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�+o ,.1 <br />APPLICATION FOR CONSTR.�CTION <br />PERMIT <br />t�e Evergreen ��vcrcl� <br />CITV OP <br />everett e <br />BUILDING DEPARTMENT - <br />259-8810 TO BE COMPLETED IN INK- PLEASE PRINT <br />OWNER MRILADDRE55 CIiY ZiP PIIONE <br />i � �= �(J. � 'f a.i �"VC/�°L�%% �" � _7�`��_� "' r-' <br />,bLNNk' N Lfl/-]n-'K �4� 4=��f'ir . / hc;�.��._( S'i�' %� _, <br />TENAYT MAILAO�RESS CItY 21P PNONE <br />- _' ' -• - '" ---_..- i:�._�._, r,i:�-__.i.rh.— <br />PLUMB�NGCONiRAGTOR MAILADORE55 CITY ZIP PIIONE LIL[NSE• <br />NEW ❑ ADL'ITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVFJFRPL INSERT ❑ BUILOING RELOCATION <br />CONiR�CT PRIGE4F WORK <br />� <br />�or�J�a e�oc� 0 or' <br />�� / <br />f�<r!r- t/e�« i r�-a�-,-s/c•d .,o <br />i•'l�1.s,1�i��c. �/ leCorY,Cs r�'���i <br />PROJECTRD�FE ' <br />rx �„ r <br />NX :i� %,: '�i!':�" �^a � t^�- <br />PLUMBING <br />TYPE OF FIXTURE <br />LAVATORY (WASH BASINI <br />SIIOWER <br />KITCHEN SINK 8 OISP. <br />DISHWASHER <br />LAUNDRYTRAV <br />UHINAL <br />DRINKING FOUNI <br />FLOOR ORAIN <br />OACKFLOW PREV <br />ROOF DRAINS - <br />SINKfRFRVICE- <br />SUB TOTAL <br />PERMIT <br />TOTALFEE <br />[ REPRSETBACN <br />� � _ � <br />�- z <br />TMp prppNST <br />ALLOWABLE/nCTU <br />_ r( <br />Si2E OP BLIIG. <br />�/S% <br />FlR�SPRNNLERSREOUIRED ❑ <br />APPLICATION AGG. BY <br />� I <br />Y I <br />S <br />VACANTSRE <br />l'/YE5 ❑ NO <br />'i�v,'��J?Ai/l .']"n ' f7� /J:J I <br />I HEREBV CF.RTIFV THAT I HAVE REAO AND EXAMINED THIS APPLICATION AND <br />KNOW THE SAME TO BE TPUE AND CORRECT. ALL PROVISIONS OF LAWS AN� <br />ORDINANCES GOVE!iNING THIS NPE OF WORK WILL BE COMPLETED WITH <br />W HEiMER SPECIFIEU IIEFlEIN OR NOT. THE GRANTING OF A PERMIT DOES NOT <br />PRCSUME TO GIVE AUTHORIN 70 VIOLATE OR CPNCEL THE PROVISIONS OF <br />ANV OTMER STATE OR LOGL LAW REGULATING CONSTRUCTION OR THE PER� <br />FORMANCE OF CONSTRUCTION. THAT I AM AUTHORI2ED BV THE OWNER OF <br />THIS PROPERTV TO PERPORM THE WORK FO(7 WHICH APPLICATION IS MADE <br />AND I COMPLY WITH THE STATE CONTRACTORS LAW 18.27 RCW AND <br />296200 W4C. <br />S�GNAIUR fCONiRPC{ip�[j�OFAU1110�E�AGENj�`��51E� <br />( 4V /C/C Q %• � V �J <br />X.O"ll.'°41C iY .�'�+%���/r}.K�. �e:J <br />PPPUCANiSCItV OUSINE55 UCLNS[ NO ANp BUSINE55 NAFIE <br />[7 i!' �/C "/' �//�I if i{� .D'/ � //C'L L <br />MECHANICAI <br />NO. 1"�PE OF E�UIPMENT <br />� A/C-A/HNDLGUNITS-H.P. <br />FORCED AIR SVSTEMS- B.T.U. <br />� UNITNEATERS-B.T.U. M <br />� CLOTHES DFYERS <br />".,�` VENTILA710N FAN <br />� RANGEHOOD <br />WATER HEATER <br />� WOOD STOVE <br />METAL FIREPLACE 8 CHIMNEY <br />FIREPLACEINSERT <br />HEAT PUMP <br />�AS PIPING <br />E%HAUSTFAN <br />FEES <br />SUB TOTAL <br />PERMIT <br />TOTAL FEE <br />F� I _� <br />�- i PIUMBING <br />TOPIES BSMi. OCGLORD <br />/ p y _ MECHANICAL <br />`� N <br />nEicnt�uiMijntioru OTHER <br />'�� `�" STATE BUILDING SURCHARGE <br />STATE ENERGV SURCHARGE <br />PPP BY <br />PUBLIC WORKS <br />1. le �. TOTAL <br />��as C�/� <br />� �r <br />54 <br />ree <br />FEE <br />J <br />