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� . <br />�'�� APPLIC,�►r10N FOR CONSTRI,�TION <br />� PERMIT <br />� fhe Evergreen everett <br /> CITY OF � <br /> everett <br /> BUILDING DEPARTMENT <br /> 259-8810 TO BE COMPLETED IN INK— PLEAS�' PRINT <br />� OWNER AIAILAODBE55 CIiY ZIN {'NON[ <br /> M�rac. ���Tcf�� S��v�cEs ,� �� F�AUC—_�vE�� c��-���=�z��,�t. <br /> TENANT MAiL/� RE55 CIiY ZIP P��ON <br /> qFlCHItECTOFDE5IGNER MAILR�DRE55 UTY ZIP PNONE <br /> GENERAL .ONTflACTUR M1IAILApOflE55 CITY ZIP PHONE LICENSE• <br /> �1 �� CITY ZIP PHONE UCENSE• <br /> �CMANICALCONTAACTOA IAAILAD�PE55 <br /> PLUMBINGCONTPACTOR MAILAppRE55 GIiY ZIP PMONE UCENSE• <br /> CLnS50F WOPK <br /> NEW ❑ ADDITION ❑ ALTERATIOf7 ❑ REP.11R ❑ OEMOLITION ❑ WOODSTOVE/FRPL INSERT ❑ BUILDING RELOCATION <br /> tE NNTIMPROVEMENTOPINTERIORREMOOELONLY / CONiACiPER OM1ANDPHONENO. � � /� �� <br /> CON`PACTPRICEOFWORK �2 ����f `� � � "+i^� . -�� <br /> DESCFIBEWORNANDSOUAREFOOTA EW �VED <br /> �LL�?�G�ll� Vy����,�7�' �7 /1 � -- <br /> P�PO(P)S/E/DUSEOFBUILDING 0�, S'T (YU � � IHEREBYCERTIFYTHATIHAVEREADANDEXAMINEDTHISAPP�ICATIONAND <br /> p�J`J� SCS� �� GI�/ U �O /J�VD d7 //DI K, ��� KNOWTHESAMETOBETRUEANDGORRECT.ALLPROVISIONSOFLAWSAND <br /> LEGALDESCRIPTIONOFPROPERTVISNOWN�LOWOAATfACMFOUR ais� ORDINANCESGOVERNINGTHISNPEOFWORKWILLBECOMPLETEDWIiH <br /> W HETHER SPECIFIED H EREI N OR NOT.THE GRANTING OF A PERMIT OOES NOT <br /> PRESU ME TO GIV[AUTHORITY TO VIOLATE OR(;ANCEL THE PROVISIONS OF <br /> �or e�ocK oF ANYOTHERSTATEORLOCALLAWREGULqTINGCONSTRUCTIONORTHEPEFi� <br /> FORMANGE OF CONSTRUCTION.THAT I AM AUTHORIZED BV TNE OWNER OF <br /> � THIS PROPERTV TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE <br /> AND I COMPLY WITN THE STATE GONTRACTORS LAW 18.27 RCW AND <br /> 296200 WAC. <br /> SIGNFN EOFCONTflAGTO�iOHPUtNORIZE�AGENT OAiE <br /> X �'J���la�� `�-�"SI <br /> �ROJEGT AOOREuS APPLIGAMS CITY DU51 IE55 LICE'SE NO.FND BUS W ESS NAIAE <br /> ' 7 5 / �` <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OH ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILEn A/C-A/HNDLG UNITS-H.P. <br /> BATHTUB FORCED AIR SYSTEMS-&T.U. M EA <br /> LAVATORV(WASHBAuIN) UNITHEATERS-B.T.U. M � (�/(/ ' <br /> SHOWER CLOTHES�RYERS <br /> KITCHEN SINKB DISP. VENTILATION FAN <br /> DISHWASHER RANGE HOOD <br /> LAUNDRYTRAY WATER HEATER _ <br /> CLOTHES WASHER WOOD STOVE <br /> URINAL METAL FIREPLACE 8 CHIMNEY <br /> DRINKING FOUNTAIN FIREPLACEINSERT <br /> FLOOR DRAIN H[AT PUMP <br /> BACKFLOW PREVENTERS GAS PIPING <br /> ROOF DRAINS-RAINLEADERS E%HAUST FAN __. <br /> SINK(SERVICE-BAR,ETC.) <br /> _ � / _ <br /> SUBTOTAL S ' �� SUBTOTAL 5 <br /> PEFiM1T 5 PERMIT 5 _ <br /> TOTAL FEE 5 � TOTAL FEE 5 ' <br /> fPONi5Ef9/LK REARSETBACN SI�ESEfB4CR PlA C Ci(NUMBER FEE n /,�O pE�NO� <br /> � C� � � <br /> uSezaNe LOTAPEA �ACnrvt ir FEES VALUATION FEE <br /> �>��, ��E5 �o Io� D � 00 � Q'� <br /> BUILDING <br /> ttPIiOFCONST. .r�^ OCWPFNLYGFOUP NO.OFDWELLINGUNITS - <br /> FLLOWABIE/ACTUPL�/ `, � � / _� PLUMBIMG _ <br /> Y !r <br /> 52EOFBLDG NO.OFSTOPIES BSMT. OCC10�0 i <br /> `� �� / p!N � MECHANICAL _ <br /> — HEIGMTLIM1IITATION OTHER <br /> FIPESPRINNLERSflEOUIpED ❑ YES �0 STATEBUILDINGSURCHARGE � <br /> STATE ENERGY SURCHARGE <br /> APPLICFTWMAC BY PLPNSFPPR.BY PUBLICWORKS <br /> � /� TOTAL <br /> �7J�.� <br />