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APPLICarION FOR CONSTRICTION <br />PERMIT <br />the Evergreen I •I I phl <br />CITY OF <br />everett <br />BUILDING DEPARTMENT TO HE COMPLETED IN INK— PLEASE PRINT <br />CLASHOFYNRK <br />❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODDSTOVFd RPE,NQERT ❑ BUILDING RELOCATION <br />TENANT IMPROVEMENT OPINTEPKM PEMODELONLY q/tlww �• wlw6./c, <br />LOT BLOCK OF <br />PIq.IECt ADORE89 (%�! `'� oy <br />3003 Gu• LA's�n�o��' b `q 7 <br />PLUMBING <br />s <br />AL <br />EE <br />c <br />1-*H <br />IIOUP <br />9 <br />BSA1T. <br />aY <br />aN <br />HEK <br />O YES a NO <br />I HEREBY CERTIFY THAT I HAVE <br />KNOW THE SAME TO BE TRUED <br />ANy YHLO THE I SrA;I ..w <br />FORMANCE OF CONSTRUCTION. <br />ON. THAT <br />I AM AU HORIZE I BY THE <br />OW <br />THIS PROPERTY CE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE OWNER OF <br />-- N IS MADE <br />AND I COMPLY TNTHR THEM STATE CORNTRACK FOR TORSHLAW L1827ORCW AND <br />296.200 WAG <br />SIGNATURE OF CONTRACTOP OR AUT 12ED AGENT DATE <br />AN I YBUSINESS LIC 9E N0 DBVSMESS NAME <br />MECHANICAL <br />NO. TYPE OF EOUIPM E NT FLU <br />A/C—A/HNDLG UNITS—H.P. J S/O <br />FORCED AIR SYSTEMS— ST.U. M EA <br />... •lul•ueetaoc_ATu. M IDYL AYB <br />FEES VALUATION rec <br />BUILDING .. <br />PLUMBING <br />MECHANICAL <br />OTHER <br />STATE BUILDING SURCHARGE _- <br />STATE ENERGY SURCHARGE <br />PUBLIC WORKS <br />TOTAL <br />