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� <br /> .-, <br /> APPLICATION FOR CONSTRl�CT10N <br /> PERMIT <br /> me Evergreen <br /> GITY OF <br /> cverelt <br /> everett � <br /> BUILDING DEPARTMENT <br /> ?59-eeto T BE CO PLETED IN INK— PLEASE PRINT <br /> ��S7URMtkN I?fi�Fl 9'�AVe}�y� � �rn r� q <br /> 'iWNER MALL�DURE55 ��fY ZIP PHONE <br /> IFN�Ni M�ILAppqESS CIIY ZIP PIIONE <br /> ►�nVlb !J. �A►►��s LA��vU� bR.#io� Iielto�Ue 99005 Y-62- S4b4 <br /> ��CHITECTdFDl�IQI�[N MqL�pORE55 J- ���y <br /> 21P PNONE <br /> J"b /� �iv�;z'.n <br /> GENER�LCCNiRRCI00 MAIL�DORE55 ��IY 21P PMONE — <br /> UCENSE• <br /> AIECHANIG�LCpNiq�CTOR M�IL�OOf1E55 �i�y <br /> 21P PMONE LICENSE� <br /> I�I I IMIIINO CbN 111A1:1f)11 - <br /> ... __.____'______.__ <br /> MMI �UIIIIRI'1 . _ . _. -. . ._ _ .__ _ . _ . .._._. _ _ "._ <br /> IAIY lIP I'111�N1 �� 111'.IN'll • <br /> CL FNVRK <br /> NEW ❑ ADDITION ❑ AL7ERATION ❑ REPAIfi ❑ DEMOLITION ❑ WOODSTOVE/FRP�INSERT ❑ BUIL�ING RELOCATION <br /> iCN�ryIiMPROVEMENIORIMEf1100f1[MO �ON/LY �)� CON14GfPLfI50NANDPHONENO. <br /> CONTRACTFPIGEOFWOflk ( 7f (/p(J <br /> u[SCRIBE WORK�NO SOIIME FOOUGE I <br /> e—9 829 Sa Fr <br /> i•noroseo use ov euaoiNa <br /> Ap�TIN EIIIT_S �f{EREBY CERTIFY THAT I HAVE READ ANO EXAMINED THIS APP�ICATION AND <br /> KNOIN TI IE SAME TO BE TiiUE AND CORf7ECT.ALL AROVIS�ONS OF LAWS AND <br /> lEOAL UESGRIPLION OF PROPEFtt�SNOWN BELOW OR�r1RGM fOUN COPIE51 ORDINANCES GOVERNING THIS NPE OF WORK W ILL BE COMPLETED WITH <br /> �p �y�.o ♦/ WHETHERSPECIFIEDHEREINORNOT.THEGRANTINGOFAPERMITDOESNOT <br /> LOi,� BLOCK `T oF .pEv6u-yNrcc.S DiV� PRESUMETOGIVEAUTHORIlYTOVIOLATEORCANCELTHEPROVISIONSOF <br /> ANY OTHEH STATE OR LOCAL LAW REGULATING CONS7RUCTION OR THE PER- <br /> /� 1l� FORMANCE OF CONSiRUCTION.THAT 1 AM AUTHORIZED BY THE OWNER OF <br /> (J�✓ / THIS PROPERTYTO PERFORM THE WORK FOR WHICIi APPLICATION IS MADE <br /> AND I COMPLY WITH 7HE STATE CONTRACTORS LAW 18.27 RCW AND <br /> 296.200 WAC. <br /> siaN�runeoFcor+rp�cionou�ui��onrzeo�ceNr oae ///�¢'/a7� <br /> �naecr�ooness X � -�jy�,�,Q/ <br /> A(' ICANI GIIYBUSNESSLICENS N Ah'DBUSINESSNAME <br /> PLUMBINO MECHANICAL <br /> NO. TYPEOFFUfTUAEOHITEM FEE NO. 'fYPEOFEOUIPMENT FEE <br /> WATER ClOSET(TOILE� A/C—lVHNDLG UNITS—H.P. <br /> _ BATHTUB FORCEDAIRSYSTEMS-6T.U. MEA <br /> _ LAVATORY�WASHBASIN) UNITHEATERS—B.T.U. M <br /> _ SHOWER CLOTHESORYERS <br /> _ KITCHEN SINKd DISP. VENTILATION FAN <br /> DISHWASHER pANGE HOOD <br /> , LAUNDRYTRAY WATERIiEATER <br /> CLOTHES WASHER WOOD STOVE <br /> URINAL METAL FIREPLACE 8 CHIMNEY <br /> _ L�R�NKINGFOUNTAIN FIREPLACEINSERi <br /> FLOOR DRAIN HEAT PUM? � <br /> _ BACKFLOW PREVENTERS pAS PIPING <br /> ROOF DRAINS—RAINLEADERS E%HAUST FAN <br /> SINK(SERVICE—BAR,ETC.) <br /> __ SUBTOTAL S SUBiOTAL S <br /> PERMIT 5 PERMIi y <br /> TOTAL FEE S TOTAL FEE S <br /> �WNTSEIBI�GK qEAR5EIB�GK SIOESE1ppCN PtANC GNNUMBEq FEE RECEIPTNO. <br /> US[ZONE � a��3� ��� 143� ? <br /> �orenee VACANTSIIE FEES Y'�UATION FEE <br /> �j,'YES ❑NO <br /> S 22� YYJ t— �_�� � <br /> �mcoreoNsc occureNcranour Ho.oroweiurmunns BUILDING ��y K/J ;S D'�V � <br /> nLIOW�OIE/ �l <br /> - —N � " I � � PLUMBING <br /> •;iZE OF OIDG NO.OF Si0111E5 BSML OGC Lp�O <br /> S$Z`�j 2. oN 3 V MECHANICAL <br /> IIEIf.MiLIMIT�T10N OTHER �� <br /> �IRESPPINKLERSREWIREU ❑YES �jp <br /> - STATE BUILDING SURCHARGE <br /> STATE ENERGY SURCHAHGE � /�1 <br /> 4PPUCMION�CGUY PLANS�PPq.BY —_G�� <br /> � PUBLIC WORKS <br /> �� � TOTAI � <br />