430 SW EVERETT MALL WAY 2018-01-01 MF Import

APPLIC�rION FOR CONSTRV.:TION PERMIT fhe Iivergreen CIP' OF everett �verett e BUILDING DEPARTMENT 259•8810 TO BE COMPLETED IN INK— PLEASE PRINT OWNEP MAILADOliE55 LITY ZIP PHONE � PLUMBIN GON RACTOP MNLADOPESS CITV ZIP PHONE LILENSE+ ��-,�1�� C.f� . f��0 - (�v� ��lc�-f . �w� � R�x>o �Gl40E�g1'147G�J"'I CLASS OF WOflK �L. NEW ❑ A�DITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/fRPL INSERT ❑ BUILDING RELOCATION CANTRPCT PflIGE OF WOflK LOT BLOGN OF PLUMBING WATER CLOSET BATHTUB LAVATORY IWAS . KITCHEN SINK 8 DISF � DISHWASHER LAUNDRYTRAY � CLOTHES WASHER UFiINAL � DRINKING FOUNTAIN FLOOR DRAIN SINK TOTAL FEE S ALLON'A9LE/ACTUAI ❑• ❑n PIRESGPINKLEfl5RE0UIPED ❑ YES ❑ NO �798 ' ((os� 1 HEREBV CERTIFVTHAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORHECT. ALL PFOVISIONS O�� LAWS AN D ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREINOR NOT.THEGRANTING OFAPERMIT DOES NOT PFiESUME TO GIVE AUTHORIN TO VIOLATE OR CANCEL THE PROV{SIONS OF ANYOTHER STATE OR LOCAL LAW FEGULATING CONSTRUCTION ORTHE PER• FORMANCE OF CONST(iUCTION. THAT I AM AUTHORIZED BY THE OWNEF OF THIS PROPEi1TV iO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE CONTRAGTORS lAW 18.27 RCW AND 296200 W.4C. 514NATUREOFCONTRPGTOROPAUTMORREDAGENT DFTE % 5� Y( ,/ n R � .... n <(26r� ( MECHANICAL NO. ^� PE OF EOUIPMENT iNDLG UNITS— H.P. 41R SYSTEMS— B.T.U. M CLOTHESDRYERS VENTILATION FAN RANGEHOOD WATER HEATER WOOD STOVE METAL FIREPLACE 8 CIiIMNEY FIREPLACEINSERT HEAT PUMP GAS PIPINCa E%HAUST FAN PERMIT TOTAL FEE VACANT SRE FEES ❑ VES ❑ NO BUILDING NO.OF DWELLING UNITS PLUMBING oca �ono MECHANICAL HEIGHTCMITATION OTHER _ STATE BUILDING SURCHARGE STATE ENERGY SURCHARGE PUBLIC WORKS TOTAL VALUATION S FEE