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i ` ?. :' <br /> � APPLI�TION FOR CONSTF��CTION <br /> PERMIT ,. <br /> fhe Everpreen <br /> i.ITV UF everett <br /> everett � <br /> � BUILDING DEPARTMENT <br /> � 259•R810 TO 8E COMPLETED IN INK— PLEASE PRINT <br /> � OWNER MAILROORE55 CIiY 21P PMOI:C <br /> � Ci'tos5r .�-.-, . < .... _ !! ao/ <br /> � TENMlT MAILAO�RE55 GITY ZIP PHONE <br /> j /`nc0 ��+ -/� Cna ./c cLvy r^�i�� Cn�eK wh �6oi,z 7 ¢,s- 0�23Z- � <br /> I ARCHITEROFOESIpNER MqL�U0NE55 CRY 21P pHONE <br /> �� c•no s stiz- � �i �-J�J <br /> OENEfUIGONTRr1CTOfl M�I�ADDRE55 :ItY ZIP PMONE ' LICENSE• <br /> � MECH�NICALCONTRBCTOF MRILApORESS CITV ZIP PNONE LICENSE• <br /> PLVMBINOCONTP�CTOR MRILADDPES9 LITY ZIP PHONE � �I9EN9E• <br /> CU9S OF WppK <br /> �) NEW ❑ ADDITION C ALTERATII�N ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL INSERT ❑ BUILOING RELOCATION � <br /> � fENANTIMPROVEMENTONINiERIORREMO�ELONLY CONTPCTPERSONANDPHONENO. � <br /> CnNTRACTPRI.EOFWORK ✓ C/Z • �y,f C,��� <br /> DEBC418E WORK ANO SOURRE FOOiROE IAVOIVED <br /> PROPOSED USE OF BUILDINO I HEREBY CERTIFY THAT I HAVE READ ANO EMMINED TNIS APPLICATION AND <br /> Si.vC/c .v-•, � /.'o / �w� o� KNOWTHESAMETOBETRUEANDCORRECT.ALLPROVISIONSOF',.AWSAND <br /> LEOALOE9CRIF�10%•:OfPPOPER1Y�:l.OWN6ELOWORATACHFOURCOVIES OFDINANCESGOVERNINGTHISTYPEOFWCRKWILIBECOMPLETEDWITH <br /> WH ETHER SPECIFIED HEREIN UR NOT.THE QRANTINOOFA PERMIT DOES NOT <br /> �OT� e�ocn oF � PRESUME TO GIVE AUTHORIN 70 VIOLATE OR CANCEL THE P.^.OVISIONS OF <br /> ANY OTH'eR STATE OR LOCAL LAW FEGULATING CONSTRUCTION OR THE PER• <br /> /SZ z- FORMANCE OF CUNSTHUCiiON.THAT I AM AUTHORIZED BYTHE OWNER OF <br /> THIS PROPERTI'TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE <br /> AND I COMPLY WITH THE STATE CONTRACTOR9 LAW 1827�RCW AND <br /> 288200 WAC. <br /> SIONRtUPEOFCONTRRC70PORAUTHOPIZEDRQENT OATE � /O q q <br /> 0 / <br /> X _�/ CHUCK L. CROSBY I <br /> j �PROJECTAU�6E5S 1 —' Pf cidenl .roah�r HOR�B$, IpG. �� <br /> y �^ ,�^ I �, J-� /� , � � � � AFPLIL�NTS 1 U NE53JCENSENO.ANDBU91NEb9NAME ' <br /> � � L7ti �^T� � /�\�_ � <br /> Y � � <br /> � PLUMBINQ MECHANICAL <br /> NO. TYPE OF FI%TURE OR ITEM FEE NO. TYPE OF E�UIPMENT FEE <br /> �' WATERCLOSET(TOILEn q/C—fVHNDIGUNII'S—H.P. � ��. <br /> BATHTUB — FORCED AIR SYSTEMS—flT.U. M EA <br /> LAVATORY�WASHBASIN) '—' UNITHEATERS—&T.U. M � <br /> SHOWER � CLOTHES D'nY[RS <br /> KITCHEN SINKB DISP, — VENTILATION FAN <br /> DISHWASHER -- RANGE HOOD <br /> LAUNDRY TRAY WAl'ER HEATER <br /> I CLOTHES WASHER � WOOD STOVE <br /> � , URINAL MEL4LFIREPLACEBCHIMNEY <br /> � DRINKINO FOUNTAIN FIREPIACE INSERT <br /> i FLOOR DRAIN � HEAT PUMP <br /> � BNCKFLOW PREVENTEHS GAS PIPING <br /> j ROOF DRAINS—RAINLEADERS E%HAUST FAN <br /> 1 SINK(SERVICE—BAfl,ETC.) <br /> 4 <br /> � <br /> � _ <br /> � <br /> ! SUBTOTAL E -- SUBTOTAL $ <br /> � . PEPMIT S PEflM1T g <br /> t TOTAL FEE $ TOTAL FEE 5 <br /> � FPONT6EfDACK REAR9E7BACN 61�ESEiBAGK � �{ PUNCNECNNIIMBEN FEE pECEIPfNO. <br /> �" `�D � c ' �-�� �'9 aa��6 �- <br /> USEZOLIG�^1 LOTAPEA t VACANTSITE �EES VALUATION FEE <br /> ' �� ,� ,q O YES ❑NO � �� �� <br /> � NPEOFCANST, OCCUPAN�Y�O1P NO.OFDWELLINOUNITS �UILDING 'l / X � <br /> �' S]_ <br /> AILOWRBLE/AGTUr1L -� ^� I PLUMBING <br /> i BI2EOF4 D/J SfY NO.OFSTORIES 85ML OCGLJPD <br /> I D fG <br /> Z oa,N MECHANICAI <br /> HEIOMTLIMIiAiION OTHER <br /> !�' <br /> FIREBPRINKLER9REOUIRED ❑YES A'NO STATEBUILDINGSURCHARGE <br /> � bTATE ENERGY SURCHARGE � <br /> APPLICATIONACGBY PL,IN9APP0.BY <br /> I . � A� PUBLIC WORKS _ � <br /> �� <br /> � TOTAL <br /> I' . <br /> � <br /> I �i ',{3'b � �; .b�Si;'7 h1:Pr`� Csn � m :�v�]r^'"'�i��' .�.t � � <br /> �P , rrl`u'^.'q .a r^' ;•�"�'�i`+r.n :'x'v 'S'S:"{CiJ,rt x ->-• _ ._.t <br />