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APPLICACION FOR CONSTRICTION <br /> PERMIT <br /> the Evergreen pvPlPll <br /> CITY or <br /> everett e <br /> BUILDING DEPARTMENT <br /> r IH 259.8810 TO BE COMPLETED IN INT:— PLEASE PRINT <br /> M �yD °SER MAILJDDRE89 CITY ZIP rrom <br /> l i�oXc) f off <br /> H •pys rtl, ouIL ADDREss 'T zm-- PHONE <br /> I'3 M ARCHITECT OR DEBgNER MAR ADDRESS city Dr PIrONE <br /> I< n <br /> Ix-I GENERAL CONTRACTOR MAIL ADDRESS CITY IIP PHONE LICENSEF <br /> v (rOLDffI1 <br /> 919CsLl� <br /> .H,. O Fs <br /> H L'171 MECNANICALCONTRACTOR MMUOOPC89 CITY 21P PHONE LICENSE• li <br /> Rt, <br /> OH MUMBINGCONTRACTOR MAILAUDRESS CITY TIP PHONE s68�1o6 CENRe �' <br /> Hro8 � �_ Uq!/I �slopu (�L)goc fJo oN GtlidSA�zc° <br /> •' ggqO <br /> 'CLASS NORK <br /> Z H 3 My NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL INSERT ❑ BUILDING RELOCATION r <br /> �H [ZLy TENANT IMPROVEMENTOR INTERIOR REMODEL ONLY CONMCI PERSON AND PHONE NO <br /> F <br /> H H CONTRACTPSICE OF WORK <br /> H-1 <br /> DESCRIBE WORK AND BOUARE FOOTAGE INVOLVED <br /> c') 17 in n) )I I LYJ l IrIGQ <br /> LT1 invorostu me OF uumplpa I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND <br /> 01 KNOW THE SAME TO BE TRUE AND CORRECT.ALL PROVISIONS OF LAWS AND <br /> H O co L al ocxRlPrloN a oPERmauowN eELow oR ATTACH rouR coPlEs ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLETED WITH <br /> WHETHERSPECIFIEDHEREIN OR NOT THEGRANTING OF A PERMITOOES NOT <br /> PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br /> Loi BLOCK_ OF ANYOTHER STATE OR LOCAL LAWREGULATING CONSTRUCTION OR THE PER. <br /> FORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE OWNER OF <br /> THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE <br /> AND 1 COMPLY WITH THE STATE CONTRACTORS LAW 1817 RCW AND <br /> 298.200 WAC. <br /> SIGNATURE Of CONTRACTOR ON AUTHORIZED AGENT DATE <br /> XI�J� E <br /> PROJECT ADORE 8 � se APPLICANTS CITY USINE99lICEN4 ANO BUSINESS NA <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> "•� -3 WATER CLOSET ITOILET) 1 A/C-A/HNDLG UNITS-H.P. <br /> BATHTUB FORCED AIR SYSTEMS-BTU. M EA <br /> C� _ LAVATORY(WASHBASIN) —_ ` UNIT HEATERS-BTU M _ <br /> t SHOWER - — - _ _ CLOTHES DRYERS <br /> r KITCHEN SINK S DISP. VENTILATION FAN <br /> �`■ DISHWASHER RANGE HOOD _ <br /> �T LAUNDRY TRAY WATER HEATER <br /> r CLOTHES WASHER WOOD STOVE _ <br /> URINAL METAL FIREPLACE A CHIMNEY <br /> DRINKING FOUNTAIN FIREPLACE INSERT <br /> FLOOR DRAIN HEAT PUMP <br /> BACKFLOW PREVENTERS GASPIPING_ <br /> ROOF DRAINS-RAINLEADERS EXHAUST FAN <br /> '=1 i SINKISERVICE-BARETC) - Y <br /> 1 <br /> I <br /> s� _ _— <br /> SUBTOTAL S _ SUBTOTAL $ <br /> PERMIT S '— PERMIT S L <br /> 's TOTAL FEE $ (' —' TOTAL FEE S <br /> 1_t IWAIT SETBACK REARSETBACK SIDE SETBACK PUN CHECK NUMBER FEE RECEIPTNO. <br /> USE ZONE LOT AREA VACANT SITE FEES VALUATION FEE <br /> YES :1 NO <br /> BUILDING <br /> TYPE OF CONST OCCUMNLY GROUP NO OF DWELLING UNITS _ e <br /> ALLOWASLEJACTUAL PLUMBING <br /> SIZE OF FILM NO Or STORIES B9M1 OCC LOAD <br /> 117 MECHANICAL . <br /> [IN — <br /> HEKInII W0.1 - OTHER <br /> FIRE SPRINKLERS REWIRED DYES T]NO _ _ STATE BUILDING SURCHARGI <br /> STATE ENERGY SURCHARCI. <br /> APPLICATION ACC I <br /> PUBLIC WORKS <br /> TOTAL <br />