7705 EVERGREEN WAY SUB SHOP 2016-01-01 MF Import

��,i^, �,: �:� APPLIC�fION �OR CONSTRI:��TION � PERMIT fhe Ever��aen CITY OF ever�tt BUILDING DEPARTMENT 259•8810 TO BE COMPLETED IN INK— PLEASE PRINT everell � MCHITECTONDESIGNEfl 1 MAILADOFE55 CITY 21P PHONE � �UYl��i1C%- GENER�LtONTflAG70P MAILFUDNE59 GITY ZIP PHONE IIGENSE• PLUMBINOCONTBFCfOfl n:iILRDDRE55 CITY ZIP PNONE LICENSE• ❑ NEW Ky A�DITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ Wc10D5TOVEIFRPLINSERT Q �UILDINGRELOCATION PpICE OF WOHK LOT BLO^.N OF PLUMBING NO. WATER SHOWER KITCHEN SINKB DISP. OR ITEM URINAL ORINKING FOUNTAIN FIOOR DRAIN _ BACKFLOW PREVENTERS ROOF DRAINS— FAINLEADERS muvieeomnr_aew FTm SUB TO' PEFMIT ov ❑N ESPPINKLER�PEOUINEO ❑YES APPLICRTIONALGBY LRN56vPR.BY � � S n 1 HEREBY CERTIFY THAT I HAVE READ AND E%AMIN ED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PR041SION5 OF LAWS AND ORDINANCES GOVER�VING THIS TYPE OF WORK WILL BE COMPLETED WITH WHEfHER SPECIFIED HEREIN OR NOT. THEGRANTING OFA PERMIT OOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHER STATE OR I.00AL LAW RE�ULATING CONSTRUCTION OR THE PER- FORMANCE OF CONSTRUCTION. THAT I AM AUT40RIZED BY THE OWNER OF THIS PFlOPERNTO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE CONTRACTORS LAW 18.27 RCW AND 296200 WAC. SIGNpTUREOF N A?OP011F111MOR OpGENT DAtE X l�l�_ � /T � �Cj, r RPPIICRNISC 9USINESSIICENSENO.PN00U51NESSNAME MECHANICAL TYPE OF EOUIPMENT �LG UNITS — H.P. i SYSTEMS— B.T.U. M RS—B.T.U. M RANGEHOOD WATER HEATER 8 CHINNEY HEATPUMP GAS PIPING SUBTOTAL S PERMIT S TOTAL FEE S �LAN CNECK NUMOEfl FEE PECEIPf N0. FEES VALUATION I euaoiNc PLUMBING MECHANICAL , OTHER STATE BUILDING SURCHARGE STATE ENEP.:iY SURCHARGE PUBLIC WORKS TOTAL FEE