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�.� . ;';,',i _��i <br />APPLIC/�`r ION FAF! CONSiR4��'IOM <br />PERMIT <br />fhe Evorproan <br />CITY OF <br />i�vcreu <br />evPrett � <br />BUILD, JG DEPARTMENT <br />259-8810 TO BE COMPLETED IN INK— PLEASE PRII�T <br />owr+er+ A1nILp�Of1EG5 cirr ;.ir vnor+e <br />/-�.1/LviGitl �AiSC�:. `�7d� ,3�`�.�vF.Z.�.E, v`GA. %�//s 5'a7-a0BS— <br />IENANi MI!�p00HE5S CIiY ZIP PIIONE <br />P..�F'..,�i�G ,9iRF�9�c.'E G'�j. I7/Q L•VF�+'1��iN lU�f-`/ �11��� <br />� <br />APCIIRECTOROESIGNEP MAI�A�DRESS CILY ZIP PHON[ <br />C-��,�' /��� ��+,eFc�ry u�r�.v.E-. ,;� �'�/�� 3�7-3���a <br />OENEMLCONiRACi011 MAILr10DfiESS ❑Y LP PIIONE �ICENS[• <br />�l�ceN /,i�L, /l.�//cZ _ qs''p�v� 5t� Si1���/or.;i� �6-a9v <br />MECIIANICALGOIIiPACiOR MAILAD�RE55 CIiY 21P PHONE �ICENSE• <br />f/�ALD�NAGD N6!GCE".� 77/7 ��%/Zc�7" 3.r,<<. S��F ���'/Gr,, �� 3-94c+-% M�,cf�Q�$"��''iC� <br />PLUMOIN4GONiP�CTOR MAllRo0NES5 GII�Y ]IP PIIONE �CE�EY—� <br />f.iAc/�ci�A.�o Mi�!!_=� �5 /••�•,� iFS A�se v� <br />❑ NEW ❑ AODITION yo� NLTERATION ❑ REPAIF ❑ DEMOLITION ❑ WOOOSTOVFJFRPL INSERT ❑ BUILOING RELOC�TION <br />� ti <br />._._........._'__._.._......_ ..A._..�.'"n"'__. <br />CANiPRC�PqILEOFWONK /Y P/•� S✓J <br />LOT BLOCN OF <br />, P/ ��/donG���.i1�l/�Gi <br />PLUMBING <br />NO. TYPE OF FI%TL <br />WATER CLOSFi (TOILET) <br />BATHTUB <br />LAVAIORV (W,15H OASIN) <br />SHOWER <br />' KITCHENSINKBDISP. <br />� DISHN.:'aHER <br />i LAUNDRYTRAI' <br />i C! OTHES WASHER <br />i _�7 URINAL <br />�. � DRINKING FOUNTAIN <br />• FLOOR �RAIN <br />BACKFIOW PREVEN7ER: <br />: <br />i <br />nvvr v .uva— <br />SIIJKISEFVICE— <br />AIlOWABLE/ACTUAL <br />IlEOUIREU ❑ YES ❑ NO <br />'Fi✓<a.v�L <br />L-�� <br />;'�3�9�c <br />I FIEREBY CERTIFY THAT I HAVE REA� AND EY,AMINED THIS APPI.ICATION AND <br />KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS AND <br />ORDINANCES GOVERNING THIS TYP[ OF WORK WILL BE COMPLETED Vr'ITH <br />WHETHER SPECIFIED HEREIN OR NOT. THE GRANiING OFA PERMIT DOES NOT <br />PRESUME TO GIVE AUTHORIN TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHEfl STATE OR LOCAL LAW REGULATING CONSTf7UCTION OR THE PER- <br />FORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE OWNEFi CF <br />THIS PFOPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE <br />AND I COMPLY WITIi THE ST�TE CONTRACTORS LAW 1027 RCW AND <br />296200 WAC. <br />SipH�TUREOfCONLPAGiOfiOiiAU1HORIZ[U/.GENI pATE <br />X /--�ceee�.� �_-�-, -�/1ac,2e�-- ��Q/i�t `�'� <br />�PPLICANIS CiTV OUSINE55 LIG[NSE NO �ND OUSINE55 NRME <br />MECHANICAL <br />FEE NO. ryPE <br />—' A/C—q/HNOLGL <br />FORCED AIR SY51 <br />� � UNITHEATERS— <br />_ CLOTHESDRYER'� <br />VENTILATIOi � FAN <br />RANGEHOOD <br />WATER HEATER <br />_ � _ <br />g i _ <br />a = <br />5 — <br />sioe seroncK <br />VACANT SIiE <br />❑ VES ❑ NO <br />FEE <br />— H.P. <br />— B.T.U. M E0. <br />M <br />METAL FIFEPLACE& CHIMNEY <br />FIREPLACEINSEFT <br />HEAT PUMP <br />)TAL 5 <br />T S <br />FEE 5 <br />neceiar <br />FEES � VALUATION I FEE <br />� r+ooFowe�ur�cururs BUIL�ING <br />PLUMBING <br />osn+r. occ wao <br />o v MECHANICAL <br />❑ �� <br />IIEIGNTLIMIiAiION OTHER <br />StATE BUILDING SURCHARGE <br />STATE ENERGY SURCHARGE <br />� PUBLIC WORKS <br />TOTAL <br />