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t�e Evergreen <br />CITY OF <br />; �ere�t <br />BUILDING DEPARTMENT <br />259•8810 <br />APPLICArION FOR CONSTRI..:TION <br />PERMIT <br />TO BE COMPLETED IN INK— PLEASE PRINT <br />cwnen m,.�. ��y.��.,_ ,.... ... ....,.._ <br />i 1w� Nl.oevl S 16 �° SI SF E,,QrefE_ W� q$Zc�2, <br />TENNNT MfpILpODRE55 CItY 21P PMOHE <br />�PGHITEGTONOESIGdER M�ILRODRE55 CItY ZIP PMONE <br />i•verett <br />e <br />'�r�i�, ����1�Q,M5 22v3����`'ft�eS, � �"OI o32_ 3°ls'����'iziK$ <br />M R� f�„ � l��� <br />MECH�MC�LCONTflFCTOR MRILAODPE55 CITY 21P PMON[ UCENSE♦ <br />PLUM8INOLONTRACTOR MAILA�OdESS CITY ZIP PIIONE LICENSE• <br />❑ NEW LJ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLI710N ❑ WOO�S70VE/FRPL INSERT ❑ BUILDING RELOGATION <br />fEN�NTIMPHpVEMENTORIN�R�IIJOO E�N`Y �ONiRGtPER50NANOPMONENO � �� ^ � I. <br />:ANTMCTPRICEOFWOPIC �� �ar�Ps �,)�c�GL��ei^� <br />OESCRIBE WOFN �NO SOU�(iE FOOTA�E INVOLVED <br />�..i�.� 11�,� �'�'7t,i o,. C� <br />' �' �_IQ� BLOLN__ OF <br />ST S F <br />PLUMBIN6 <br />NO. TYPEi <br />WATER CLOSET <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />ROOF <br />SINKI <br />SUBTOTAL 5 <br />PERMIT S <br />TOTALFEE S <br />8 REPRSEfeACK SIO[Si <br />/ <br />LOTAflER �ACNN <br />i ❑ YES <br />n � <br />� NO OF STC <br />2 I � �_ <br />.ERSREOIIIPED ❑YES �p'I <br />ISPPPq 9Y <br />1 C.�J <br />UY <br />u N <br />� <br />� <br />IHEREBYCER7IFYTHATIHAVEREAUANDF,;cAMINEDTHISAPPLICATIONAND I <br />KNOW THE SAME TO BE TRUE AND CORRcCT. ALL PROVISIONS OF LAWS AND <br />OROINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLETED WITH i <br />W HETHER SPECIFIED HEREIN OR NOT. THE GRANTING CFA PERMIT DOES NOT <br />PRESUME TO GIVE AUTNORITV TO VIOLATE OR CANCEL THE PROVISIONS OF , <br />ANYOTHERSTATEOFLOCALLAWREGUTATINGCONSTRUCTIONORTHEPER- �. <br />PORMANCE OF CONSTRUCTION. THAT I AM AUTHOFI2ED BY THE OWNEfl OF '� <br />THIS PFiOPERNTO PERFORM THE WORK FOR WHIC{i APPLICATION �S MA�E � <br />AND 1 COMPLY WITH THE STATE CONTRAC70R5 LAW 1827 RCW AND ' <br />296.200 WAC. . <br />SIGNAiUPEOFCOYTPACIOfIORRlI1MOfl12EDRGENT OPTE �. <br />x �n o Q . � �1��/A� <br />MECHANICAL <br />FEE NO. TYPE OF EOUIPMENT <br />A/C— A/HNDLG UNITS — H.P. <br />FnRCED AIR SYSTEMS-- B.T.U. M EA <br />UNIT HEATERS— B.T.0 M <br />CLOTHESDRYERS <br />VENTILATION FAN <br />WATER HEATER <br />WOOD STOVE <br />METAL FIREPLACE! <br />FIREPLACEINSERT <br />HEATPUMP <br />GAS PIPING <br />E%IIAUST FAN <br />TOTALFEE <br />FE�n � <br />� FEES <br />BUILDING <br />PLUMBING <br />MECHANICAL <br />STATE BIHLDING SURCHARGE <br />STATE ENERGV SURCHARGE <br />PUBLIC WORKS <br />TOTAL <br />Z <br />