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APPLICATION FOR CONSTRUCTION PERMIT everett <br />the Evergreen TO BE COMPLETED IN INK —PLEASE PRINT <br />CITY OF <br />eve re } It HEATING SYSTEM: ❑ GAS r ELECTRIC ❑ <br />BUILDING DEPARTMENT <br />259-8810 <br />1 DEMOLITION ❑ COMBINATION C:I BUILDING ❑ MECHANICAL U PLUMBING 0 SIGN <br />OWNER MAIL ADDRESS CITY ZIP PHONE <br />ve lVeyo 41 <br />TENANT MAIL ADDRESS CITY ZIP PHONE <br />ARCHITECT OR DESIGNER <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />GENERAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE LICENSE # <br />4w/✓ej' <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE LICENSE # <br />o co /tJ ey <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE LICENSE # <br />CLASS OF WORK <br />l NEW 45 ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION Cl WOODSTOVE/FRPL INSERT ❑ BUILDING RELOCATION <br />CONTRACT PRICE OF WORK 8 $ <br />COeNiTA(CT PERSON AND PHONE NO. �} <br />0 .�� L U d G/ � 1,77 <br />/ <br />DESCRIBE WORK AND SQUARE FOOTAGE INVOLVED <br />c. f o 4� <br />1 <br />PROPOSED LfEOFBUILDING <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />X <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH FOUR COPIES) <br />LOT BLOCK OF <br />PROJECT ADDRESS <br />J " <br />/ j I r <br />APPLICANT CITY BUSINESS LICENSE NO. AND BUSINES NAME <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />A/C-A/HNDLG UNITS-H.P. <br />BATHTUB <br />; <br />FORCED AIR SYSTEMS-B.T.U. M E.A. <br />' <br />LAVATORY (WASH BASIN). <br />UNIT HEATER$-B.T.U. M <br />SHOWER <br />' <br />CLOTHES DRYERS <br />KITCHEN SINK & DISP <br />; <br />VENTILATION FAN <br />' <br />DISHWASHER <br />/ <br />RANGE HOOD <br />LAUNDRY TRAY <br />; <br />WATER HEATER <br />CLOTHES WASHER <br />i <br />WOOD STOVE <br />URINAL <br />; <br />METAL FIREPLACE & CHIMNEY <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />' <br />FLOOR DRAIN <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />; <br />GAS PIPING <br />ROOF DRAINS-RAINLEADERS <br />EXHAUST FAN <br />SINK (SERVICE -BAR, ETC.) <br />' <br />SUB TOTAL <br />$ <br />; <br />SUB TOTAL $ <br />' <br />PERMIT <br />$ <br />PERMIT $ <br />