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fhe Evergreen <br />��N oF: <br />e�eret� <br />259-8745 <br />� IIVSTRUCTION <br />PERMOT <br />r��Rnnir No. 19964 <br />❑ DEMOLITION C3cC^MBINATION ❑ BUILDING ❑ MECHANICAI G PLUMBING ❑ SIGN I <br />OWNER MAILADDF[55 CITY ZIP P�ION[ <br />Melum & Smlth P O Rox Se� T kp Gta�F � LT qR7SR (t�3 2025 <br /><i.;:"rtFCtOROE5IGNER MAILAODRE55 CiTY Z�P FHONE <br />GENfRI.L CONiRACTOR MAIL AODRE55 <br />ZIP PHONE �.ICENSE <br />Owner h1ELUt•1180P7 <br />MECHANICnICONffiACtOR RINLAD[1RE55 CITY ZIP PNONE �ICENSEs <br />PWMOING <br />CIiV ZIP PHONE <br />CtA55OF WONM. <br />L� NEW ❑ ADDITION ❑ AL}-EFiATION ❑ REPAIR ❑ DEMOLIT�O�I ❑ BUILDING RELOCATION <br />VALl/ATION OF tVORK <br />S 43,000.00 <br />DESLRIOE WOliK <br />(Jonstruct Single family residence <br />HEATSOURCE <br />❑ ELECTRICITY ❑ GAS ❑ WOODSTOVE ❑ OTHER <br />Single family residence <br />LEGAL DESCRIPTION OF PROPEf�iY �SHO W CELOIY OR nTThCH POIIR COPiE51 <br />�or 4 o�ocK _ <br />�oo aooaess <br />10920 <br />PLUMBING <br />�� <br />R-1 <br />TYPE OF ( <br />V�� <br />Larson Place <br />WATER C�OSET (TOILET) <br />BATHTUB <br />LAVATORV(WASH BASIN� <br />SHOWER <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />LAUNDRVTRNY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTnIN <br />FLOOR DRAI:V <br />BACKFLOW I'REVENTfRS <br />ROOF �RAINS — RAWLEADERS <br />SINK (SERViCE — BAR, ETC ) <br />SUBTOTAL <br />PERMIT <br />TOTALFEE <br />szeoro�or, � wo nFsroaies <br />MPLICAiIONACC aY <br />S.H. <br />1 <br />B.E. <br />ITEM <br />6 <br />VAf,ANT SIT[ <br />�YE$ ❑ NO <br />I HEREk3Y CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOIN THE SAME TO BE TRUE ANG <br />CORRECT. ALL. PROVISIONS OF LAWS AND ORDINANCES <br />GOVERNING THIS TYPE OF WORK WILL BE COPnPLIED WITH <br />WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A <br />PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO <br />VIOLATE OR CAtJCEL THE FROVISIONS OF ANY OTHER <br />STATE OR LOCAL LAW REGULATING CONSTRUCTION OR <br />THE PERFORMANCE OF CONSTRUCTION. <br />SiGn'�t /E OF CONTRACTOR. AUTHORIZED FGENT.OF Cl':NER �iD4T <br />X.rls„ /%��%%/;�i,�� �i'/���/d � <br />MECHANICAL <br />FEE NO. TYPE OF EOUIPh1ENT <br />A� C— AiHNDLG UNITS — HP. <br />REFAIGEHATION UNITS — HP. EA. <br />DOILERS -- BS U.-H.P. <br />GAS FIRED A.0 UNITS — BSL. <br />FORCED AIR SYSTEMS — B T.0 M EA. <br />VlALL HEATERS — � TL. PA <br />UNIT HEATERS -- B TL. b1 <br />EVAPORATIVE COOLERS <br />1 CLOTHESDRYERS <br />l VENTILATION FAN <br />flP.NGEHOOD <br />WATFR HEATER <br />INOOD STOVF <br />METAL FIREPLACE 8 CHIMNEY <br />FIflEPLACF MSER7 <br />NEAT PUMP <br />GAS PIPING <br />EXhIqUST FAN <br />NO OF pWEIIING IINIiS <br />ocr.i.ono <br />APPR FOII ISSUnNCE 11v <br />B.E. <br />PLAN Ch1Ef.K NUMBER <br />FEES <br />6UILUINC <br />PLUM9ING <br />MECHANICAL <br />INVESTIGATIrJN F�E <br />SU�TOTAL <br />PEqMIT <br />TOTALFEE <br />FTEE <br />VALUATION <br />5 �� ��� , <br />Sec.304�e) <br />FEE <br />STATE BIJILDING SURCHARGE <br />STA7EENERGYSURCHARGE � <br />DfiIVEWAY PERMIT <br />TOTAL <br />PERMIT VALIDATION <br />WHEN PROPERLV VALIDATED pN THIS SPACE) THIS IS YOUR PERMIT <br />