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APPLICATION FOR CONSTRUCTION <br />PERMIT <br />the Evergreen <br />CITY OF <br />everett e <br />BUILDING DEPARTMENT <br />259.8810 TO BE COMPLETED IN INK — PLEASE PRINT <br />OWNER MAIL ADORE SS t.11. ZII PHONE <br />_:3140 i✓WW, Mtn. ro. tic Goqb tUGL'VlT _9tqz(D 3�5(r'Lo401 <br />a <br />TENANT MAILAODRESS 'IY ZIP PHONE <br />AM141TECT OR DESIGNER MAIL ADDRESS PHONE <br />GENERAL CONiRACTOn MAIL AODntSS CITY Z PHONE LICENSEE <br />MECIMNICALCONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSEE <br />PLUMBINGCONiBACTOR MAILAODRESS CITY ZIP BONE LICENSE E <br />NEW gy ADDITION µu ALTERATION ❑ <br />PRICE OF WORK <br />LOTH BLOCK OF <br />PROJECT ADDRESS ^K <br />IJ <br />PLUMBING <br />NO. TYPE OF FIXTURE OR ITEM _ <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY (WASH BASIN( _ <br />SHOWER _ <br />KITCHEN SINKIL DISP. <br />DISHWASHER <br />LAUNDRY TRAY <br />CLOTHESWASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />ROOF DRAINS — RAINLEADERS <br />SINK (SERVICE — BAR, ETC.) <br />SUBTOTAL & <br />PERMIT & <br />H TOTAL FEE & <br />❑ DEMOLITION ❑ WOOOSTOVE/FRPL. INSERT ❑ BUILDING RELOCATION <br />.n A CONTACT PERSON AND PHONE NO. <br />SIM ` NIl -!5i%ot - I�w54 <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND <br />KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS AND <br />ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLETED WITH <br />WHETHER SPECIFIEDHEREIN OR NOT. THEGRANTING OFA PERMIT DOES NOT <br />PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PER- <br />FORMANCE OF CONSTRUCTION, THAT I AM AUTHORIZED BY THE OWNER OF <br />THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE <br />AND I COMPLY WITH THE STATE CONTRACTORS LAW 18.27 RCW AND <br />296.200 WAC, <br />SIGNMUnE OF COIQRACIOR OR AUTIKNIIZED AGENT DATE <br />JT <br />MECHANICAL <br />FEE NO. TYPE OF <br />Air — A/NNIYI n 1 U Y <br />'ERB—BTU. M <br />DRYERS <br />ON FAN <br />WOOD STOVE <br />METAL FIREPLACE& CHIMNEY <br />FIREPLACE INSERT _ <br />HEAT PUMP <br />OAS PIPING <br />EXHAUSTFAN <br />f <br />O YES O NO <br />TYPEOFCONST. <br />OCCUPANCYGROLIP <br />No OF OMLLIND UNITS <br />BUILDING <br />c,� <br />— <br />VLL <br />PLUMBING <br />ALLCYMBL AL�­/ <br />13— <br />SIZE OF ELM <br />NO. OF STORIES <br />SSMI. <br />OCC LOAD <br />' <br />a, <br />-- <br />MECHANICAL <br />HEIGHT UMRATION <br />OTHER <br />FIRE SPAINKLERSREOUInEO BYES G <br />STATE BUILDING SURCHARGE <br />STATE ENERGY SURCHARGE <br />APPLICATION ACC BY PLANS APPR BY <br />PUBLIC N'ORKB <br />>,NI <br />TOTAL <br />� I <br />"1 i �� <br />C _ <br />� ) <br />