1305 SE EVERETT MALL WAY BASE FILE 2016-01-01 MF Import

, APPLICI�,'I�N FOR CONSTRI;.:TION PERMIT fhe Evergreen everet[ CITY OF everett e BUILDING DEPARTMENT 259•8810 TO BE COMPLETED IN INK— PLEASE PRINT OWNER AIAILA�OPESS CiTY ZIP PNONE �/��D /P(� B/'� /�O c S E, EuE,eErr rna cc c� Y E � F,P err c. � a. �rypryT MPILA��FE55 CITY � PMONE �� �LICMITECTOFDESIGNER MRILADORESS CITY 21P PMONE GENCPALGONTRACTOP MAILADDRESS GITY 21P PMONE LICENSE• Sou,vorr�7�ceP � SO_y��/� C� �iV'�_�/� � L� /a1`f�i C£R TTGf Gl �'�/�S� ;j6a-/y99 MECHANICAICONTRAC R MNLAODRE55 CITY 21P PNONE LIGENSE� PLLIMBINGCONTRAGTOB MAILROOBESS CITY ZIP PHONE LILENSE� ❑ NEW ❑ ADDITION ❑ ALTERATION ❑ FEPA!'7 ❑ DEMOLITION ❑ WOODSTOVE/FRPL INSERT ❑ BUILDING RELOCATION fENNNTIMPROVEMENTOFINTERIOPREM00/ELO'�NLY/'�J� � CONTACTPENSONANDPHONENO COHTRACiPRICEOFWOFk % � // �/ / _ _ _ u LOT BIOCK Oi '�4 /3os S•E . F � PLUMBING NO. TYPE OF LAUNDRYTRAY CLOTHES WASHER � REOUIflED ❑ YES ❑ NO ❑Y ❑ N ❑ YE3 ❑ NO FEE I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION ANU KNOW ?HE SAME TO BE TRUE AND CORRECT. ALL P(iOVI510N5 OF LAWS ANQ ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLETED WITH WHETHERSPECIFIEDHEREINOR NOT.THEGRANTINGOFAPERMIT�OESNOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHER STATG OR LOCAL Lt.W REGULATING CONSTRUCTION OR THE PER• FORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BV THE OWNER OF THIS FROPERN TO PEFFOfiM THE WORI< FOR W HICH APPLICATION IS MADE AND I COMPLY WITH THE STATE CONTRACTORS LAW 1827 RCW AND 296.200 WAC. �J p SIGNATUPEOFGONTRPCTOROflAUTHORI2EDPGENT OATE �J ��— p 9 �LA� � � MECHANICAL NO. TYPE OF EOI A/C— A/HNDLG UNITS— FORCED AIF SYSTEMS— UNIT HEATERS— B.T.U. CLOTHES DRYERS VENTILATION FAN RANCaE HOOD HEAT PUMP GAS PIPING E%HAUSTFAN SU B TOTAL PERMIT TOTAL FEE FEE BUILDING PLUMBING MECHANICAL OTHER STATE BUILDING SURCHARGE STATE ENERGY SURCHARGE PUBLIC WORKS TOTAL FEE u 0