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A�PLIC�►TION FOR CONSTR�JCTION <br /> PERMIT <br /> I�e Evergreen �•v�relt <br /> CITY OF � <br /> everett <br /> ' BUILDING DEPARTMENT <br /> 259•8810 TO BE COMPLETED IN INK— PLEASE PRINT <br /> OWNER I.IAII POORE55 CITY ZIP PIIONE <br /> CaIANN I MA�'oL,4 5O3o £✓�2C1zE�N WA�(�'V. `18203 7 52 Z-`f35 <br /> TEN�NT 1.IAILPODRE55 CIIV ZIP PIIONE <br /> �FCFITELTOfl0E51GNER ilAILR�OBESS CIIY ZIP PHON[ I'C�"1 <br /> (�jD'� C�hAMPlol�l 38n2 ��-�����2�Tj' `IgZ.ol 2S'�i 313Co �� <br /> GENERALCONTR�LiOP MAILr10�fiESS GiY ZIP PHONE LICENSE♦ <br /> � MEGH� ICALCONTMCTOP MAILAD�� / L17Y ZI PHONE LICENSEa <br /> � oWr.)�f"4�nV'E <br /> PLUMBINGCONTRAGTOR MlILR�GNE55 QfV ZIP PIION[ LICENSEs <br /> _"—_____ """"___"_...___'_ '__—'_ <br /> C1A550F WV PK <br /> ❑ NEW � AODITION ❑ ALTERFTION ❑ REPAIp G DEMOLITION ❑ WOODSTOVE/FRPL.IIJ&ERT ❑ BUILDING RELOCATION <br /> ______"___"__—" .' _'—' _ _"__'__' __""______'.____.___ <br /> TENANTIMPROVEMENTONINTEFIp{(p[q[lldOOELONI.Y GOHIAGIPLRSOHANOPIIONEKO <br /> CCNTRACTPRIGEOFWOFK ' •>/1 � C�(,�V "____ __"__ _. ..__.___'_—.__. _——.---------- — <br /> DESGPIBF.WOFN RNl1 S0IJARE FOOTAGE INVOLVEU <br /> 58`f �c,�__���1_. --- <br /> raoaoseo us¢oF aunowc I HEREBY CERTIf Y THAT 1 HAVE READ AND EXAMINED THIS APPLICATION AND <br /> � _�'�ST�1� F�N 1 KNOWIH�SAMEIOBETRUEANDCORRECT.ALLPRUVISIONSOFLAWSAND <br /> I LEOFL OESCflIPTIONOF PROPERTYISHOWN B lOW OR PTfRCH FOl1qCOPIESI OHDINAN::ES GOVEIiNING THIS NPE OF WORK WILL BE COMPLETED WITH <br /> � ��� WHETHERSPECIFIEDIIEREINORNOT.THEGRANTINGOFAPERMITDOESNOT . <br /> PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br /> �pi e�ocK oF FNYOTNEFSTATEOflLOCALLAWREGULATINGCONSTRUCTIONORTHEPER• <br /> FORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BYTHE OWNER OF ! <br /> TIiIS PROPERN TO PERFORM TF{E WORK FOR W HICH APPLICHTION IS MADE <br /> AND I COMPLY WITH THE STATE CONTRACTORS LAW 18.27 RCW AND <br /> 296.200 WAC. <br /> SIGNA�URhOFCONTNRGIORON Iill ZEUAGENT OlTE <br /> � ' Z 18 <br /> � .� .�o � c.,. G./c <br /> PPOJECT��OHESS qpp�i ANTS INESSIIC NSENO.PN�6U INESSNAME <br /> �S� OtU� -2 �'cBOV� <br /> I� . MECHANICAL <br /> j PLUMBING <br /> � Mp, TYPE OF FIXTUfiE OH ITEM FEE NO. TYPE UF tOUIPMENT FEE <br /> � WATERCLOSETITOILEn _ _ A/C—A/HNDLGUNITS--H.B _ _ <br /> I BATHTUD _ _ --- PORCED AIR SYSTEMS--B.T.II. M EA — <br /> LAVATOiiY�WA5HBA51N) UNITkIEATERS=B.T.U. M <br /> � SHOWER __ CLOTHES URYERS <br /> ; KITCHEN S�NKB DISP. VENTILATION FAN _ <br /> DISHWASHER RANGE HOOD _ <br /> : LAUNDRYTRAY WATERHEATER _ <br /> ' � CLOTHES WASHER WOOD STOVE _ <br /> 1 — - - <br /> � � URIIIAL _ _ METAL FIREPLACEB CHIMNEY <br /> � DRINKING FOUNTAIN FIREPLACE WSERT _ <br /> FLOOR DRAIN HEAT PUMP __ — <br /> BACKFLOW PREVENTERS GAS PIPING . _ <br /> -- __— _ — <br /> I ROOF DRAINS—RAINLEADERS E%IIFUST FAN _ __ _ _____________ ____ — <br /> � --___— —._ . ___._ _ .' ..._. ._..__ .. _ . ' <br /> � SINKISERVICE—BAR,ETC.1 .. .____.-_—.-- --- --- --�--- <br /> — --'_ .. ___— . ._... .. _..._ .. _ .... <br /> I . .._ ._.. .'__—'_____—__ '— —_'— _ <br /> — __ _ ____ _"'_'_ _._.._ .. _ _ .. . .. <br /> � '_'_— —' ____ _—._______ __..__ — <br /> ; ... ._._.________ ._'____ ___'_'_- - <br /> SUBTOTAL 5 SUBTOTAI $ <br /> PERMIT 5 PERMIT 5 _ <br /> TOT�LFEE 3 TOTALFEE 8 <br /> FRONTSETBRCK flERRSETOFCN SIOESETDALY. PIANCHEC NUMBEfl FEE /C": f� HELEIPTNO. <br /> D Ib� b �'�1-����/ � J� - � � � i s- G 5 i <br /> uSezoNe LOTAflEA VACANiSIiE FEES VALUATION FEE <br /> i�2. � 400 5.�. o Y�5 �,�o <br /> oui�oiNc �V ��v�� -�'� 8`f � <br /> lYPEOFCANST. OCC ANCYGFOt1P NOOF014ELUNGUNIIS <br /> nuo�w�neLE/ACTl1AL A�� O PLUMBING __ <br /> SIZEOFBLOG. NOOFStORIES USMT. OLGIOAp MECHANICAL <br /> 58`� Q�v I °N � �� � <br /> M[IGHTI IMITA ION OTHER�t,( ,¢C ��� c/_' 3"z S� <br /> __� __.— -�--- ------ -- <br /> FIRESPPINHLERSREOUIPED CI YES �NO $TATE BUILDING SURCHARGE I � � <br /> STATE ENERGY SURCHAfiG� <br /> pPP�ICQ10NACG0Y PLRNSRPPH.BY PUBLICWORKS <br /> �� rora� �J� �� <br /> k <br />