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�;���'.� <br /> APPLIC�:'i`ION FOR CONSTRIi:.T10N <br /> PERMIT <br /> \ <br /> fha Evergreen everett <br /> CITY OF � <br /> everett <br /> BUILDING DEPARTMENT <br /> zs9-eeto TO BE COMPLETED IN INK— PLEASE PRINT <br /> UWNER MMLAUOIIESS CIIY IIP 1'IWN[ <br /> �o�a�n D, 2F/b JCBL'7- 5�-�� nVe s e �ver�rt 9�za6 <br /> iE ANT MPILPDDRE55 CIiY ZIP PNONE <br /> AfICNIIEGTOR�[S�Gt1E11 MAll�00RES5 CI1Y ZIP PMONE <br /> GENERNLCONIRRCIOR MNL�DDf1E5G GIIY ZIP PIIONE UGENSE• <br /> 5izvepr,A� C�Nst' �uc po• gox Siv�EveK�rr Sb2o� asa-n3� StLII�CL/�/ MS <br /> t1ECNRNIC�LCONTIiAGTOR MAILADOPE55 CITY 21P PIIONE UCENSE• <br /> PLUMBINaGONTRALIOH MAILAUOPE55 GIIY ZIP PMONE UCENSE• <br /> CLnSS 0F WOPN <br /> NEW ❑ ADDITION ❑ AITERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL INSERT ❑ BUILDING RELOCATION <br /> IENRNIIMPROVEMENIORINIERIOF REMODELONLY CON1�CtPEP50NANDPNONE ND. <br /> CONiR�CTPt110EOFW01iK ���/� � • ��`�JG✓� ��� _���/ <br /> DESCPIBE WORN RND SOUROE fOOIRGE INVOLVED <br /> ���K � aoo 5�� r-r <br /> PPOPOSED USE OF BUILDING I HEREBY CERTIFY THAT I HAVE READ AND E%AMINED THIS APPLICATION AND <br /> ��� 7.� i KNOWTHESAMETCBETRUEANDCORRECT.ALLPROVISIONSOFLAWSAND <br /> �� ORDINANCES GOVEiiNING THIS NPE OF WORK WILL BE COMPLETED WITH <br /> LEGRLDESCRIPiIONUFPFOPENiY15110WNBELOWOflAllAC11FUURCGVIES� WHETHERSPECIFIEOHEREINORNOT.THEGRANTINGOFAPERMITDOESNOT <br /> � �.or_� mock or �F�C��EK__L7-CV__��__ PRESUMETOGIVEAUTHORITYTOV�OLATEORCANCELTHEPROVISIONSOF <br /> —� ANY Oil IER S7ATE Of7 LOCAL LAW REGULATING CONSTRUC710N OR THE PER- <br /> ,y FORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE OWNER OF <br /> p LGOiCplA16 �_ r��T / N��eCoF �L'CB2D (�QC • ?HISPROPERTYTOPEF?FORMTHEWORKFORWHICHAPPL�CAT�ON�SMADE <br /> ' rS AND I COMP�Y WITH THE STATE CONTRACTOF3 lAW 1827 RCW AH9 <br /> 29620 C. <br /> N� g L�� /� /9f� /9� 7 an�O SIGNA REO CONiflACTORO�R`tNORIZEDAGENi OATE <br /> (T V N <br /> 1�1 SIlOHO�t�fN CauNrv. �✓A a � '/5 � <br /> PPOJEC�eODPESS /�pp���qN S CRY BUSINE55 LIGENSE NO AND BUSW E55 NRME <br /> /D'�z7 -S�` Av�. S�E. E�lrve{-�- �/110� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTUf1E OH ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER ClOSET(TOILEn A/C—A/HNDLG UNI1S—H.P. <br /> BATHTUB FORCED AIR SYSTEMS—&T.U. M EA <br /> IAVATORY(WASH BASINI UNIT HEATEfiS—9T.U. M <br /> SHOWER CLOTHES D.7YERS <br /> KITCHEN SIhK 8 DISP. VENTILATION FAN <br /> DISHWASHEA RANGE HOOD <br /> LAUNDtiYTRAY WATER HEATER <br /> CLOTHES WASHER WOOD STOVE <br /> URINAL METAL FIREPlACEBCHIMNEY <br /> DRINKING FOUNTAIN FIREPLACEINSERT <br /> FLOORDRAIN HEATPUMP ` <br /> BACKFLOW PREVENTEI+S GAS PIPING _ <br /> ROOF DRAINS—RAINLEADERS E%HAUST FAN <br /> ' SINKISERVICE—BAR,ETC.) _ <br /> SUBTOTAL 3 SUBTOTAL S <br /> PERMI� S PERM:T S _ <br /> TOTAL FEE S TGTAL FEE S <br /> iRONLSETBACK RE�PSEtBRCtt ' SIDESEIBRCR � ' VUNC�CKNU BERI�� FEE-^ PEiE�NO. - ^ <br /> � � � �. �(XJ <br /> �� iJ`j cT� � <br /> uSEZON iornnEn vnCnNrsrte EES VALUATION FEE <br /> ��1 n ves ty+o <br /> � BUILDING ' C�� <br /> tYPEOFCONSi. OGGUPANGYGROUP NOAFOWELLINOUNI;S <br /> pLLOWpBIE/PCIUFL PLUMBING <br /> s- N Q- — <br /> SILEOFBLDG. NO.OFSI0NIE5 BSMi. OCGLDAD <br /> ' n ❑Y MECHANICAL , <br /> w' IIEIGNLLIMIIAiION OiHER I� <br /> FlqESPRINKlEP5RE0UIFE0 ❑ves kc�o STATEBUILDINGSURCHARCE <br /> STATE ENERGY SURCHARGE <br /> �PPL'GAiION/GCBY PLANSAPPR.BV . <br /> --� 1 PUBLIC WORKS <br /> �/lA� �(� TOTAL <br /> v� <br />