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APPLICI�►��'ION FOR AONSTR4'�:TIOK <br /> PERMIT <br /> Ihe Evergrean everett <br /> CIIY OF � <br /> everett <br /> BUILDING DEPARTMENT <br /> 259-8810 TO BE COMPLETED IN INK—PLEASE PRINT <br /> UWNER hl/�IlP0U0ES5 GIIY IIP PHONE <br /> 7Jc�l 2F�n �a$�� -SF�' Ave. �".�• E✓4Yef� 9Bza8 3��-3ic8 <br /> tENpNT �_ADDFE55 GTY 2J PHONE <br /> ��9t�� <br /> FHGNItEGTOR0E51GNER MRIlAODPESS GItY ZIP PMONE <br /> ,��^�E. <br /> 1,�.. G[NERALCONTRACiOIi MAILp�DBESS � GIIY 21P PHONE UCENSE• <br /> ' ;���vF�eeAke Cm,�S;r.� i,Uc R�' Aa�( S�YS EUF-Ee�T 9BZow ,7s',�-r131 SFLVESZ/GiMS <br /> MECN�NICALCONiPRGTOfl MAILAOORE55 CIiY ZIP PNONE LIGENSE• <br /> �.�... �mFJ� <br /> - . PLUMBINaLOLNiP�L10F MRIL40�RESS CIIY 21P PHONE LICENSE� <br /> �C�V __ <br /> G1�55 0F M'OPN <br /> ❑ NEW ❑ ADDITION �(I ALTERATION ❑ REPAIR ❑ OEMOLI710N. ❑ WOOOSiOVE/FflPL INSERT ❑ BUILDING RELOCATION <br /> TENRNT IMPHOVEMENt OR INTERIOR FEMO�EI ONIY CONtAGt PERSON AND PIIONE NO. <br /> CONTP�CTPFICEOFWOPK �/yQQ Cu <br /> DESCRIBE WONN ANO SOUAf1E FOOUGE INVOLVEO <br /> �P�,C1 EXT� k/A�L �GlDD BA� [diN00�_ /(n '"� <br /> FPOFOSED USE OF BUILDING I HEREBY CEHTIFY THAT I HAVE FiEpD AND ExAMINED THIS APPIICATION AND <br /> �F 5/DE.i/GC, KdOW THE SAME TO BE TRUE AND CORRECT.ALl PROVISIONS OF LAWS AND <br /> lEORL DESGRIPIION UF PROPER7Y ISMOWN BELOW Oq piTRGN FOUR COPI[SI OFiDINANCES GOVERNING THIS iYPE OF WORK WILI BE COMPLETED WITH <br /> . I, WH ETHER SPECIFIED HEREIN OR NOT.THE GRAt�TiYG OFA PERMIT DOES NOT <br /> ior� e�ocK oF �LF�SG��G`� ��y� •� PRESUMETOGNEAUTHORINTOVIOLATEOFGANCELTHEPROVISIONSOF <br /> ANY OTHER STAiE OR LOCAL LAW REGULAiINCi CONSTRUCTION OR THE PER• <br /> FOfiMANCE OF CONSIRUCTION.T�IAT I AM AUTHORI2ED BV THE OWNER OF <br /> A-CLtJ,�DIN r(___T� l��o�' HF,.ee-o 2E�a�itn THISPROPERNTOPERFORMTHEWORKFOF�IVHICHAPPUCAT10NI5MA0E <br /> � AND I COMPLY WITH THE STATE CONTRACiORS LAW 1827 RCW AND <br /> `n� ,) 296.200 WAC. <br /> VOLL(ci'IE yG dF P�A7� / y�j� �9D� /�� SIGN�i OFCONiPRLTOROq�TNOR2EDAGENT DRTE <br /> = fl EJ/ li..l �IJOFIOtc�iSy COuflr i �v� /o�-c,L �..� a � �-89 <br /> PflOJECt�00NESS AP IC4 ISCILY^;;;,.NESS4GENSENO.�NDBUSWESSNAME <br /> /OSz:-- .S�`' Ave• 5• E.� Eve�Fr7 t��n yBznf� <br /> PLUMBING d�/� MECHANICAL ��,�.LG� <br /> NO. TYPEOF FIXTUHE OH ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILEn AIC—A/HNDLG UNIT,S—H.P. <br /> BATHTUB FORGEO AIR SYS(EMS—B.T.U. M EA <br /> LAVATORY�WASH BASIN; UNIT HEATERS—6T.U. M <br /> SHOWER _ CLOTHES DRYERS ___ <br /> KITCNEN SINKB DISP. VENTILATION FAN _ <br /> DISHWASHER RANGE HOOD <br /> LAUNURY TRAY WATER HEATER <br /> CLOTHES WASHER WOOD STOVE <br /> UFINAL METAL FIREPLACE 8 CHIMNEY <br /> DRINKING FOUNI�AIN FIFiEf�LACE INSERT <br /> FLOOR DRAIN HEAT PUMP � <br /> BACKFLOW PREVENTERS GAS PIPIPlG <br /> ROOF DRAINS—RAINLEADERS ExHAUST FAN <br /> SINK(SERVICE—BAR,ETQI <br /> SUBTOTAL 5 SUBTOTAL S <br /> PERMIT S PERMIT S <br /> TOTAI FEE $ TOTAL FEE 3 <br /> FRONfSETGCK REr1R5ETBRGN SIOESELBRCN PUNCNELKNUM9EP FEE AECEIVTNO. i <br /> u5ezun[ �oranea VRG4NiSIlE FEES VALUATION FEE ' <br /> ❑YES N f7b <br /> BWLDING � <br /> TIPEOFGONST. OCLUPANGYGROUP NO.OFpWELLINGUNITS <br /> RLI.OW�BLE/RCTW�L'I I PLUMBING <br /> –N Z-� <br /> �;ZEOFBL00. NO.OFSIOFiES BSMT. OCGLOA� <br /> p y MECHANICAL <br /> — NEIGHTLIMI7RIION OTFIER <br /> FIRESP(IINNL[RSREOUIpED ❑YES Ho — STATE BUILDING SURCHARGE <br /> STATE ENFHGV SURCHARGE <br /> RPPLICAIiONPCC.BY PLRNSNPPRBY <br /> PUBLII;WORKS ' <br /> �� TOTAL <br />