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�ha7� <br />07dx <br />C H <br />9 H V� <br />Y <br />y H <br />K n <br />H71 <br />'��] H hO7 <br />VJ H <br />C�7 O � <br />H t7 <br />OH <br />��g <br />�V � <br />zH�yH <br />r �-+ y <br />g�' <br />H <br />C]C5v� <br />t�J <br />HO� <br />t.a. ,...� <br />APPLICATION FOR CONSTRUCTION PE�MIT <br />fhe Evergreen everett � <br />everett e �� <br />BUILDING DEPARTMENT <br />259-8810 TO BE CQMPLETED IN INK—PLEASE PRINT <br />I I DEMOLITION I I COMBINATION I I BUILDING I I MECHANICAL Xi PLUMBING 17 SIGN <br />ow/r+e�n nnnooness arv e nP // PIIONE <br />,�1'�i�t .�v�o � ��-�..� /�'oo �i�i-c ,�12�. � � 3� zd X�r-ee,1-.,..= �t 77e'T7 �i�,) a GG -s'a-�� <br />TENANt MNl40�RE5S C Y liP PNOHE <br />r1lICHRECT011DEFIGNEfi MNLAOORESS . GTY ZiP PNONE <br />GENE1i4LCONiPACtOB � MAIL�ODt1E55 Clrv 21P PIIONE LIGENSE� <br />,n��� a����r�� <br />Ii11Y LIY <br />/ <br />PI,OMOIN GON11 GIn�H MNLP11tl11tS5 GIIY ZIp PIIONE IICEN$ER <br />�.f�CO r��N. �.(J. (3�x aUU7 (oX¢5,113nTQeE. 97o'ro LG7-i�di LJOLCOPC/Ft.�/��_ <br />c�n55 or wonK <br />�NEW I J ADDITION I I ALTE(iAiION I I REPAIR I I DEPAOLITION I I WOODSTOVElFRPL INSERT I I BUILOING RELOCATION � <br />TEN�Ni IMPROVEMENT Ofl INTERIOR REMOGEL ONLY GONiACT P[RSON �N� P1101![ NO. '� <br />CONtRACT PIi�CE OF WOfiN: <br />O�ESCRIBE WORK AN� SOURRE FOOTAGE INVOLVEO . <br />(/..Lc.�.,�/ n<c._i E-h-i ..�-� �w ' �I <br />PPOPOSEOUSEOFBWLDiNG ' �— I HEREBV CERTIPY � <br />LOI_ . OLOGK <br />O 9— <br />WAl"EA CLOSE7 <br />BATHTUB <br />KITCHEN SINK 8 <br />DISHWASHER <br />LAUNDRYTRAY <br />FLOOFl DRAIN <br />BACKFLOW PRE\'[NTERS <br />FRONi5ET0�GK <br />USE 20NE <br />IYPE 0! LONSi PLIOWAptE <br />SRE OF BLDG. <br />OCCUPANCYLOAD <br />REASON fOR SPRiNKLERS <br />qrrucnTwrv ncc. ev <br />or <br />,� <br />FEE <br />THAT I HAVE READ AND EXAMINED THIS <br />APPL�Cl:TION AND KNOW THE SAME TO BE TPUE AND COR7ECT. ALL <br />PRO� i510NS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WII.L BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. TIiE GRANiING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHOtiITY TO VIOLATE OR CANCEL THE PROVi510NS OF ANV <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPL�CATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br />SIGNAIUfiEOFCONiRACLOIIORAUtHONZEDAGENi pAiC <br />APPLIGIN�C85L N��USIN SN�ME�``� PD <br />MECHANICAL <br />NO. TYPE OF E�UIPM[NT FEE <br />FORCEDAIRSYSiEMS—B.T.U. M <br />UNIT HEATERS—B.T.U. M <br />CLOTHES DRYERS <br />VENTILATION FAN <br />I.YI:L�JSd�lq <br />�71 [/n i <br />& CHIMNEY �— ��I <br />SUBTOTAL $ p <br />PERMIT $ j(7 <br />TOTAL FEE $ �' <br />REARSET�ACN SiUESElOACK PI.4NGIIECNNUM�Ef1 ([[ <br />ioTnnen VACNJTSIiE FEES <br />IJ VES I 1 NO BUILOING <br />irreorcnNsr.ncma� rcurnxcv rrommvfwxcm,ns <br />cnmm <br />PWMIi1NG <br />NO.OFST0111F.G O�SEMENt MECHANICAL <br />❑ VES CI NO <br />FlFESPRNNLERSR[OD HEIGIIfUMINIION OTHER <br />L1 VES ❑ NO S7n7E�UIL�INGSURC11nRGE <br />SIATEENERGVSUPCNARGE <br />rinusnrrnovEoov CITYOFEVEHETf ruoucwonHs <br />LOCALSALES <br />TAX CODE IS 3105 TOTAL <br />$� C <br />RECEIPT NO. <br />