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Ihe Evorgreon <br />CITY OF <br />ever�tt <br />BUILDING DEPARTMENT <br />259-8810 <br />;;�;}�;') <br />APPLICp�IOhl FQIR CONSTI�Irc�T00N <br />PERINlT <br />TO BE COMPLETED IN INK— PLEASE PRINT <br />owHEn Mnunooness � c�rv <br />V��7\S CC� <br />1EN41i h1AllA�DqESS CIIY ZIP PHONE <br />�j�� S�O t�' �� �S �V�'LG�.� G A� k2c'L�l—��.1�.4�_-( <br />ANCH11ECfO11�E510NER MNIADDRE55 CIIY ZIP PHONE <br />L`VCfCII <br />� <br />OEHE1iA�CONin�C1UR M/.i�A00R[55 CIIY 21P PIIONE LIGENSE� <br />�� vQ-T \-1 C O N S-I <br />MECIIeNIG�LCONiR+CiOR MTILADOPESS CIiY 21P PMONE LICENSE• <br />PLUMBiNOGONiRACTCfl MPILR00lIE59 CIfY ZIP `1PIION`��`� IICENSE� <br />�N � <br />(11.K \ �i L�r��� NC \`tZ \o �'3�� 11.�P �aP ��y,�c�t c.�v � i i E q4s5`17_ a��L ��_l—. �� �1 <br />CUSS OF WOP1t <br />❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FHPL INSERT <br />IENRNT IMP90YEMENT OR IN7EBIOR REIAODEL ONLY CANTACT PEfI50N RND PMONE N0. <br />LOT ULOCK OF <br />PLUMBINO <br />NO. i <br />� WATER CL <br />BATHTUB <br />7 _ IAVATORY <br />LAUNORYTRAY <br />CLOTHES WASHEIi <br />ROOF DRAINS — RAI N <br />SINKISERVICE— BAR, <br />I�LIOW�BLE/ACTUAI <br />ITEM I FEE <br />TOTAL FEE <br />o res ❑ no <br />❑r <br />❑N <br />❑ YES [] NO <br />❑ BUILDING RELOCATION <br />I H EREBY CERTIFY THAT i HAVE READ AIJD EXAIAIN ED THIS APPLICATION AND <br />KNOW THE SAME TO BE TRUE AND COP.RECT. ALL PROVISIONS OF LAWS AND <br />ORDINANCES GOVERNING THIS TYPE OF lM1'ORK WILL BE COMPLETED WITH <br />WHETHER SPECIFIED HEREIN OR NOT.THEGRANTINGrIFAPERMITDOESNOT <br />PRESUME TO GIVE P.0 �HOPIN TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OF THE F'ER• <br />FOR1dANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BV THE OWNER OF <br />THIS PROPERTY TO PCRFOfiM THE WORK fOR W HICH APPLICATION IS MADE <br />AND I COMPLY WITH THE STATE CONTRACTORS LAW 1827 RCW AND <br />298.200 WAG <br />5101lRTUREOFCONLflACiORORAU1HOfUZEO�GENT DATL �`r�`Z'$� <br />X�1�t��... `C: ��� <br />APPUCFNiS QiV BUSINE°5 UCENSE NO.I.ND BlI51NE55 NAME <br />MECHANICAL <br />I:O. TYV'E O <br />A/C — A/HNDLG UN <br />FORCED AIR SYSTE <br />UNITHEATERS—R <br />CLOTHES DRYERS <br />VENTILATION FAN <br />Y`'ATER HEATER <br />WOODF,TOVE <br />METAL FIREPLACEB GHIMNEY <br />GAS PIPI� <br />E%HAUST <br />TOTAL <br />FEES <br />BUILDING <br />PLUMBING <br />MECHANICAL <br />OTHER <br />STATE BUILDING SUFCHARGE <br />STATEENERGVSURCHARGE <br />P' BLIC WORKS <br />TOTAL <br />VAL <br />FEE <br />