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� �_�� <br />A :�PLI�.�.TION FOR COKSTR�CTION <br />PERIIAIT <br />��.ti <br />�� <br />9HV� <br />��� <br />H �1 <br />�y��x <br />O � d <br />0 <br />c��o <br />H <br />7.H <br />�Hy <br />8y <br />c�gCt�i� <br />W�+ <br />H v�'1i <br />H O fn <br />fhe Evergreen <br />C�7� �F <br />everett <br />� BUILDING DEPARTMENT <br />259•8810 <br />TO BE COMPLETED IN INK— PLEASE PRINT <br />�f{ %�r< ���i : l� , � t f <br />ppCMiLEGiOR0E51GNEP MAILAOOPE55 CILY 21V VMONE <br />rvwrll <br />� <br />GENEHRLGON(RAGTOR MAl�qppR[53 CITY ZIP FNONE UCENSL• <br />r�A1�0At ¢nmPrtf(plRp� �C�. l;lc �;'r�7U RL-' i.-I/C'�P� — <br />MECMANICALCONiPALTOR 1�5 E� ��Lr�l.'Wsbr. ���� 21P FIIONE IICENSE • <br />%` �%L� <br />PLUMBINOGONTRRLTOR xN tDDFE55 O�TV ZIP PNONE 4f.LN5E• <br />w <br />��.�� �...,,.,.. <br />❑ NEV! ❑ A��ITION OO ALTERAiION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPLINSERT ❑ 9UI��INGRELOCATION <br />TENANTIMPROVEMENTCAIMERIORPEAIO�ELONLV CONIAGTPERSONANDPNONENO \ <br />fANTRACTPR!CEUFIYONK ':).C'l.� I '�]� ���,�I\ �I I f .�� <br />OESCRIBE WORN ANO SOU�RE fOOT�GE INVOLVED <br />ru ��c�ce.- +,<<rcr���1c�� �a- ��'r�E�►�errf„c ���;,��-,},N�l � <br />vNoa05EDu5Eora �oiec IHEREBVCEFTIFYTHATIHAVEREADANDEXAMINEDTHISAPPLICATIONAND <br />'-�1�', r, .`�F\t\•,- �.141I��`����' �C� KNOWTHESAM[TOBETHUEANDCORRECT.ALLPROVISIONSOFLAWSAND <br />N-- 1 ORDINANCES GOVERNING 1HIS TIPE OF WORK WILL BE COMPLETED WITH <br />LEGALDESCAiPtIQ OFPflOPERttISMOWNOEIOWOP�RAGHFO0RL0%E51 y,�HETHERSPECIFIEDHEREINORNOT.THEG(iAN71NGOFAPERMITDOESNOT <br />PflESUME TO GIVE FUTHORITV i O VIOLATE OR CANCEL THE PROVISIONS OF <br />�oi BwGK oF — ANVOTHERSTATEOaLOCAILAWREGULATINGCONSTRUCTIONORTHEPER� <br />FORMANCE OF (;ONSTRUCTION. THAT 1 Ah1 AUTH�IRITED BYTHE OWNER OF <br />LHIS PROPE(iTV TO P2qFORM TH E WORK FOR W H ICH APPLICATION IS MADE <br />AND I COh1PLY WITN THE STATE CONTRACTORS LAW 1827 RCW AND <br />296,200 WAC. <br />SIGNAiUR[OfCONTPACiCROFaUi1�UR4EDAGEVt DAtE <br />X (' <br />�.(�`���.,�c_r�-��� c�._. .�1, ��,�. <br />PROJECT��ORE55 ppP�ICANISCIiYDU$WCSSLICENS[M1 PN�OUSItIF55NAME <br />��1_1'l1b A=, /[I�l('Il`L— <br />PLUMBING <br />10. TYPE OF FIXTURE ON I <br />\VA7ER CLOSET ITOILEn <br />BATHTUB <br />LAVATORV (WASH BASIN) <br />SHOWER <br />KITCHEN SINKB DISP. <br />DISHWASHEP <br />LAUN�RYTFAV <br />CLO7HES WASHER <br />URINAL <br />DFINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />ROOF ORAINS — RAINLEADERS <br />SUB TOTAL <br />FEE <br />�IRESPNINKlERSREOVIRE� ❑ YES � NO <br />5 <br />MECHANICAL <br />FEE NO. TYPEOFEOUIPMENT <br />AJC — A/HNDLG UNITS — H.P. <br />� FOFCEDAIRSYSTE�dS—BT.U.I`J� <br />UNITHEATERS—B.i.U. M <br />CLOTHESDRYERS <br />VENIILATION FAN <br />RANGEMOOD <br />J_ WATER HEATER <br />WOOD STOVE <br />METAL FIREPLACE 8 CHIMNEV <br />FIREPLACEINSEPT <br />HEAT PUA1P <br />GAS PIPING <br />EXHAUSTFAN <br />SUBTOTAL g <br />PERMIT 5 <br />TOTAL FEE S <br />1MBEN FEE pE' <br />FEES VALUATION <br />❑ YES ❑ NO <br />_ BW�OING <br />NOAfpWELLINGUNIiS — <br />PLUMBING <br />esmr. occ wno <br />❑ y MECHANICAL <br />❑N <br />MEiGMTLIMITAtION OTHER <br />STATE BUILOING SURCHARGE <br />STATE ENERGV SURCHARGE <br />� PUBLIC WORKS <br />707aL <br />FEE <br />7e <br />U I ` <br />� <br />