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rs- .. %y,� ..., <br />APPLIC�'�r ION FOR CONSTR4'�TION <br />� PERMIT <br />the Evergreen <br />CITY OF evcrell <br />everett � <br />BUILDING DEPARTMENT <br />259•8810 TO SE COMPLETED IN INK — PLEASE PRINT <br />ownen nmunooness cin zir r�wNe <br />y�������A�so�. ��as� 3��.��F�.-,�. sE,�. 9.�iis 5a7-aPk.f <br />TENRNi MAILAOOFE55 CIIY 21P PHONE <br />nXJF✓1�16 .9/R/�A/t•'E Cd. j7/Q GVF.�'1��'!=`fN WiF`� ,Ei/E:['bT/ — <br />ue��vnu�m�nu� mni �uur.coa �nr <u• rnune <br />��`s� //�� ��,e� ��ry ur•,ri,E-. ;s�- S'�/�S 3�7-3��aa <br />QENEMLCONIBACTON MAILADORE55 ITV ZIP PIIOtlE ULENSC• <br />,c��ce�v >�, /lo/%Z 9sT.��a� 5�� �����ar.;�� �sa�v <br />MECHFNICRLGONTRACTOP MAILR�ORE55 CI7Y ZIP PMONE LICENSE• <br />/�/IALDGNAGD N:LCE.� 7%/J Y��%!ZG/%?7.l.C''., $�i�f `,i�+'/Ci/e f(�3-9?�G+�i hlA4ct.�x'�•Y <br />PLUMBINOCONIMCTOFl MAILAUORE59 GIIY 21P y 1'110NE �GERSE� <br />�AG/.�CN.4�t-O M/L�i°� ��/.i'qG� � /f!jy,SpU� <br />❑ NEW ❑ ADDITION <br />JVCLV�'ILl <br />a.,� s�� <br />iot a�ocK ov <br />❑ REPA�R ❑ DEMOLITION ❑ WOODSTOVE/FRPLINSER7 ❑ BUILDINGRELOCATION � <br />77/0� C��x��v �u,� <br />�� PLUMBING <br />NO. TYPE OF FIXTUHE OR ITEM <br />WATER CLOSET(TOILEn <br />BATHTUB _ <br />� LAVATORVIWASHBASIN) <br />SHOWEFi <br />� KITCHEN SINKS D�SP. <br />� DISHWASHER <br />� LAUNDRYTRAY _ <br />i CLOTHES WASHER <br />i URINAL <br />�, DRINKING FOUNTAIN <br />• FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />ROOF ORAINS — RAINLEADERS <br />SINK (SERVICE — 6AR, ETG) <br />! � c.F?E Ex�sT.r, tii } r <br />SUB TOTAL <br />A <br />fIPE SPRINNLEFS REOUIpEO <br />TOTAL FEE <br />5 <br />a <br />5 <br />O YES o no <br />/i/13f:�i�.�s <br />;'G3�9?�c <br />I HEREBV GERTIFY THAT I HAVE RE/1D AND EXAMINED THIS APPLICATION AND <br />KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS AND <br />OROINANCES GOVERNINCa THIS TYPE OF WORK WILL BE COMPLETED WITH <br />W HETHEF SPECIFIED HEREiN OR NOT. THFGFANTING OFA PERMIT�OES NOT <br />PRESUME TO GIVE AUTHORIN TO VIOLAIE OR CANCEI THE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUC710N OR THE PER• <br />FORMANCE OF CONSTRUCTION. THAT I A1A AUTHOf71ZED BY TNE OWNER OF <br />THIS PROPERN TO PERFORM THE WORK FOR W HICH APPLICATION IS MkDE <br />AND I COMPLY WITH THE STATE CONTRACTOflS LAW IB27 RCW AND <br />296200 WAG <br />SIGNqTUf1E0FGONTPACiOROqAU1NOfiRE0A4ENt �AiE <br />x/^�CeGP.t�'i U" '/1/I!}G��r-- �ja%'.�/G ��� <br />APPLICANiS CITY �USINE55 LiGENSE NO. ANU O115111E55 NANE <br />MECHANICAL <br />FEE NO. TYPEOFEOUIPMENT <br />A/C— A/HNDLG UNITS— H.P. <br />.�{ FORCEO AIR SYSTEMS — 6T.U._ <br />�I/� � UNITHEATERS—B.T.U. M <br />RANGEHOOD <br />WATER HEATER <br />'—' MEfALFIREPLACEI <br />� FIREFLACEINSERT <br />HEATPUMP <br />SUBTOTAL 5 <br />PERMIT S <br />FEE <br />FE@S I VALUATION I FEE <br />' NO.OiJWElLIN40N17S BUILDING <br />PLUMB�NG <br />65ML pLGLOAD <br />❑ Y MECHANICAL <br />ON <br />MCIGNTLIMITRLION OTHEF <br />STATE BUILDING SURCHARGE <br />STATEENERGYSURCHARGE <br />� PUBLIC WORKS <br />TOTAL <br />