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AF�t�G.ICA'PIOt� FOR C�DNSTRI;�YION <br />PERNfIT <br />(�e Evergraon ' <br />CITY OF evere❑ <br />ev�rett � <br />BUILDING DEPARTdAENT ' <br />253-BBiO TO BE COMPLETED IN INK— PLEASE PRINT ( <br />ONNER I,IpILApDliESS CItV Zip pryDNE <br />�\• (pp� �'`� 3Cp"��1�f�i� <br />SC�Qt•�lG� Y�n.�CJ'��� ��.,.> 'C �.r�„ T�n� =�G"' � J� JeC� �� FVGT�-�146ZGi <br />TENA`N (� MpILA��RE55 ( � GTY ZI c� I�MONE � <br />'1� � \-L� ���� \`i��� �-Ve U.�. \'L �^�21 � \�'LU i <br />r1RCI11TEGTORDE5IGNER IAAILRODqE55 CITY 2�P PM�� <br />��atv�e •f <br />GENEflALCONiRACTOF MA:LAO' �E55 <br />MELMRNICR� TRaCTOfl� .....rt....L_�55 <br />/. . <br />LICENSEa , <br />PHONE LILENSE� <br />❑ NEW � AD�ITION ❑ ALTERATION ❑ REPAIR ❑ OEMOLITION ❑ WOODSTOVE/FRPL INSERT ❑ BUILDING RELOCATION <br />���.,.�.��m.,,....,.,.......,.,...,.,....,...��,.,,�,...n�`�T/�J L= <br />CONTRAGT PPICE OF WOflK <br />' C�Q ^C.0 <br />LOT� �_ ��OCK OF <br />PLUMBING <br />NO. TYPE OF FI%TUHE OR ITEM <br />WATER CLOSET(TOILE'f) <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINKS DISP. <br />DISHWASHER <br />�AUNDRYTRAY <br />CLOTHES WASHER <br />UFiINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />flOOF DRAINS — RAI NLEA�EqS <br />SI NK (SERVICE — 6AR, ETG1 <br />SUB TOTAL <br />__ PEFMIT <br />TOTAL fEE <br />FRONi5EiE1uCH fiEARSET�AGN <br />� <br />USE220NE �j LOT EA <br />v' !� <br />TYPE OF CANST. OC W PANCY GPOUP <br />�LLOWPBLE/qCiuAL , �V <br />'T� N z <br />_Y. <br />SIZEOFBL�G NO.OFSTORIES BSM' <br />�6 � / o r <br />1 N <br />FIPESPflINKLER5flE0UIRED ❑YES �j10 <br />PPPLICATION CG BY PLqNSAPPH.OY <br />od�-� <br />FEE <br />$ <br />❑ YES �0 <br />h�,'S' L�1`6 � <br />i ntHttlY c:EFTIFY THAT I HAVE REAU aND E%AMINED THIS APPLICATION AND <br />HNOW ?HE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS AND <br />ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLETEO WITH <br />WHCTHER SPECIFIEDHEREIN OR NOT.THEfiRANTINGOFA PERMIT�OES NOT <br />PRESUME TO GIVE AUiHORIN TO VIOLA7E OR CANCEL THE PROVISIONS OF <br />ANV OTHER STATE OR LOCAL LAW REGULATINCa CONSCRUCTION OR THE PER� <br />FOflMANCE OF CONSTFiUCTION. THAT I AM AUTHORIZED BY THE OWNER OF <br />THIS PROPERTY TO PERFOP,M THE bVORK FOR WHICH APPLICATION IS MADE <br />AND I COMPLY WITH THE STATE CON(RACTORS LAW 1827 RCW AND <br />29u200 WAC. <br />SIGNRTUREOFLONTFACiONORPUiMOflIZEOAGENT DATE �/�'J� <br />15 S� S (o <br />APPLI�NTSGITY SIN�NS[N0.�1 BO [SSNRME <br />MECHANICAL <br />NO. TYPE OF EOl <br />A/C — A/H� DLG UNITS — <br />FORCED AIF SYSTEMS— <br />UNIT HEATERS— B.T.U. <br />CLOTHESDRYERS <br />VENTILATION FAN <br />WOOD STOVE <br />METAL FIREPLACE 8 <br />HEAT <br />FAN <br />FEE <br />SUBTOTAL Y� <br />PERMIT ;, <br />TOTAL FE[ <br />UMOEfl FEE O NCEIPiNO. <br />�,�g �Ic g ��i a3 <br />FEES ;�ALUATION FEE <br />WEILINGUNiTS BUILDING __ <br />—� PLUMBING <br />�D <br />�MECHANICAL <br />i� <br />.irA1iRT10N OTHER <br />� <br />STATE BUILDING SURCHARGE <br />STATE ENERGY SUf:CHARGE <br />PUBLIC WORKS <br />TOTAL <br />0 <br />