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APPLIC�..'ION FOR CONSTRI►.:TION <br /> PERMIT <br /> Me Evergreen rveret� <br /> GTV OF � <br /> everett <br /> BUILDING DEPARTMENT <br /> 259•eet0 TO BE COMPLETED IN INK— PIEASE PRINT <br /> OWNER MAILAO�FE55 CILV ZiP PnONE <br /> �1/ClZGTf ( EN6l'AL laC--f'�'r1L /�C. i3iX IIq7 EVEi:-�—rTT '�fi7-C( z5$ -(o�?��-� _ <br /> TENANT MRILADORE55 CiiY ZIP PMONE <br /> ARCHITECTORDESiGNER MAIL�D�RE55 CITV 21P PMONE <br /> GENERRLCONTRACTOR MAiLApDRE55 C�iY ZIP PMONE LILENSE• <br /> MECH44iCALGONiRPCiOR MAIL�DORESS GITI' 2iP PHONE LICENSE• <br /> � 7G7�-a9c�e ^'nc.`x''" <br /> n�n� xNnu� ;���I�-� C� �-7� 7 i�c��c,�r Sw Sr�Tn..s �f�iu6 zqe:�-� <br /> PUIMBINGGONTRACiOR MPILAODRE55 CiTY 21P PNONE LILENSE• <br /> CUSSOF WORK <br /> ❑ NEW � ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL INSERT ❑ BUILDING RELOCATION ' <br /> TENFNT IMPROVEMENi OR INTERIOR-R7EMODEL ONLY CONTACT P[RSON ANO PHONE NO <br /> CONTR�CTPRICEOFWORR � / IVI � ' ��1�-r����LY'�' ��� `��G� <br /> OESCRIBEWORKANOSOUAREFOOTAGEINVOLVED Clv�f�C..��N���U? ������~ �''"J <br /> n.u�� �7��=t�v��=s gr�, 'r� or2� � 3`'t'o `}'� <br /> PROPOSED USE OF BUILDING I H EREBY CERTIFY 7HAT I HAVE READ AND E%AMINED THIS APPLICATION AND <br /> KNOW THE SAME TO BE TRUF AND CORRECT.ALL PROVISIONS OF LAWS AND <br /> LEGRl0E5GRIPT10N UF PROPEHTY ISNOIVN BELOW OP ATTACN FOUR COPIESI ORDINANGES GOVERNING THIS TVPE OF WORK WILL BE COMPLETED WITH <br /> W H ETHER SPECIFIED HEREIN OF NOT.THE GRANTING Of A PERMIT DOES NOT <br /> PRESUME TO GIVE AUTHORITV TO VIOLATE OR CANCEL THE PROVISIONS OF <br /> �oT e�ocK oF ANVOTHERSTATEORLOCALLAWREGULATINGCONSTRUGTIONORTHEPER• <br /> FORMANCE OF CONSTFUCTION.THAT I AM AUTHORIZED BY THE OWNER OF <br /> THIS PROPERN TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE <br /> AND I GOMPLY WITH THE STATE CONTRACTORS LAW 1827 RCW AND <br /> � 296.200 WAC. <br /> ` SIGNPTUREOFGONLPPCipRORAUT110RiZF.DAGENT OAi[ <br /> 1 <br /> ` X � �� <br /> �Ilcfi: '- <br /> PRO C 55 hPPLIGANTSCIiYBl15iN[SSLILENSENOAHOBUSMESSNAME�. � � <br /> i3zl C:uLt�y A�• Fou�t�-I ��.cot� ;����u���n�Au.� I1�ILL'U` c� �,o�'� <br /> PLUMBIN6 MECHANICAL <br /> Np. TYPE OF FI7(TUHE OH ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) NC-A/HNOLG UNITS-H.P. <br /> BATHTUB FORCED AIA 5YSTEMS-B.T.U. M EA <br /> LAVATORYIWASHBASIN) UNITHEATERS-B.T.U. M <br /> SHOWER CLOTHESDRYERS _ <br /> KITCHEN SINKd DISP. VENTILATION FAN <br /> DISHWASHER F7ANGE HOOD <br /> IAUNDRY TRAY WATER HEATER <br /> CLOTHES WASHER WOOD STOVE <br /> URINAL _ METAL FIREPLACE 8 CHIMNEY <br /> DRINKING FOUNTAIN FIREPLACEINSLRT _ _ <br /> FLOOR DRAIN HEAT PUMP <br /> BACKFLOW PREVENTERS GAS PIPING — <br /> ROOF DRAINS-RAINLEADERS E%HAUST FAN <br /> SINK(SERVICE-BAR,ETC) — � N� ' � �� <br /> SUBTOTAL 5 SUBTOTAL g <br /> PERMIT S PERMIT 5 <br /> TOTAL FEE 5 TOTAL FEE 5 <br /> iPONTSETBACN FE4qSEiBALK SIDESETBRGR PIANGHECRNOMBEH FEE RECEIPTNO. <br /> USEZONE ��tAREA <br /> vncnrvTSrte FEES VALUATION FEE <br /> ❑ YES ❑ NO <br /> BUILDING _ <br /> TYPEOFWNST. OCCUPANCYGROIIP NOOFDWELLINGUNIiS <br /> �LLOWRBLE/AGiUAL P�UMBING <br /> 52E OF BLDG. NO.OF STORIES BSMT. OCG LOAD MECHANICAL / � <br /> ❑V — <br /> ❑ N <br /> MEiGHTLIMiTATION OTHER <br /> i1RE SPpINNLEPS REOUIRED ❑YES u NO STATE BUILDING SURCHARGE <br /> STATE ENERGY SURGHARGE <br /> APVL!CRTIONPCC.9Y PLFNSAPPF.BY PUBLICWORKS <br /> rora� �( < <br />