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APPLIC�.f10N FOR CONSTRV�TION <br />PERrVI1T <br />Ihe Evergreen everetl <br />CITY OF � <br />everett <br />BUILDING DEPARTMENT <br />259•88�0 TO BE COMPLETED IN INK— PLEASE PRINT <br />OWNER MRILRD09E55 C�iY ZiP FHONE <br />TEN�NT � DFE55 CITY ZIP PMONE .��I'/ <br />LiM6E2 lAD`/,SvD�% up�k� h�����w�/.�Jd.tA �U�4 �B2z% eS�f%�,Z/.h'7 <br />/.i..�_.� r-n��r.� n.trO�n..eAl IfIL�At.F <br />� ����-ArN � Nomf!� � <br />l.�t �Ai�E g?E�Enfi �A 48x58 <br />❑ NEW ❑ AODITION ALTEriATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSiOVE/fRPL INSERT ❑ BUILDING RELOCATION <br />TENANTIMPPOVEMEM OP INT'EIFION REMOOEL ONLY CONTAQ PEflSON PND PMO1NE N0. <br />CANTHACTPPILEOFWOPICp �/. v��/'� /��r�' ���rr 334-8s <br />0 <br />� <br />� <br />�� <br />DESCRIBE WOFK RND SOUAPE FOOTAGE INVOLVE�'�✓��5%D�E �fi%J Q p /��� i/r1 rS <br />Lo-�w�.� $M 5£cT�oN oF CE�UNIa i� � •�-•-� <br />PPO�POSVEOUSEOFBUILOIN� IHEREBYCERTIFVTHATIHAVEREADANDE%AMINEOTHISAPPLICATIONAND '.. <br />�ETWIL C�-�T�IN� SA�S KNOWTMESAMETOBETRUEANDCORRECT.ALLPROVISIONSOFUIWSAND �' <br />— DINANCES GOVEFNING THIS TVPE OF WORK WILL 6E COMPLETED WITH _ <br />LOT BLOCK OF <br />PLUMBING <br />�KIST <br />G�'/l��ly <br />SHOWER <br />KITCHEN SINK 8 <br />CLOTHES WASHE <br />URINAL <br />DRINKING FOUNI <br />FLOOR DRAIN <br />BACKFLOW F 9EV <br />ROOF UAAINS — <br />CIAIK ISFRVICF — <br />c- <br />T /1�A��— K6Mo�D <br />STDltc LoGi4r c'D <br />SUBTOTAL 5 <br />PERMIT 5 _ <br />TOTAL FEE $ <br />REAPSETBAGK SIDESETBRCK <br />' _ i <br />LOTAFEA WGTNTSITE <br />❑ vE5 `J�NO <br />� <br />OGGUPANCYGROUP NOOFOWELLIN <br />RL <br />� � <br />NO.OFSTORIES BSMT. OCGLOAO <br />T.�i' � ❑ v .SCo <br />HEiGMi LIMITATII <br />n�. � <br />RE�l11RED tJ�scS ❑ NO <br />OR <br />W HETH EF SPECIFI ED HEREIN OR nOT. THE CaRANTING OF A PERMITDOES NOl' <br />PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHEfl STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PER• <br />FORMANCE OF CONSTflUCTION. THAT I AM AUTHORIZEO BV THE ON'NER OF <br />THIS PROPERN TO PERFORM THE WORK FOR VlHICH APPLICATION IS MADE <br />AND I COMPLY WITH TI1E STATE CONTRACTORS LAW 1d27 RCW AND <br />296200 WAC. �Q <br />SIGNATUREOFCONtRRC10ROFAUTHO(iREDRGENT DATE �/� vu <br />X ��� ' � <br />APPLICANTSCITYBUSINESSLILENSEN I: BUSINESSNAME <br />MECHANICAL �—� <br />A/C—NHNOLG UNITS— <br />FORCED AIR SYSTEMS — <br />UNIT HEATERS— B.T.U. <br />CLOTHES URYERS <br />VENI'ILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />W OOD STOVE <br />METAL FIREPLACE 8 CHII <br />FIREPLACEINSERT <br />GAS <br />TOTAL <br />' FEES <br />BUILDING <br />PLUMBING <br />MECHANICAL <br />OTHER <br />STATE BUILDING SURCHARGE <br />STATE ENERGY SURCHARGE <br />PUBIIC WORKS <br />TOTAL <br />0 <br />M <br />� <br />3 <br />� <br />FEE <br />