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APPLICATIOI. FOR CONSTR � ��e�e�c <br /> UCTI..N PERMIT <br /> Rre Evergreen TO BE COMPLETED IN INK—PLEASE PRINT � <br /> CITY OF <br /> eve rett HEATING SYSTEM: GAS ❑ELECTRIC ❑ <br />� �y ,� BUILDING DEPARTMENT <br /> ' 259-8810 <br /> DEMOUTION COMBINATION �BUILDING MECHANICAL PLUMBING SIGN <br /> OWNEF MAILADDRE55 CIiV ZIP <br /> PHONE <br /> Co .s o ..� .cvo �' <br /> TE T MAIL ADORE55 CITV ZIP PMONE <br /> � .flC/y/.A:�.O ��L��et?�.(.rr ��i1�L9�06 �.�S77�S <br /> ARCMRECTORDCSIGNER MAILADDRE55 GTY Z1P PHONE <br /> Ga��`�DGQ �,�/t �o/�u �O �j14/ a�,j�9�2 <br /> GENCRAL ONTqpCTOR MAILRUDRE55 � qiY ZIP PHONE LICENSEI <br /> %v,c�r.sd' �r�s- �s,.�:r �r 9 ti�.s <br /> MECMRNICRLCONTRALTOF MAILADORESS dTY � PMONE LIGENSEs <br /> �s�.s�/` �� �f1P6�e�� fv <br /> PLUMBINGCONTRACTOR IA4ILADDRESS / GITV ZIP PHONE LICENSER <br /> �-� / / 7 <br /> L�iVI//� /i <br /> CLNSS OF WpqK <br /> � �� NEW '. �� ADDITION nALTERA ION � : REPAIR ' DEMOLITION ��. . WOODSTOVBFRPL INSEFT � �� BUILDING RELOCATION <br /> �' CONTACT PEP:.ON AND PHONE NO. <br /> ,(y � � i <br /> GONTfUCT PPICE OF W0 — OO� � <br /> pESCIUBEWORKAND50UARE OOTAGEiNVOLYED <br /> � ��474 �7 <br /> PROPOSEDUSEOFBUILDING ,�/ HEFEBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> O�y X �"/' 7�' APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECL ALL <br /> ' LEGALDESCRIPTIONOF PROPEFTY�SNOWN BELO ORATTACN F RCOPIES� PROVISIONS OF LAWS AND ORDINANCES GOVEFiNING THIS TYPE OF <br /> ''�}� ''' �or eiocK ov ��� �'�'ORK WIIL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR I <br />� I ��•:'� � , NOT. THE GRANTING OF A PERMIT DOES VOT PRESUME TO GIVE <br /> � AUTHORITY TO VIOLATE OR CANCEL TH� PROVISIONS OF ANY I <br />� OTHER STATE OR LOCAL LAW REGULATING�JONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I hM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 1 .27 RCW AND 296200 WAC. �����'�L1Y <br /> SIGNR7UREOFCONi pqUTMORI2EDAGENT DFTE �� <br /> X /0 �3 - � / <br /> PRQIECT RDDR[SS � <br /> O ' � P A BUSINESSLICENSE I151NESSN�AIE <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM EE NO. TVPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) A/C—FVHNDLG UNITS—H.P. <br /> BATHTUB ; FORCED AIR SYSTEMS—B.T.U. M E.A. <br /> LAVATORY(WASH BASIN; UNIT HEATERS—B.T.U. M <br /> SHOWER CI.OTHES DRYERS � <br /> KITCHEN SINK 8 DISP i VENTILATION FAN � <br /> DISHWASHER RANGE HOOD <br /> LAUNDFY TRAV ; WATER HEAI'ER � <br /> CLOTHES WASHER WOOD STOVE <br /> URINAI METAL FIREPLACE 8 C NEY <br /> DRINKING FOUNT FIREPLACE INSERT � <br /> FLOOR DRAIN HEAT PUMP <br /> BACKFLOW EVENTERS GAS PIPING <br /> ROOF DR S—RAINLEAOERS EXHAUST F ; <br /> SINK� RVICE—BAR,ETC.) � , <br /> � <br /> � <br /> � <br /> �� SUBTOTAL $ ; / SUBTOTAL $ � <br />' PERMIT $ PERMIT $ <br /> "fOTAL FEE $ � TOTAL FEE $ <br /> FOR OFFICE USE ONLY: <br /> ivn- yc <br /> FflONT SFTORCK HEFR SEiBAGN SIpE SETBACN PUN CHECK UMBER FEE RECEIPT NO <br /> i _ yc, s-�rJG a�,'�7 3 �.o•�Co. os S'��� 9 <br />` usezorie � �oraAen VACRNiSITE FEES VALUATION FEE <br /> I �- N(9 , <br /> BUILDING �7 � � � a 7 �Q a <br /> 7VPC 0 CONlS PLIOWABLE iYPE Oi CONSi RCiUAL occm�vcr No a oWFwMGUN��S "q U� � <br /> I �N �'N �9p .� PLUMBIN y.� �+ � <br /> SizeoFa�oG NoovsiqiiEs ASEMENT MECHAN '�� �L/ <br />�� 1�7a �-�� Y-�'� ���w t�av � <br />�I OCLOPA�NgY�L,OAD FlR[SPRNKLERSREO'0 HEIGHTLIMITATION ADDI7iOf c�(� / � ? � <br /> I Y�'G Y(S��y�Ar�T�!�/��-/�",klt' on+ea ���� �'i[OO. �. ; _ s <br /> 1 FEASONFOPSPqINKLERS C�V/hil 4�1�C� ''— �/ <br /> �� �Y � � II � <br /> I '�J �I:�T. ��T^U��C/ STATE 01 �7 � --?j-� <br /> W1ANE8V PLANSAPPROVE�BV CITYOFEVEHETT PU�LIG\ �� <br /> LOCAL SALES <br /> ��,�J) � TAX COUE IS 3105 1orn� � - - �� �r. �� <br /> 'F ' <br />