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I ' � pPpLICI��'ION FOR CONSTRI��TIOQ+I <br /> PERIV�IT <br /> tha Evorgreen rverell <br /> CITY OF � <br /> everett <br /> BUILDING DEPARTMENT <br /> 259•8810 TO 8E COMPLETED IN INK— PLEASE PRINT <br /> OWNER MAILADURE55 CIIY 21i' ['MONE <br /> FlSHERrotAN1s �Ar SHuP. �Q� (o - ��1�P,VE ��E7T- 9gLO 1 z59 — 0137 <br /> TENANT <br /> MAILADORES$ Gllv ZIP PHONE <br /> PHCHITEGTOR�ESIGNEP M41LP00lIE55 r � LIIY 21P P��ON[ <br /> VG2+aF 1... �..inioOCas, Pr 7..go2 P��,hic p.uE. CuP-Rt'r 98� I 252-512G <br /> � + CitY ZIP P��ONE LICENSE• <br /> OENEPnICONIPACTOR MRII��OBE55 <br /> OWNE(Z <br /> MECHRNIC/LGONLFACIOR �•�A��ADDfif:55 CIIY ZIP PIIONE LICENSE> <br /> /� NA . -- <br /> VLUMBINGCONLRPGLOR M1�A�lP00R[55 GIIY l.IP PIIO��E LICENSE• <br /> �� �� __— —_ _---_._— <br /> CLA550�WORK • <br /> ❑ NEW ❑ AD�I710N ❑ �LTERAiION ❑ REPHIR ❑ DEMOLITION co'❑ACWOOD�+�N�/f'110NENp$ERT A� BUILDINGRELOCATION _ <br /> IENANTIMPROVEMENfORINtEP10R REMOOELONLY �Q�.�///- <br /> CONIPACiPflICEOFWOfIN: � I�J ��� !/ /`� //�____ __ _.__.—"' —"—__.___--.-- <br /> DESCRIBE WOfiR�ND SOUAR[FOOI�GE W VOWED <br /> I � <br /> RG�oGAtF_ A�� SfEEI 28 X 0Q 6LOG fh",2 D�1�n'D-�d117 _. <br /> PROPOSED USE Of�UILUING I H F 9EBY CERTIfY THAT I HqVE PEAD AND E%AMINED THIS APPUCATION AND <br /> A55Fs16�Y S��'• KNOWTHESAME70AETRUEANDCORRECT.ALLPROVISIONSOFLAWSAND <br /> ORDINANCES GOVERNWC THIS NPE OF WORK WILL BE f,OMPLETED W�T4 <br /> LEGALDESGRIPiIONUFPPOPER1Y�5110WN0EL0\YORRTI/CNfOUNGOPIE51 WHETHERSPECIFIEDHEREINORNOT.THEGRANTINGOFAPERMITDOESNOT <br /> PRESUh1E TO GIVE AUTFiOfiITV TO VIOLATE OR CANCEL THE PROVISIONS OF <br /> �or B�ocK OF ANYOTHEfiSTA1EORLOCALLAWREGULATINGCONSTRUCTIONORTHEPER� <br /> FORMANCt OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE OWNER OF <br /> Q�(Tp,CHED �P�ES THISPROPERTI'TOPERFORMTh1EWORKFORWHICHAPPLICA710N15MADE <br /> AND I COMPLY WI1H THF STATE CONTRACTORS LAW 1827 RGW AND <br /> 296.200 WAC. � <br /> � SIGNAIUREOFCON1MCi OP. i1HORK[OAGENT DATE (�/�,L/8g <br /> Bux, F3 ` X��„,��_ ,�ie.Syr�..�r. <br /> PPOJECtA00RE5S I('��(� �q+S � � PPPLIC�NIECIiYflUS1E55UCFN5E OBlI51NES5NAlAE <br /> r_vF._rce.rr W�� �8�� Goi e6i aob <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TURE OR ITEM FEE N0. TYPE OF EO'JIPMENT FEE <br /> WATEPCLOSET�TOILEn __ NC—WHNDLGUNITS—H.P. _ <br /> BATHTUB _ FORCED AIR SYSTEMS—B.T.U. M EA <br /> LAVATOPYIWASHBASIN) __ UNITHEATERS—B.T.U. M <br /> SHOWER _ CLOTHES DRYERS <br /> KITCHEN SINKB OISP. VENTILATION FAN —_ <br /> DISHWASHER RANGE HOOD _ _ <br /> LAUNDRYT(7AY _ _ WATERFIEATEq <br /> CLOTHES WASHER __ WaO�STOVE __ <br /> URINAL _ METALFIREPLACEBCHIMNEY _ <br /> DRINKING FOUNTAIN FIREPLACE INSERT _ <br /> FLOOR DRAIN HEAT PUMP <br /> BACKFLOW PREVENTERS GAS PIPING <br /> ROOF DRAINS—FAINLEADEfiS _ _ E%HAUST FAN <br /> SINK(SERVICE—BAR,ETC.) _— <br /> SUBTOTAL $ — — -- —_ �_____ - SUETOTAL 5 _ <br /> � PERMIT S _ _ _ PERMIT g _ <br /> TOTAL FEE 5 IOTAL FEE � <br /> FPONTSETOAGN �EA�SEI9AGN S�DESETBFGK PIAHCN I(NOM�EfI FEE �J,( � AECEIPTNO. <br /> � � ,�., ,� IC �'�! f(��.�>= - �-I` > I � <br /> � � >�, <br /> USE2oi�E LOiAREF VACPNi51iE FEES VALUP710N FEE <br /> ❑ YES �O �— /, <br /> ��/ BUILDING _ ,���_1 <br /> TYPEOFCANST. OCCUPAN YGROUP HOOFOWELLINOUNIfS ----- ----- <br /> ALLOWABLE/AGiUAI'TI�� �/ � � � PLUMBING _ _____ _ __ <br /> �, /Y <br /> 91iEOFBL�G No.oFstonies osMr. occioAo�� MECHANICAL <br /> 22 �d5� 1 ° ; -- -- — <br /> NEIGIIILIMII/IInN OTHER _ _ <br /> Nr <br /> fIRESPRINKIERS REOUIOE� ❑YES O STATE BUILDING Sl1RCHARGE <br /> STA7E ENERGY SURChIAFGE <br /> RPPL'CAl10NACG0V PLANSFAPR�.JBY PUBLICH�O(IKS <br /> /wL'�� TOU1L <br /> ,1':'I Jn , • <br />