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.y <br /> a� APPLICATIOi.4FOR CONSTRUCTI�N PERMIT �V1fe1 <br /> fheEvergreen TO BE COMPLETED IN INK—PLEASE PRINT � <br /> CITY UF <br /> eve rett HEATING SYSTEM: O GAS ❑ELECTRIC ❑ <br /> BUILDING DEPARTMENT <br /> 259-8810 <br /> DEMOUTION COMBINATION BUILDING xMECHANICAL �PLUMBING SIGN <br /> OWNER MRILADORE55 GITY 2 PHONE <br /> � 1 I�v�Gl yU3 l�Pa�ci If','l� V�!v f��1L � P�� 3�-(`I-�l!N,�, <br /> TENRNT MAII AODqESS CITV ZIP PHONE <br /> .�I')1P� <br /> AqCMITECiCi1�ESIGNER MAILRDDRESS CITY IIP PHONE <br /> GENEBALCONTRAGTOR MRILADpPE55 C�T1' 21P PHONE UCENSE� <br /> MECNANICAt CONTRACTOR MAII AODRESS CITY ZIP PHONE LICENSE� <br /> IU�r-Ft��+-- 3llu �li II l�tr`e� �cVP�'��H �l��l 25���31 tilor��.uhl��l2a- <br /> PWIdBMCCONiRPCTOR MNLADDRE55 GiTY )IP PHOHE UCENSE/ <br /> �/u'l�v <br /> C:A55 OF WORK <br /> �NEW ', ADLITION '. ALTERATION ._ REPAIR � DEMOLITION �. � WOODSTOVE/FRPL INSERT . � BUILDING RELOCATION <br /> GOrNTACT PERSON AND PH1O� NE NO. /� J� p� // � <br /> C(hlPRCTPRICEOFWOnn � I��� • \�� .�I .y�l •�`�'�J `��� <br /> (;ESCRIBE WOPN�ND SOUPFE POOTAGE INVOIVED V•--� <br /> T ' – <br /> V l� <br /> �� �- ( � � � 3 -- <br /> PROPOSEDUSEOFBUiLO I HEREBV CERTIFY THAT I HAVE READ AN� EXAMINED THIS <br /> G I�� I� , e APPLICATION AND KNOW THE SAME TO BE THUE AND CORRECT.ALL <br /> imn�oe c ation oF a rearv isHo r+ee�owoa nrrncN Founcoriesl PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> �or o�ocK or NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> I � ! O —O �— �QO OTHER STATE OR LQCAL L W EGULATING CONSOTRIUCOT ON OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTNORI2ED BY THE <br /> OWNER OF THIS PflOPERTV TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br /> SIGNATUREOFCONTRACTORORAUTNORIZEDAGENT D4TE <br /> y� P��C� I� � �� �1�-f�v� �10�-�����L,1�31�'�— <br /> anaect nooaess <br /> APPLIGANTS CIiV BUSMESS US:NSE NO AND BOSINESS NAME <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FI%TURE OR ITEM fEE N0. TVPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) A/C—lUHNDLG UNITS—H.P. <br /> BATHTUB FORCED AIR 5`.'STEMS—B.T.U. M E.A. <br /> LAVATORY(WASH BASIN) UNIT HEATERS—B.T.U. M <br /> SHOWER CLOTHES�RVERS <br /> KITCHEN SINK 8 DISP VENTILATION FAN <br /> OISHWASHER R�NGE HOOD <br /> LAUNDRYTRAY WATER HEATER <br /> CLOTHES WASHER WOOD STOVE <br /> URINAL METAL FIREPLACE 8 CHIMNEY <br /> DRINKING FOUNTAIN FIREPLACE INSERT <br /> FLOOR DRAIN HEAT PUMP <br /> BACKFLOW PREVENTERS GAS PIPING <br /> ROOF DPAINS—RAINLEADERS EXHAUST FAN <br /> SINK(SERVICE—BAR,ETQ) ; <br /> i <br /> _ ; <br /> SUB TOTAL 3 SUB TOTAL $ O ; <br /> PERMIT $ PERMIT $ �— <br /> TOTAL FEE 5 TOTAL FEE $ (3 � ' <br /> FOR OFFICE USE ONLY: <br /> I�IiONI5Lif1RCN R[PPS[TpACK SIOES[TBACK PIANGHEGKNUMB[B FE[ RECEIPiNO <br /> 3,5�� a <br /> n,[zorve �orneen VACRNTSITE FEES VALUATION FEE <br /> T <br /> eua�wc <br /> iYPF Of L�NiS.ALLOWABIf ME Of CON57.FCiuAI occureq:r xo wOw4iUx6urvrt5 — <br /> cnou> PWM�ING <br /> 512EOFBLOG. NOAFSTORIES BASEMi.NT MLCHANICAL �S 'OG <br /> OCLUPANCV LOAO FIPE SPRNNL[q5 REp D NEIGNT LIMITATION A�DITIONAL PLAN CHECK <br /> OiHER <br /> HEASONfORS�RINRLEFS - <br /> STATE OUIIDING SURCHARGE <br /> iNTANEUY PLANSAPGROVEDBY CITYOFEVEREIT PU3LICWORKS <br /> LOCAL SALES � <br /> TAX CODE IS 3105 TOTAL �,��aa <br />