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� I <br /> i <br /> ' APPLIC�f10N FOR CONSTRI�TION <br /> PERMIT <br />�� � fhe EverDreen Cvcretl <br /> CITY OF <br /> everett e <br /> BUILDING DEPARTMENT <br /> 259-8810 TO BE COMPLETED IN INK— PLEASE PRINT <br /> OWNER ��ARR�ORE55 CIIY ZIP PIIONE � <br /> /�ye�F�c ffu�3.�` CAsn�s /y,zo N[c� Gn-h+un /�c1�1J�,71_F-�,5�a�r�4�cvA�d'o���33:2-9�0.� <br /> TEN�NT MAllA0�RE55 CItY ZIP PMO E <br /> � ARGNRECiORDESIGNER MAILpp�BE55 CiiY ZIP i'I�ONE <br />� " OENEMLCONTFRCtOR MAiLqODRE55 CIiY ZIP PHONE UCENSE• <br /> il <br /> C. � � MECNRNIC�LCONiRPC10R MAi�qODRESS GItY 21P PIIONE 4CENSE• I <br /> f'" � <br />�" /�FC ffec.riiuo 3 9U l-S/+�irx�U e EUERETt 93.�U J��-O/yy /aFCHE/.�P/�P41, <br />�' � j :; PLUMBINOCONTR�CiOR � MMLAOOBE55 CrtY 21P PI+ONE LICENSE• <br />� I <br />� � CUSSOFWOpN i� <br /> r� ' ❑ NEW ❑ ADOITION ❑ ALTE9ATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPLINSERT ❑ DUILDINGPELOCAiION � <br /> ' ' — <br />� TENANTIMPqOVEMENiORINTEPiOBLEMOUELONLv GONMCiPER50N�NI1P110N[NO <br />� <br />�, <br /> ' CONTRACiGRICEOFWOPK <br /> DESCN�BE WOPN ANO SOU�RE FOOT/.GC':NO W EO . <br /> �s�cT LGaTin,J OF FURNRGE � l-fIJH <br /> PNOPOSEO U9E OF BUILDING I H EREBY CERTIFY THAT I HqVE READ AND E%AMI NED THIS APPLICATION AND <br /> ' .�In�e_F2"i�+. LV RPSJrIpnC f KNOWTHESAMETOBETRUEANDCORRECT.ALLPROVISIONSOFLAWSAND , <br /> LE��LD RIPTIONOFPROPERiYSNOWNBEIOWORNlAG11FOlINGOPIES� ORDINANCESGOVERNINGTHISTVPEOFWORKWILLBECOMPLETEDWITH <br /> W HETHER SPECIFI ED HEREIN OR NOT.THE GRANTING OFA PERMIT DOES NOT <br />� PRESUME TO GIVE AUTHORIIY TO VIOLATE OR Cl+NCEL THE PROVISIONS OF <br />�f- � �' �Or o�oCK ov qNYOTHERSTATEORLOCALLAWREGULATINGCONSTRUCTIONORTHEPER- ' <br /> t' � � FORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE OWNER OF � <br /> G I ' THISPROPERTYTOPERFORMTHEWORKFORWHICHAPP'ICATIONISMADE I <br /> AN� I COMPLY WITH THE STATE CONTRACTORS LAW 1827 RCW AND � <br />'i �'� 296.200 WAC. <br /> SIGNPTU�EOFCONIlI�C10qONAUiHORIZEDAGENf OAtE <br /> f <br /> IF i�, FNOJECiA�ORE55 ������,�/��y��� -�"-+�- <br /> � ' APPI�CIlYDU51NE5S1�ENOPNOBU3V NAME <br /> �.� - T� ue <br /> � PLUMBIN6 MECHANICAL <br /> � ! NO. TYPE OF FI%TUHE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOI LEl) A/C—A/HIJDLG UNITS—H.P. <br /> BATHTUB _� FORCED AIR SVSTEMS—B.T.U. M EA , <br /> LAVATORYIWASHBASIN) UNITHEATERS—B.T.U. M <br /> SHOWER CLOiHES Df7YERS �. <br /> ' KITCHEN SINK 8 DISP. VENTILATION FAN <br /> DISHWASHER RANGEHOOD '' <br /> � LAUNDRYTRAY � WATEFHEATER _ '. <br /> CIOTHES WASHER WOOD S70VE <br /> . URINAL METALFIHEPLACESCHIMNSY �. <br /> . �RINKING FOUNTAIN FIREPLACE INSER` � <br /> FLOOfl DRAIN HEAT PUMP � <br /> BACKFLOWPREVENTERS GASPIPING __ <br /> ROOF DRAINS—RAINLEADERS EXHAUST FAN <br /> , SINK(SERVICE—BAR,ETC.) _ <br /> � SUBTOTAL 5 SUBTOTAL S <br /> PERfAIT 5 PERMIT S <br /> TOTAL FEE S TO1AL FEE 5 <br /> • FqONT5EIB�CY, REFRSEiDACK SIpESE1Br1CR PUNCNECKNUMOEN FEE RECEIPTNO. <br /> � USE20NE LOIMEA VACRNiSIIE FEES VALUA710N FEE <br /> ❑Y[S ❑ NO <br /> - _ BUILDING <br /> ttPEOFCONST. OCGUPRNCYGROIIP NO.OFOWELUNOUNIIS <br /> �LLOWpBLE/.1CtUAL <br /> PLUMBING <br /> ' sizeoFe�oo. rvo.orsromes esMr. occiono <br /> ' ❑ Y MECHANICAL <br /> „' nN <br /> � uEmirtunnurior+ OTHER <br /> ' FIPE SPfiINN�EfiS REOUIliED ❑ YES O NO STATE BUILDING SURCHARGE <br /> ' STATE ENERGY SURCHAP.GE <br /> � �PPLILFiION ALG BY PLANSAAPR.pV <br /> , PUBLIC WORKS � <br /> TOTAL <br /> .�"ti.J;^.lY�'f'!i}�':I'. . ,. . , . . . . . . . . . . . <br />