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1 ' . �.1 <br /> APPLIC�f ION FOR CONS'TR��.TIOi�i <br /> �EF:31111T <br /> Ihe Everpreen everet[ <br /> , CITYOF <br /> everett e <br /> BUILDING D[PARTMENT <br /> 259-8810 TO BE COiiAPLETED IN INK— PLEASE. PRINT <br /> OWNER � ��AILADORESJ CIIY ZII' PHONE <br /> �a�c-i r�� �+�s C4s��s Cc.vs;. i¢Zo Nw C�,��--r.a.� %3tv4� Z��Z <br /> . TENANT • MAILADORE55 CiiV ZIP PMONE <br /> --- �JJ'.4c:�� GU/-t �id'U 2.� <br /> MCMITECTOROESIGNEP M4ILADOf�FSS CIIY 1�' PMONE <br /> OENERALCONiR�GTOR MAILADORESS CITY ZIP 'MONE LICENSE� <br /> CZ�-vue � l�.4G/�.�f�'. i6/ Kp <br /> � MECHPNiCr1LCONTRACTOR MAILADONE55 CIiY ZIP PMONE LICENSE• <br /> ' PLUM6INGCONTflRCTOF MAILADOR[55 G�tY 21P FUONE Llf,[NSE• � <br /> � <br /> �. ' CV.SSOVwORN ___— j <br /> � NEW ❑ A�DITION ❑ AUERAiION ❑ FiEPAIR ❑ �EMOLITICN ❑ WOODSTOVE/fRPL.IHSERT ❑ 6UIL�ING RELOCAiION _ <br /> . TEN�N7IMPROVEMENiOPINTERIORPEMOOELONLY CONIAC1PEn50NnrvDP��OHE�iO/// <br /> CONiPAGT PqICL OF WORIE ,��� � �� t�C�L����F_ �f�- %�C• r <br /> OESCRIBE WOHK RNO SOUAFE FOOTAGE� `/OLVED <br /> �.c� Co�vsr�cuc�-+u.-r /2oosc.� �r <br /> I .' PROP09ED119'OFBWl01N4 /� IHEREBYCER7IFVTHATIl�fAVEREADANDEXAMINEDTHISAPPUCATIONAND <br /> SINC��-� ��K��T !\fS - KNONTHESAMETOBE'.RUEANDCORRECT.ALLPROJISIONSOFLAWSAND <br /> LE(LILDESCPIPTIONUFPFOPERIY�SHOWNBELOW011q1U^.HFOURCOPIES� ORDINANCESGOVERNINGTHISTYPEOFWORKWILLBECOMPLETED'NITH <br /> WHETHERSPECIFIED HEREINOR NOT.THEGRANTINGOFAPERMITDOES NOT <br /> � �Or � e�oCe orC�XBENWLUO �3LU�� PRESUMETOGIVEAUTHORITYTOVIOLATEORCANCELTHEPROVISIONSOF <br /> ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR TH E PCR• <br /> . • FORMAN:E OF CONS7RUCTION.THAi I AM AUTHORIZED BY THE OWNER OF <br /> THIS PROPEfiTY TO PERFORM THE WONK FOR WHICH APPLICATION IS MADE <br /> � AND I COMPLY WITH THE STATE CONTRACTORS LAW 7827 RCW AN� <br />� 296200 WAC. <br /> �' SiGNAiUP[OFCOAHN A . IIIOPILF.OQGENT DALE /L/Z}/��' <br /> ' ^ \ / \ �r <br /> � ' V 0 <br /> PRpJrCT ADDRESS APPIIGANiS CI f Y BUSMESS IICENSE NO AND BUS W f5S NAME <br /> . �-1�3� `5�� ��/� � ��Ac. ,�:t�.� �' C-��Fr C�.rr <br /> � PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TURE OR ITEM FEE NO. TYPE OF EOUICMENT PEE _ <br /> WATEF CLOSET(TOILEn A/C—AlH NDIG UNITS—H.P. <br />. � BATHTUB FORCED AIR SYSTEMS—B.T.U. M EA <br />. LAVATORY(WASHBASIN) _�_ UNITHEATERS-6.T.U. M <br />. � SHOWER I CLOTNFS DRYERS _ <br /> � i � KITCHEN SINK 8 DISR __�_ VENTIL.ATION FAN <br />� DISHWASHER RANGE HOOD � <br /> —�—_— <br />, ! LAUNDRYTRAY _� WATERHEATE(i 'I <br /> ' CLOTHES WASHER WOOD STOVE <br /> ' URIIJAL _ _L h1ETAL FIFEPLACE 8 CHIMNEV I <br />� ' DRINKING FOUNTAIN FIREPLACEINSERT �I <br /> (.'1 FLOORDRF�IN HEA7PUMP <br /> BACKFLOW PREVENTERS GAS PIPING I. <br /> � —— <br /> , ROOF DRAINS—RAINLEADEfiS E%HAUST FAN � <br /> SIN K(SEFVICE—BAR,ETC.1 _ � <br /> � i <br /> 1 <br /> ' <br /> .' <br /> �1��� SUBTOTAL 5 _ _ _ SUBTOTAL 5 __ <br /> ! I PERMIT 5 PERMIT 5 <br /> TOTAL FEE S TOTaL FEE S <br /> � FPONTSETdAGK REAqSETBACK Si0E5E1flACK PIANCN NNUMOEfl FE f1ECEIPiNO. � <br /> � Z° 20 � f�l�� . � , <br /> USEiOru I IOTAREA �vync�,a�irsir FEES VALUATION _ FEE <br /> �! / O �SZ '�"'ES ❑ ND <br /> TYPEOFLONST. OCCUP� CYGROUP NOOiOWEIUNGUNliS BUILDING . _ SY �'`� p' � � <br /> ' "_ ______ _. -/-._L7__.�-- <br /> � AILowRPIE/ActUnL PLUM6ING L�� <br /> � N �• '3 -�-- ------ ------- - ---- —— -- — <br /> SREOF BLDO NO Of S10NE5 OSMI OCC LOAD �-Q� <br /> II�p Z�yN MECHANICAL ' . <br /> —____—___._ .___._.._—... __--__--_. �.152� <br /> , ii[imnuurtnnoN -- otHEn <br /> � IIqESPRINKIEFSREOUIq:O IJ YES r-rv0 <br /> __ — STATE BUILDING SURCFIARGE _ � �- <br /> ; STATEENERGYSURCFIARGE �� � <br /> APP4CAilONRCC.BY PLpNSAPPROY �� <br /> , PUBLIC WORKS <br /> . � �^-� TOTAL � <br />