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r` t ' VC. v�' " �� <br /> APPLIC�ION FOR �NS-ff�llr�-T-1()�l <br /> � PERNiIT <br /> � fhe Everproen <br /> � CITYOF evcrell <br /> t everet� � ; <br /> BUILDING DEPARTMENT , <br /> 259-8810 TO BE COMPLETED iN INK- PLEASE PRINT ', <br /> � OWNER M41LPpUflE55 CIfV ZIP PHONE � <br /> �.�,��e�e�rlberl� � aaa3 ��I� D(�. 0 � (�1� 33'�-3U5� ��I <br /> iE`i�NT MAIIA[1�RE55 CIiV ZIP PHONE , ' ' <br /> � <br /> ' AflCNITECfOfl0E51GNER IdAILA0DRE5S CIiY ZIP PHpNE III + <br /> I ��I <br /> � GENERRLWNIRALIOR MAILADORESS CIfY ZiP PMONE UCENSE� <br /> i <br /> ! Et,HRNICALCONiRFGTOR AIFIIFODFE55 GITY ZIP PlIONE `, OEN$[�/_ I/�� <br /> , ��1�,,-�;a�-�,Q �o.s 2�o s m�p�a�� C-v�cr� �1��► 25�-�49z � 1�1.C/Il7L� <br /> PLUMBINOC iqAGOP MniLR�ORESS � GrtY ZIP PMONE UGENSE• <br /> I <br /> Gll.So OF WORN <br /> ❑ NEW ❑ ADDITION � ALTERATION L7 REPAIR ❑ UENOLITION ❑ 1VOODSTOVE/FRPL INSERT ❑ BUILDIIlG RELOCATION , <br /> T[NANTIMPRpVEMENiOPINTERiON REMODELONLV GONTACLFEHSONANOP110NEN0. � <br /> � CONTRAdTFflICEOFYlOPK i, <br /> ' OE3CRIB�WOflNpND50UAPEfO01AGE1NVOLVED � <br /> � Pa �sSEDUSEOFBUIL�INO IHEPEBYGERTIFY7HATINAVEREADANDE%AMINEDTHISAPPLICATIONAND <br /> �I�1� KNOWTHESAMETOBETRUEAPIDCORRECT.ALLPROVISIONSOFLAWSAND � <br /> LEOALOESCRIPTIONUPPPOVERttIoHOWNBEIOWORRCACHiOURCOPIES� ORDINANCESGOVERNINGTHISNPEOFWORKWILLPECOMPLETEDWITH <br /> ' WHETHERSPECIfIEDHEREINORNOT.THEGRAN7INGOFAPERMITDOESNOT <br /> ' PRESUME TO GIVE AUTFIONI7Y TO VIOLATE OR CANCEL THE PROVISIONS OF <br /> � �oT e�oCn oF ANYOTFIERSTATEORLOCALLAWREGULATINGCONSTRUCTIONORTHEPER• <br /> , FORM1fANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE OWNER OF <br /> ., THIS PROPERTY TO PERFOR�d THE WORK FOR WHICH APPLICATION IS MADE <br /> AND I CC;APLY WITH TFIE STATE CONiRACTORS LAW 1827 RCW AND �i <br /> 296200 WAC. I <br /> SIGNAiUPEO�CONtRPQORORAUiNORIZEDFGENi OATE '' <br /> "��� _�.�.�-�.1-��__��._ a�i�� �� <br /> ' PFOJECTFODRESS qPP��C�N15CfYBUSINES`vIICENS[NO/NOBUSINESSNAAIE <br /> ; i 2223 1 ����` <br /> 1 PLUMBING MECHANICAL <br /> NO. TYPE OF FI%T�r7E OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> �� WATERCLOSET�TOILEn A/C—A/HNDLGUNITS—H.P. <br /> i BATHTUB � FORCED AIR SYSTEMS—B.T.0 (�vt EA <br /> LAVATORY(WASH BASIN) � UNIi HEATE(75—B.T.U. M �, <br /> �� SHOWER CLOTHESORYEflS � <br /> i i <br /> ; YITCHENSINKBDISP. VENTILATIONFAN � <br /> DISHWASHER RANGE HOOD ; <br /> LAUNDRY TRAY WATER HEATER I <br /> CLOTHES WASHER WOOD STOVC I <br /> :� URINAL __ METAL FIREPLACE 8 CHIMNEY i <br /> � DRINKING FOUNTAIN FIREPLACE INSERT _ <br /> � FLOOR DRAIN HEAT PUMP <br /> i BACKFLO'N PREVENTERS GAS PIPING <br /> , ROOF DRAINS—RAINLEADERS EXHAUST FAN j <br /> , SINK�SEFiVICE—BAR,ETCJ I ���'���� r' �I <br /> SUBTOTAL S SUBTG�AL 5 <br /> , PERMIT S PERMIT S '-' <br /> ' TOTAL FEE S TJiAL FEE S � <br /> � FFONTSETBACK RERqSEiB/CN SIDESETOACR PLANCMELNNUMBEP FEE R[CEIPTNO. I <br /> usezor+e �ornnea vacnNrsne FEES VALUATION FEE <br /> n res u rvo <br /> � IYPEOFCONST. OCGUPANCVGROUV NOAFp1YELLINOUNliS BUILDINCa — <br /> ALLGNABLE/ACTUAL <br /> � PLUMBING <br /> � SRE UF BL�G. NO OF Si0NIE5 p9Ai. OCC LORO <br /> � u v MECHANICAI. C''� <br /> ❑ N __ _— �J <br /> � MEIGNILIMIiR110N OTHER <br /> , FIRESPFINKLERS REOUIRED ❑ vEs ❑No STATE BUILDING SURCHARGE <br /> � STATE ENE�GY SURCHARGE <br /> � hPF�ICATION ACC BY PI.ANS APPR.OY <br /> PUBLIC WORKS <br /> TOTAL ,�� <br /> �,C;4�t" � , .. : ;: <br />