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APPLICATION FOR CONSTRUCTION <br /> PER!!�IT <br /> the Evergreen everetl <br /> GTV OF � <br /> e��erett <br /> BUILDING DEPARTMENT <br /> 269-6ato TO BE COMPI.ETED IN INK— PLEASE PRINT <br /> OWNEP MAIL�DORE55 CIIY 21P PHON[ <br /> BERGSAG� c. CoiYSTR Co� 111�.2 .Z��h/�VE.. S,z�. �UF12�7'f' S2o� .�.3�7-U'727 <br /> TEN�NT M�ILPDORE55 CiY �ZI� P110NE <br /> �� �� _ <br /> �OGYITECTOf10ESIGNER M�ILRD�HESS CIiY 21P PI.ONE <br /> l� � r <br /> GENERAlCON1AACfOR MRIL�DDRE55 CITY ZIP FHON[ IIGENSE• <br /> , � c� ��,e�rcc r3so g <br /> AIECN�MGLCONiRRGTOR M�IL�DDRE55 CITY GIP PNONE IICENSE� <br /> �( k <br /> PLUMBINOCONLPle,CtOA M�Il�0�RE55 CIIV ZiP P�IONE L6ENSE• <br /> R � <br /> CU55 OF N'OHIt <br /> NEW ❑ AODITION ❑ AITERATION ❑ REPAIF ❑ DEMOLITION ❑ WOODSTOVFJFRPLINSERT ❑ BUILDINGREIOCATION <br /> TEN�NTIMPROVEMENiORINTEP10R REMO�ELONLY CONTAGTPERSONRNDPHONENO. <br /> CANTRACTFRILEOFWORK ,KcX 7S0 a� ���-- �• ��GSAG�'-C_ 3.��'���2� <br /> OESCNIBEWORN�NDSOWREFOOi�� pINVOLVED �� C ,.,-. <br /> pppvo9�5EOFBU�i�a /��D '�'n'�,—�I �� C IH REBYCw1'�FYTH�AT H VEREADANL`EXAMINEDTHISAPPLICATIONAND <br /> ��Sl�iQ'L_ O�y��� KNON'THES�METOBETRUEANDCORFECT.ALLPROVISIONSOFLAWSAND <br /> icc��oesceirriorvorPeoaearvly�a+'�+e ���nen�C�irounCoriesl � ORDINANCESGOVER�INGTHISTYPEOFWORKWILLBECOMPLETEDWITH <br /> W HETfiER SPECIFIED HEREIN OR NOT.THE C�RANTING OF A PERMIT DOES'IOT <br /> L � �,�r��� PRESUMETOGIVEAUTHORINTOVIOLATEORCANCELTHEPROVISIONSOf <br /> �Or B�ocK oF ANVO7HERSTATFORLOCALLAWREGULATINGCONSTRUCTIONORTHEPER• <br /> FORMANCE OF CUNSTRUCTION.THAT I AM AUTHORI2ED BY THE OW�.ER OF <br /> 'n,�� ��� !% � THIS PROPERN TO PERFORM THE WORK FOR WN�CH APPLICATION IS MADE <br /> V(Jl ��� A11D I COMPLY WITH THE �TATE CONTRACTORS LAW 1827 RCYf AND <br /> 2d6.200 WAC. <br /> .4GNRiVf1EOFCONTRRCiORONRU1110R12EDAGENT D�IE <br /> ��� ru�Q�„— c�fl,_� X F.Q. ���— Y�v�B'9 <br /> FPOJFCTAO�RESS � � err� 4i5CItYBUSINESSLI .NSEN �NODUSiNE55N�ME <br /> 9J��o3 BE26S116�C. �NSTR.�. <br /> PLUMBING MECHANICAL <br /> NO. TYPEOFFIXTUREORITEM FEE NO. TYPEOFEOUIPMENT FEE <br /> WATER GLOSET(TOILEn A/C—A/HNDLG UNITS—H.P. _ <br /> I BATHTUB FORCED AIR SYSTEMS—B.T.U. M EA <br /> LAVATORYIWASH BASIN) UNIT HEATERS—0.T.U. M <br /> SHOWER CLOTHESDRYERS <br /> 2 KITCHEN SINK3 UISP. f VENTILATION fAN <br /> ,Z DISHWASHER RANGE HOOD <br /> LAUNDRYTRAY WATER HEATER <br /> CLOTHES WA6HER WOOD STObE <br /> URINAL METAL FIfiEPLACE 8 CHIMNEV <br /> DRINKING FOUNTAIN FIREPLACE INSERT <br /> I FLOOR ORAIY HEAT PUMP <br /> BACKFLOW PREVENTERS GAS PIPING — <br /> ROOF DRAINS—RAINLEADERS ExHAUST FAN _ <br /> SINK�SERVICE—BAR,ETCA — <br /> SUBTOTAL S SUDTOTAL S <br /> PERMIT 5 PERMIT 5 _ <br /> . TOTAIFEE S TOTALFEE $ <br /> FRONTSETB�QK NEARSETOACK� , SIDESE�MC VUNCNE NNUMPER FEE IIECEII'TNO. <br /> 2o�a'� �'J,96 S-� � �.� � 3 �- a 3 <br /> usezoee �ounEn d�7 VAGNi511E FEES VAWATION FEE <br /> R—� � �/"I 1 S��fT,. r[s n rvo — <br /> Y BUILDING <br /> TYFEOFCONST. OCC�IGYONOUP NO.O/i��WELLIN6UN1i5 — <br /> ALLOWAl�Ll�CL1UrZAK •/ pt,UMBING _ <br /> U /� <br /> SIZEOFOL � NO.OFSiOPIES �c occ�o�o MECHANICAL <br /> /3�?7 o N — <br /> NEIGHiIIIAITA710N OTHER <br /> FIRESPFINNLERSPEOUIf1E0 ❑YES NO N/T. STATEBUILDINGSURCHARGE <br /> STATE ENERGY SURCHARGE <br /> APPVC��ION�CGOY PUNS�PPfl.OY �UB��OWpRKS <br /> �� TOTAL <br />