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���� � � <br /> APPLICAT�ON FOR CONSTRU�. �ION PERMIT ��`'`�" <br /> .�.�: <br /> e �-� <br /> � tlre Evergmen TO BE COMPLETED IN INK—PLEASE PRINT <br /> CIT�OF <br /> eve rett HEATING SYSTEM ]GAS U ELECTRIC ❑ � <br /> BUILDING DEPARTMENT <br /> 2`,9-8810 <br /> DEMOLITION COMBINATION 7� BUILDING MECHANICAL PLUMBING SIGN <br /> �-"� OWNER MNL�DDPESS LIiV Z�P Pl10NE <br /> � 87C.1� (�u4�lEs A/� Z �e�o� oR. 6Je¢e77" 779 - 5247i <br /> k Z�p PMONE <br /> , tE��pryt M4R�DDf1E55 CItY <br /> ARCHrtEGTOR0E51GNER MMLFDDRE55 <br /> CITY 21P PNOHE <br /> Gw'.NrERPLLONTRACLOR MAILAO�FESS <br /> GiV ZIP PNONE LICENSE• <br /> ��y </W N E PNONE LiCENSE• <br /> IAECNANICAI LONTR�CiOR IANL AODRESS GIiV ZIP <br /> D�x QTY ZiP PNONE UC[NSE� <br /> ❑ N PWMDiNGCONTP�GtOB MnII�DORE55 <br /> ay!C�v+ <br /> yG"�H CLASS OF WORN - <br /> T �/ <br /> k y� ,\ NEW � ADDITION NTER TION FiEPAIR DEMOLITION WOODSTOVEIFRPLINSERT f. BUILDINGRELO <br /> �"� � CONTACTPERSONRNDFHONENO <br /> � yH �'Z �t�� CK�r) T�t�t'.ZY �R�'-T' - �'79 • 5Z4-Z <br /> CONtRACT PRIGE OF 1VORN I � <br /> F] z� DESCRiOE WORK AND SOUPRE FOOTAGE INVOLVEO �. <br /> � � 4 8 c� � s��- c.�.��P.-�- <br /> d l+FOPOSEOUSEOFBUiLDING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> G�R���T qpPLICATION AND KNOW THE SAME TO BE TRUE ANO CORREGL ALL <br /> � �gL[GAL OESCPiPT10NOf PROVFRTY�SHOWNBELOW OR ATTACM FOUFCOPIESI PROVISIONS OF LAWS AND ORDINANCES GOVER�JING THIS 7YPE OF <br /> ,C�� f] WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> � y� �or Z 3 e�ocn _� or �.T O F NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANV <br /> t� �..�y S�G G�v�-( Lt OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OF THE <br /> N PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> � �..� OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> dC/7 �L , �� ?�" qppLICATION IS MADE AND I COMPLV WITH THE STATE <br /> � �,�"� CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br /> SIGNATUREOFCONTRACT OHRUiNOHIZEDAGENT DATE <br /> H tn <br /> H O�n <br /> PRQIEGTA�DRE55 r qpp��CA SCItYBU MESSLiLENSENO.AND9USINE55NAME <br /> �'i�a /—LoR/O F �,� . <br /> PLUMBING MECHANICAL <br /> � NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> V�ATER CLOSET(TOILET) A/C�AIHNDLG UNITS—H.P. <br /> 'a. � FOFCED AIR SYSTEMS—B.T.U. M E.A. <br /> _ ' BATHTUB UNIT HEATERS—B.T.U. M <br /> LAVATORY(WASH BASIN) <br /> SHOWER CLOTHESDRYEflS <br /> f � KITCHEN SINK 8 DISP VENTILATION FAN <br /> ,�I DISHWASHER RANCaEH00D <br /> LAUNDRY TRAY WATER HEATEfl <br /> CLOTHES WASHER WOODSTOVE <br /> �� � URINAL METAL FIREPLACE 8 CHIMNEY . <br /> '�i DRINKING FOUNTAIN FIREPLACE INSERT , <br /> FLOOR DRAIN HEAT PUMP <br /> � BACKFLOW PPEVENTERS GAS PIPING � <br /> ROOF DNAINS—RAINLEA�EflS EXHAUST FAN <br /> ' SINK(SEfiVICE—BAR,ETC.) , � <br /> �=1 1 _ II <br /> SUBTOTAL B SUBTOTAL 3 I <br /> � PERMIT $ <br /> ' �! TOTALIFEE S TOTALFEE 5 <br /> FOR OFFICE USE ONLY: <br /> '��� FRONTSEtBACK FEARSEI LK SiDESEi�ACN PIANCNECNlIUTABER iEE PEGEiPTNO <br /> �. 5�' g 90 �.�3� s� y4Po 3 ��r <br /> usE io�+e �or aaea VAGA1+15i�e FEES VALUATION FEE <br /> 'R- ti pp N� BUILDING QGO- 7�C '�n <br /> IYPE Of C01115 >llOVlABIE IVPE Oi CO'ISt AL1lIAL xLuoUp v x0 arv�twucux�ts — <br /> PLUMBING <br /> "P Al �"hl <br /> SRE OF BLDG. NO.OF ST08IE5 DASEI.1ENi MECHANICAL _ <br /> 486 I ^�v <br /> ADDITIONA�PLAN CHECN <br /> OCGUP NCYLOAD FlR[SPRtMLlRSRGOD HEIGMTLrtA4�yJN <br /> HlJ ( S OTHER <br /> RETS NFOi15PqINHLEfiS ��3� <br /> STATE�UILDING SURCHARGE <br /> INTAKEOY PLANSA['PROVFDO'/ CITYOFEVEflE1T PUBLICWORK$ � <br /> LOCAL SALES � (p jS0 <br /> � � q TAX CODEIS 3105 rora� <br />