iic���( � <br /> LAUNDRVTRAV � WATERHEATER <br /> ' CLOTHES WASHER � WOODSTOVE � <br />� URINAL METAL FIREPLACE 8 CHIMNEY � <br />�, �1 DRINKING FOUNTAiN FIREPLACE INSERT .. . . _. . �':������Pk?�: <br /> FLOOR DRAIN HEAT PUMP <br />' ' BACKFLOW PREVENTERS � GAS PIPING I <br />� ROOF DRAINS—RAINLEAOERS EXHAUST FAN <br /> �' SINK(SERVICE—BAR,ETC.) � <br />' 1_ � <br /> i � <br />' � — <br /> I �j SUB TOTAL 5 SUB TOTAL 5 <br /> � PERMIT S PEAMIT 5 <br />� _____ TOTAL FEE 5 iOTAL FEE 5 <br /> FRONTSETDACK REAfl5ET8ACN SIDESETBACK PIANCMECKNOM1I9ER FEE �� �,� RECEIPTNO.O <br /> r <br /> Ex�sr �� - R " 3 <br /> �use"ioNe �otnaen VAC/NTSRE _FEES VALUATION FEE <br />� {1�Z M . �� YES � BUIL0ING ' (� y 'S <br /> I IXNPiYCY i10 IOW[IlING11Ni15 <br /> IYPEOfCONSiAILOWABIE TYPEOiC�'SLFCiUAt ' � <br />, _ V � p�''P PLUMBWG <br /> y� <br /> SIZEOFXB6�SP/�G NOAF�tORIES BASEMENT MECHANICAL ' <br />' �'L�jZ S� . ' YES NO <br /> OCCUPANCVLOAO FIflESPRNKLERSR[O� MEtGHTUMIiAT10N O7HER <br /> II � ves �(No �X�.S7G ;5 <br /> STATE BUILDING SUFCHARGE <br /> fiEA50N FOR SPRINNLERS <br /> i STATEENEflGVSURCHARGE <br />' APPLICRTIONACC.BY PLANSFPPROU DBV CITYOFEVEREIT PUBLICWORK$ � <br />� � /'� LOCAL SALES T— <br /> �1 TAX CODE IS 3105 TOTAL G _ <br />