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. --.� <br />� � APPLIC�ION FOR CONST�R4�TION �' � <br />�- PERMIT j <br /> E�� �, fhe Everpreen �� <br /> everett i <br /> R' j° CITY OF � .. <br /> a everett <br /> , <br /> "��+'� BUILDING DEPARTMENT <br /> ';,� 259•8810 TO BE COMPLETED IN INK— PLEASE PRINT ' <br /> r „ 3"/Z i/6 � � <br />� ti� OWNER MNIAppAE55 C�IY ]ii' �9�ONE � <br /> I . T f � ��'�Z �J /�I41 �j/t..-. •q"�J /3[ V,O � 2?7Z �I <br /> �� P���� +1„ s ��fS �o��T <br /> TENANT , MRILADORE55 C�i! ZIP P�IONF ' <br /> � /J 1 Q-y� (J f�l--� W � / �U L � � <br /> ' �RCHIIECTORDESIGNER MAILFOORE55 CIIY 21P � P110NE I <br /> QENER/LCONiRRCiOR MAILADORESS CIfY ZIP PIIONE LICENSE� ��, <br /> [�w.�+ F ,C �i4'G/FHG' / , lG <br /> MECMANICALCONiRRCiOR MAILROOR[55 CIiY ZIP PHOHE LICENSE� <br /> PLUMBINQCONTRfCTOR MFRADORE55 CItV ZIP PIIONE UCENSE• I <br /> �:1 CLASSOPWOflK �_�--- �I <br /> ' ��NE PROV❑EMENT�ORINOtER10�EMOLDELRpry`ON ❑ REPAIR ❑ D'cMOLITION coN❑iAGi ERSD'O4RNC/PIwPE tiSERT ❑ BUILDINGRELOCAT!ON �' <br /> .`� [- /' p � <br /> CqNTRACTPRICEOFWONK �`' UOO.OU v �EC_ f/JCIJCE \SZ �'//GT _ , <br /> ,�'a DESCRIBEWORKANOSOURREFOOTAG WYOLVED � <br /> '�'-' �EW ConiSTe �c,iO.J '_" /S�C� SCL F�' I <br /> ii <br /> PROVOSEDUSEOF9UILDMa /� IHEREBVCEf'TIFY:NATIHAVEREADAkDE%AMINEDTNISAPPLICATIONAND �i <br /> S��VL� �y ,^ ,� � /Cp$ i`j_ KNOWTHESAME70BE7RUEANOCORRECT.ALLPRCVISIONSOFLAWSAND I <br /> � LEw�DESGaianoruoranoreatt�5��owN ee�Owor+nnnCn Foua covies: ORDINANCES GOVERNING THIS 7YPE OF WORK WILL 8E COMPLETED WITH <br /> I7 WHETHERSPECIFIED HEf7EIN OR NOT.THEGRANTING OFAPERMIT DOES NOT <br /> LO7� e�ocK ovGRE.zn� G(J�ZU C�LUr-7= PRESUMETQGIVEAUTHORI7YTOVIOLATEORCANCELTHEPROVISIONSOF <br /> , — ANVOTNERSTAiEORLOCALLAWi7EGULATINGCOIJSTRUGTIONORTHEPER� <br /> �ORMANCE O�CONSTRUCTION.THAT I AM AUTHORIZED BY THE OWNER OF <br /> i THIS PROPERTY TO PERFORM THE 1h'ORK FOR W WCH APPLICA'f10N IS MADE <br /> + AND I COMPLV WITH THE STATE CONTRACTORS LAW 1827 CW AND <br /> ' 296200 WAC. y <br /> '�'S SIGtlAiU(IEUFCONIfVAGIplIOPAUIHOPREUAGENi OAi[ �Z/Z��O� <br /> ' �J � <br /> PROJECTADOnE55 <br /> pFPLIGANIS GIt V OUSINt55 UGENS[NO.RND BUSINE55 NnME �^• <br /> f�4tir�c rs o �i�J'Zr! lO+�ii <br /> PLUMBING MECHANICAL <br /> � � NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET�TOILEl) — A/C–A/HNDLG UNITS–H.P. <br /> BATHTUB ____ � FORCED AIR SYSTEMS–B.T.U. M EA <br /> � � LPJATORYIWASH BASIN) UN!T HEATERS–B.i.U. M <br /> ����:i SHOWER �= _�_ CLOTHESDRYE[iS _ <br /> -� I KITCHENSINK801SP. _ � � _ � L� VENTILA710NFAN <br /> ��� I DISHWASHER _�"�_�_ RANGE HOOD <br /> LAUNDRYTRAY '__.__ _�_ W4TEtiHEATER <br /> CIOTHESWASHER � '� WOODSTOVE <br /> -'J --- - <br /> URINA� METAL FIPEPLACE 8 CHIMNEY � <br /> __" J_ - <br /> `�I DRINKINGFOUNTAIN FIREPLACEINSER7 <br /> ;'� FLOOR DRAIN , ___ HEAT PUMP _ <br /> :j BACKFLOW PREVENTERS _ GAS PIPING <br /> ROOF DRAINS-RAINLLF�OERS EXHAUST FAW <br /> _y SINK�SERVICE-BAR,ETGi _ _ _ _ _ <br /> � __. — <br /> ' — — ' <br /> •Ii — ' <br /> -- - _ <br /> ..i — _ _ '__-- <br /> SUB TOTAL fr SUB TOTAL 5 �1..�— <br /> �'t — __�-- --- — <br /> ������ PERMIT $ - PERMIT 5 <br /> , � TOTAL FEF S � � 70T�L FEE 5 <br /> FpONTSETNACR FEAR�E.OA�K SIOESEi6ACK PUNCIIE I(NUMUEII FEE PECEIP�NO. <br /> ; ..� =�n �. � '�ly �� — _. <br /> � USEZONE LOIANEA VACANf511E FEES VALUATION FEE � <br /> ',1 � �1 �O/'� yGY[5 ❑ NO ���t/� � <br /> "�� TYPEOFCONST. OCGUPANCYGROUP NOAFDWEILIN�UNIiS BUILDING �/ 11 J_ <br /> �ILOWABLE/ACTUAL / l.•N` <br /> '' �� �7_ 3 PLUMBING � ^ <br /> � SKEOFOLDO NO.Of510RiE5 BSMi. OCClOA� <br /> o-i �C.� J � ��� — MECNANICAL—'_——.— -- ___�� � <br /> I HEiG�IiLIMIIAtiON QTF{Ef7 <br /> �� FIRESPflINNLERSREnpiq�p ❑YES O -_- _-_ _ - � ' �1/\ <br /> � _—_ --._--- STATF BUILDING SURChIAf7GE �`� <br /> -+ STAIGENERGYSUI7CIIARGE_ _I � <br /> ' APPLICAiIONRCGBI PL4NSAPPRBV _ l <br /> � PUBLIC WORKS f <br /> –� TO7AL � <br />