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�-. .r <br /> APPLICATION FOR CONSTRUCTION <br /> PERMIT <br /> Ihe Everpreen <br /> CITY OF <br /> evereU <br /> everett e <br /> BUILDING DEPARTMENT <br /> 259•8810 TO BE COMPLETED IN INK— PLEASE PRINT <br /> OWNEfl MAILAODHE55 GIIY ZIP pH(INE <br /> ��Itc:� R�on/nIJ �`/c?b 1�NCh_�C-^ r�9_e_F.��il��o�01 .' ,3�/�/- <br /> TENANf 7�M�i�pODRE55 d1Y ZIP PHONE 0��� <br /> •BCNIiECtOP0E51GNEH Me1LA0DRE55 CiTy Zlp PNONE <br /> OENEH�LCONTPACTOR MqI�ODRE55 CIfY 2iP PHpNE - <br /> �ICENSE• <br /> MECM�NIC�ICONTRAGTOR MqLADDRE55 CItY 21P VHO�lE <br /> LICENSE• <br /> VLUM91N4CONTFA�tOR MML�OOiiE55 PHONE <br /> CIiY 21P IIfEN9E l� <br /> CQS Pl irnbina �(,�s��E� f�v� N4) S-lanc�, 9�29� h5,�-614�7 6sr�`^Sw-ras <br /> CLASSOFKVRK '. <br /> I� NEW ❑ AODITION ❑ ALTEFATION ❑ REPAIR ❑ OEMOLITION ❑ WOODS70VE/FRPL.INSER7 ❑ BUILOINOqELOCpTION <br /> TENANT IMPROVEMENi OF IHTERIGN HEMOOEL ONLV CONiAGi PENSON ANO PHONE NO <br /> fANT1UCT PRICE OF WORIh <br /> CE$LIryBEW�KANO50U�REFpp7�GEINVOIVFD � <br /> V� % <br /> W10 EO�Wc^ ...nui���nu — <br /> I HEFEBV CERTIFY THAT I HAVE READ AND EXAMINEU THIS APPLICAiION AND <br /> KNOW?HE SAME TO BE TRUE AND CORRECT.ALl pqOVl$IONS OF LAWS AND <br /> � o�� ESCNIVTIONOFPROPERIY�SNOWNBELOWOR�TIACHFOUHGOPIEury ORDINANCESGOVERNINGTNIS7YPEOFWORKWIt.LBECOMPLETEDWITH <br /> WHETHER SPECIFIED HEREIN OR NOL THE GRANTING OFq pERM1T DOES NOT I <br /> lor B�ocK pF PRESUMETOGIVEAUTHORITITOVIOLATEORCANCELTHEPROVISIONSOF <br /> ANY OTHER STATE OR LOCAL LAW REQULATING CONSTRUCTION OR THE PEfi� <br /> FORMANCE OF CONSTRUCT�ON.THAT I AM AUTHOpIZED BY THE OWNER OF <br /> THIS PROPERTYTO PERFORM THE WORK FOR WHICH APpLICATION IS MADE <br /> AND I COlAPLY WITH THE STATE CONTRACTORS LAW 1827 RCW AND <br /> 296.200 WAC. <br /> SIGNRtUREOFCONiqACiORORAUiNORIZEOAGENT D�TE <br /> x C.�� �l,.�a�-- �z a�-gq <br /> vaaecreooness <br /> �^1 IL � � n �;% ; � / APPIIG�NiSCiIYBU51NE55LICENSENO�ND6U51NE55NAME. <br /> o•bC � �' G •� oa�4.�3 c�l ��,�,b� <br /> PLUMBINO MECHANICAL <br /> NO. TyPE OF FIXTURE OA ITEM FEE NO. TYPE OF E�UIVMENT FEE <br /> WATERCLOSET�TOIL "" q/C—A/HNDLGUNITS—H.P. <br /> BATHTUB — �ORCEDAIRSYSTEMS—BT.U. MEA <br /> LAVATORY(WASH BASIN) — UNIT H[ATERS—BT.U. M <br /> SHOWER CLOTHESDRYERS <br /> KITCHEN SINKB DISP. -- VENTILATION FAN <br /> DISHWASHER `� -' RANGEHOOD <br /> LAUNDRY TqAY WATER HEATER � <br /> CLOTHES WASHER -- Wr�I�D STOVE <br /> URINAL METAL FIREPLACEB CHIMNEY <br /> ORINKING FOUNTAIN FIREPLACE INSERT <br /> FIOOR ORAIN HEAT PUMP <br /> BACKFLO'N PREVENTERS GAS PIPING <br /> RnOF DRAINS—RAINLEADERS EXHAUST FAN <br /> _ SINK(SERVICE—BAR,ETC.) <br /> SUBTOTAL S = SUBTOTAL E j <br /> PERMIT S PERMIT S I <br /> TOTAL FEE S � — TOTAL FEE S <br /> fAONISETBACN REAR5ETBApN SIDESEi&1CK GIAHCNECKNUMBER FEE PECEIPfNO. <br /> U9E20NE LOUREA WCANISIIE pEEg �/(��UATION FEE <br /> ❑Y�5 O NO <br /> TYPEOFCANST. OGCUPNlCYOi10UP NOOFOWELLINOUNITS bUILDING <br /> •ILOWABLE/ACTU�� <br /> PLUMBING ` I , r- <br /> 512EOFBLDp NO.OFSTORiES BSMC OCCLO�O <br /> �Y MECHANICAL � <br /> ❑N <br /> MEIGNiLIMI1ptION OTHE{� <br /> FItiESPRINI(�ERSREOUIqED ❑YES O NO -- <br /> STATE BUILDING SURCHARGE <br /> STATE ENERGY SURCHARGE <br /> �PpLIGA710N,1CG6Y PL�NS�PPP.BY <br /> �Q PUBLiC WOPKS <br /> {�� <br /> TOTAL � ��j <br />