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_ � <br /> ' ., _1 ''� <br /> APPl�IC�i ION FOR CONSTR4�.TION I a <br /> PERMIT � <br /> �� fhe Everpreen � ,_ <br /> � CITV OF everett <br /> everett e <br /> BUILDING DEPARTMENT <br /> 259- 1U /� TO BE COM�E D IN INK— PL ASE PRINT <br /> � �la�rrcP �/. �� 2Yv(ol� 5"8/9 � .f�� Eurre� rf8�o_3 J S�' - Jr`7� �`/ <br /> �' �OWNER MNILPppRE55 GIiY IP PNONE I . <br /> TEN�Ni MAILApDRESS CiIV ZIP PHONE I <br /> 1 I <br /> ♦RCHITECTOPDESIONER IdA1LA00RE5S Ci1V ZIP P��ONE � <br /> lI �rY y G � �r�r�lF' S a,..,�� ' <br /> � <br /> - �/OENERQCONTRACIOR MAILAOpfiESS �Irv IiP PHONE LICENSE• �� <br /> T I I <br /> MECH�NICALCONTRaGtOR MAILAOD1iE55 CItY ),IP PIIONE �ICENSE• I <br /> PLUMBINOCONtpACTOR IAAILApDRESS �IIV iIP PIIONE UCENSEr I <br /> ' CLA990FWORN -- <br />� i��rv�NiEMPNOV❑EMENT�ORM ENOO(JEMOLOELRO(N''�)ON ❑ (7EPAIR ❑ DEMOLiTION `o'❑nCWOOD�S'+ONo/r oPE oSERT ❑ �UILDINGRELOCATION <br />, , <br /> CONTfl�CiPRICEOiWORK' I a /X ( d 3 .C'j.���"" (I�'t,f�J__"'_."__"_—"__' _-- '. <br /> OE9CqIBE WORN AND 90U49E fOO1�0E INVOLVFD ' <br /> '� Y�.a.,." ��. a �-�. <br /> � : �PAOP08EDUSEOF6UILOINO / IHEREBVCERTIFYTHATIHAVEREADANDEXAMINEDiHISAPPLICAT10NAND ,I <br /> ,` Llrt�'���."�'"�`I� �Y �'�}�,,/M--�C�Q�,��� �p, KNOW7HESAMETOBETRUEANDCORRECT.ALIPROVISIONSOFLAWSAND I <br /> � ���LEGA�DESGRIPf10 OF PROPEPttISHOWN BELOW OR RTT CH FOIIRC viE51 ORDINANCES GOVERNING THIS TVPE OF WORK WILL BE WtdPLETED WITH ' <br /> ,� I . p � (� WHETHERSPECIFIEOHEREINORNOLTHEGRANTINGOFAPERMITDOESNOT <br /> y�. y : Loi �-� e�oCK O00 oF �1�`�^�o' ���� ANYOTHER�ATEORLOOAL AWREGULATNGCO SERUCTIONOVRTIHEPERF <br />���- � �I L�I __ S N �O� L£5S �{F_ tif //(�� FORMANCEOFCONSTRUCTION.THATIqMAUTHORIZEDBYTHEOWNEROF <br /> � � � Y �G W� THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE <br />. AND I COMPLY VlITH 7HE STATE CONTRACTORS LAW 1827 RCW AND <br />�, . ��J1 e /o.s' oF s. /7�. a,' oF tvT zss.zoow.ac. <br /> SIGNAiUREOFCONIRACIOlIOIlAU1HOf11ZE0AGENi OATE <br /> . 9 �`�',-�i19� '7�T <br />� c� cF E�.�ElA�� c� n �F S�' � X <br /> y.,�.��8� s'f: Z>9- �„�.��;_� 1�c � � � �. 1 <br /> , �PflOECTA0DRE55 p r � L['' aPP�ILpNI5Clt1 p 511[SSLICENSENOANOO�E�A �� I <br /> s � .t�-�e-, L v e.r e, 1 [ � <br /> ' PLUM61N6 MECHANICAL <br /> � NO. TYPE OF FI%TURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATEF CLOSET(TOILEn A/C—q/H NDLG UNITS—H.P. <br />�� BATHTUB FOFCED AIR SYSTEMS—B.T.U. M EA <br />. J _ LAVATORY�WASHBASIN) UNITHEATERS—BT.U. M <br />. , SHOWER CIOTHESDRYERS <br />. KITCHENSINKBDISP. _ _I VENTILAiIONFAN _ <br /> DISHWASHER RANGE HOOD <br /> � LAUNDFiYTRAY WqTER HEATER <br /> . � CLOTHES WASHER WOODSTOVE �. <br /> �- i URINAL METAL FIREPLACE 6 CHIMNEY <br /> ' DRINKING FOUNTAIN FIREPLACE INSERT � <br /> � FLOORDRAIN HEATPUMP I <br /> BACKFLOW PREVENTERS GAS PIPING , <br /> �� ROOFDRAINS—RAINLEADERS EXHAUSTFAN �, <br /> � SINK�SERVICE—BAR,ETC.) ii <br /> —-- -- I <br /> .' _ —_ — — I <br /> i <br /> � SUB TOTAL $ SUB TOTAL 5 <br /> � PERMIT 5 PERMIT S <br /> TOTAL fEE $ iOTAL F[E $ <br /> FRONi5E78RCK BE�PSEIORGR SIOESEtpACN PISNCHECKNUMpEH FEE RECEIPTNO. <br /> 20 2c� 5 S 9 2a a� � 9 ys �23 � <br /> USEZONE r � �orane� VAC�NLSIIE FEES VALUATION FEE <br /> �,e /� LI YES �V�10 <br /> � BUILDING � Z - _ 1 '� c7Q <br /> ttPEOFW Si. OGCl1PRNCYGfiOUP NOAFOWELLINGUNItS _�_j <br /> �LLOWABLE/A '-7 — <br /> � �c--3 � PLUMBING <br /> SI2EOF9lDG. NOOFSiORIES 95fAi. OGCLOnD <br /> . ��Y MECh1ANICAL <br /> 3Z z `� --- -- -- — <br /> � ue�r,��rwartnnoN OTHER <br /> �/ __ _ —_ <br /> ' FIRESPRINKLERS REOl11RE0 n ves +o STATE BUILDING SURCHAR�E <br /> STA1 E ENERGY SUI7CHARGE <br /> , �PPIICRIONACC.DY PLANSMPBBY — - — <br /> � � I./I PUBLIC WORKS <br /> /II <br /> TOTAL <br /> � <br />