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fhe Everpreen <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />259•8810 <br />�ti... -;":'. <br />APP�.ICi���ION FOR CONS�Rt�i��TION <br />E�ERM17' <br />TO B� COMPLETED IN INK— PLEASE PRINT <br />MCHITECTOHOE�IGNEN µqlLAp�RE55 G17V ZIP PMONE <br />everett <br />e <br />QENEfULCONTMCTOR MpILA00flE55 CITY SIP PHONE �IGENSE• <br />NEW ❑ ADDITION ❑ PLTERATION C� REPAIf: ❑ OEMOL�7'ION ❑ WOODSTOVE/FRPL INSERT ❑ BUILDING FELOCA710N <br />VT IMPHOVEMENi OR INTEqIOF REMODE� ONLY CONT�CT PERSON AN� m�oue Hn <br />CANTRACT Ph:CE <br />LOT BLOCK OF <br />PLUMBIN� <br />�O. TYPE OF FU(TURE OH ITEM <br />WATEFCLOSET�TOILEq <br />BATHTUB <br />UVATORYIWASH BASIN) <br />SHGWER <br />KITCHEN SINKE DISP. <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FGUNTAIN <br />FLOOR DRAIN <br />SINK ISERVICE — <br />u <br />SUBTOTAL <br />PERM�T <br />TOTAL FEE <br />O NO <br />i <br />I HEREBY CERTIFY THAT I I1AVE REAO AND E7(AMINED THIS APPLICATION ANU <br />KNOW THE SAME TO BE TRUE AND CORRECT. ALl PROVISIONS (7F LAWS AND <br />UROINANCES GOVERNING THIS 7YPE OF WORK WILL BE COMPLETED WITH <br />WHETHERSPECIFIED HEREIN OR NOT.THE GRANTING OFA PEflMITUOES NOT <br />PRESUME TO GIVE AUTHOPITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW REGUTATING CONDTRUCTION OR THE PER• <br />FOFMANCE OF CONSTqUCTION. THAT I AM AUTHORIZED BY THE OWNER OF <br />TFIIS PROPERiY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE <br />AND I COMPLY WITH THE STATE CONTHACTORS LAW 18.27 RCW AND <br />296200 WAG /D y� �� <br />516N4iUPE0FCONi AUTNORIZEDAGENT UpTE <br />nPPUChNTSCIiY9U51�Ery�� BUSINESSNRME <br />MECHANICAL <br />NO. <br />T'�=, <br />PE OF EOUIPMENT <br />3 UNITS — H.P. <br />(STEMS—B.T.U. M <br />—&T.U. M <br />:FS <br />4N <br />�CE 8 CHIMNEY <br />I !7 YES ❑ NO roca _ <br />-- � BUILDIN3 <br />' NO.OFDWELLINOUNITS <br />PLUM6ING <br />&SM'. OGG LO�D <br />� Y MECHANICAL <br />❑N <br />HEIOHTIIMIT�TION OTHER <br />— STATE BUILDING SURCHARGE <br />STATE ENERGY SURCHAfiGE <br />PUBLIC WORKS <br />TOTAL <br />5 <br />a <br />8 <br />FEE <br />FEE <br />