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. APPLICMTION FOR CONSTR�CTION <br />PERMIT <br />f�e Evergreen <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />259•8810 <br />TO BE COMPLETED IN INK— PLEASE PRINT <br />OWNER MRILAOOPE95 CItY ZIP PMONE <br />Circuit Citv 9950 Mavland Drive, Richmond. VA 23233 (800) 627-2274 <br />TENANT MAIL.IODRESS GITY ZIP PHONE <br />Circuit City 510 S. W. Everett Mall WaY, Everett <br />AflGHITECTOR0E51GNEF MAILA�ORE55 CiTY ZIP PHONE <br />evere[t <br />e <br />GENERALGONTR�CTOR MAILFDOFE55 CITY ZIP PHONE LICENSE• <br />Plumb Siqns Inc. 5838 S. Adams. Tacoma. WA 98409 (206) 473-3323 PLUMBSI0770S <br />MECMRNICALGONTRFCTOfl MIILFDORESS GiTY 21P PHONE 4CEN5 � <br />PLUMBINGGONTRRGTOfl MRILADOflE55 CITY ZIP PHONE LIGENSE• <br />xE� NEW ❑ ADDITION ❑ ALTERATION ❑ PEPAIR ❑ DEMOLITION ❑ WOODSiOVE/FRPL INSERT ❑ BUILDING RELOCATION <br />CONTHRCT <br />� <br />Install fascia siqn & freesta <br />PROPOSED 113E OF 9UILDING <br />Retail <br />LE6AL UESCRIPrION OF PROPEfltt (SHOWN OELOW OR ATTRGH <br />LOT BLOGK OF <br />I HEREBY CERTIFY?HAT I HAVE READ AI�D EXAMINED THIS APPLICATION AND <br />KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS AND <br />ORDINANCES GOVERNING THIS TYPE OF WORK WILL 6E COMPLETED WITH <br />W HETHER SPECIFIED HEREIN OR NOT. THE GRANTING OFA PERMIT DOES NOT <br />PRESUME TO GIVE AUTIIORINTO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTH ER STATE OH LOCAL LAW REGULATING CONSTRUCTION OR THE PER• <br />FOFMANCE OF CONSTFUCTION. THAT I AM AUTHORIZED BY THE OW NEF OF <br />THIS PROPERNTO PERFORM THE WORK FOR WHICHAPPLICATION IS MADE <br />AND I COMPLY WITH THE STATE CONTRACTORS LAW 1827 RCW AND <br />296200 WAC. <br />SIGNATUREOFCONTRICTORORAUTHOPI2EDAGENT OATE <br />/ p ,� <br />X 1���:o2t����g��� 3/n/95 <br />APP�I�qNT5GTV8l/51NE55LIC NSENO 51 NAME <br />510 S.W. Everett Mall Way I <br />PLUMBIN6 . I MECHANICAL <br />FI%7UHE OR ITEM <br />BATHTUB <br />KITCHEN SINK 8 <br />DISHWASHER <br />P1:11:F7� <br />BACKFLOW PREVENT�FS <br />ROOF DRAINS — RAINLEADERS <br />muv�ecovice_ wna crc� <br />rp � 5 <br />SUBTOTAL S <br />PERMIT S <br />TOTALFEE S <br />! - I� YES ❑ NO <br />t�p <br />or <br />❑ N <br />FIRESPRINKlERSRE�UIFEO ❑ YES ❑ NO <br />TYPE OF E�UIPMENT <br />A/C — A/HNDLG UNITS — H.P. <br />�ORCED AIR SYSTEMS— B.T.U. M EA <br />UNIT HEATERS— B.T.U. M <br />CLOTHESDRYERS <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />WOOD STOVE <br />METAL FIREPLACE 8 CHIMNEY <br />FIREPLACEINSERT <br />HEAT PUMP <br />GAS f'IPING <br />EXHAUST FAN <br />SUBTOTAL 5 <br />�PERMIT 5 <br />TOTAL FEE S <br />FEE RECEIPfNO.Q � <br />j.�.LnS ��o�/"� <br />VALUATION FEE <br />BUILDING <br />/NITS <br />PLUMBING <br />MECHANICAL <br />OTHER <br />�ur STATE BUILDING SURCHARGE <br />STATEENERGYSURCHARGE <br />PUBLIC WORKS <br />TOTa� <br />