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tl1 [�a�1 � <br />A .'cl x <br />9H V~i <br />y <br />y�t�-+ <br />fC Cl <br />H X1 <br />"�lJH� <br />V1 H <br />U7O� <br />OHb <br />F^�'�g <br />Y. V �C <br />9HL�J <br />rHH <br />gy <br />� <br />�d� <br />� � � <br />HOt�i� <br />�, ,.-. <br />Al�PLICE.TION FOR CONSTR1,C410N <br />P�ERMIT <br />fhe Evergreen <br />CITV OF evemll <br />everett e <br />BUILDING DEPARTMENT <br />259-8a�0 TO BE COMPLETED IN INK— PLEASE PRI4T <br />OWNER MAILFOOPESS CIiY ZiP VHONE <br />SCOTT LOOMIS 7719 LOWER RIDGE R�=:D EVERETT 96203 348-9367 <br />iENANT MAILADDFE55 GITY ZIP PHONE <br />MCHRECiOR0E51GNER MPILAOORE55 CItY ZIP PHONE <br />GENEPNLWNiRACTON lAPILPDDFE55 CIiY 21P PHONE LiLENSE• <br />3810 196th St. SW, #8 Lynnwood <br />S 2 <br />1256 ARCOIL*141I,� <br />❑ NEW ❑ ADDITION � AITERATION ❑ fiEPAlf. ❑ OEMOLITION ❑ WOO�STOVE/FRPLINSERT ❑ BUIL�INGflELOCATION <br />TENANi IMPROVEMENT OR INTEiiIOF FEMODEL ONLY COYi/.GT PEPSON AND PMONE NO � <br />GONiRACTPRICEOFWORK $504.00 I <br />OESGRI6E WOFK FN� SOUAP[ �OOIAGE INVO W EO <br />INSTALL GAS FIREPL�FICE AND HOT WATER TANK ; <br />PROPOSEDUSEOFBUIL�ING IHEHEBVCERTIFYTHATIHAVERE4DANDE%AMiNEDTHISAPPLICATIONAND ' <br />S� KNON'?HESAMETOBETRUEAN�CORRECT.ALLPROVISIONSOFLAWSAND I <br />- ORDININCES GOVERNIkG THIS TYPE OF WORK WILlBE COMPLETEO WITH � <br />LOT 9LOGK OF <br />7719 LOIVIIt RIDGE ROAD, EVEItL'iT <br />PLUMBING <br />TVPE OF <br />WATEti CLOSET(T( <br />KITCHEN SINKB <br />DISHWASHER <br />LAl1NDRY TRAY <br />DRINKING FOI <br />FLOOR DRAIN <br />BACKFLOW PF <br />ROOF DRAINS <br />SINKfSERVICE <br />ALLOWABLE/ACTUAL <br />FIRE <br />RAINLEADERS <br />SUBTOTAL <br />PERMIT <br />7'7TAL FEE <br />� res ❑ <br />FEE <br />5 <br />WHETHERSPECIREDHEREINORPIOT.THEGRANTINGOFAPERMITDOESNOT I <br />PRESUMGTOGWEAUTHORITYTOVIOLATEOROANCELTHEPROVISIONSOF I <br />ANVOTHERSTATEORLOCALLAWREGULATING JNSTRUCTIONORTHEPER- <br />FORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BYTHE OWNER OF <br />THISPROPERTYTOPERFORMTHEWORKFORWHICHAPPLICATIONISMADE �I <br />AND I COMPLV WITH THE STATE CONTRACTORS LAW 1827 RCW AND <br />296200 WAC. I <br />SIGNAi11'+EOFCONTRALIORCI�iAUi110RIEE�AGENi OAiE ��. <br />X �X ( � i�,�ie � / 2/20/9/ <br />MECHANICAL <br />� <br />A/C=aHNDIG UNITS_H P. <br />FORCED AIR SVSTEMS— BT.U. M EA <br />11NITHEATEFS—&T.U. M <br />CLOiHES DRYERS <br />VENIILPTION FAY <br />WOOD £TOVE <br />METAL FIREPLACE f <br />FIREPLACEINSERT <br />3S-/Y z <br />FAn; <br />PERMIT <br />❑ YLS ❑ NO <br />NOAFDWELLINGUNIiS BUILDING - <br />PLUMBING <br />65Mi. OCGLOAD <br />❑y MECHANICAI <br />❑N <br />MEIGHTLIMITATiON QTHER <br />STATE BUILDING SURCHARGE <br />STATEENERGVSURCHARGE <br />� PUBLIC WORKS <br />TOTAL <br />VALUATION <br />5 <br />5 <br />5 <br />