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APPLICafION FOR CON.rsTRl,CT10N <br />PERMIT <br />t�e EverOreen evcrell <br />CITV OF � <br />everett <br />BUILDING DEPARTMENT <br />259-8810 TO BE COMPLETED IN INK— PLEASE PRINT <br />�,NEq MAIiApfIPE55 C�IY IIP PIION[ <br />ls � o iJ a c� W 1n �v _/_0' 7����c_C�` �('-f���%� c� o u_� _�JU. 77.� ^D�1's'3 <br />'J <br />. <br />SIP PIIONE IICENSE • <br />PLUFI&NOGONTflAGtON MMlA00PE55 CIfY IIP P110NE LICF.NSE• <br />❑ NEW ❑ AODIfION ❑ ALTERATION. ❑ i7EPAIR ❑ DEMOLITION <br />CANTPACT PPICE OF WOPK <br />DESCRIBEWOPNANDSOUIJIEF T�OEINVOLVE� <br />' �vJ eJ� � <br />P OP09E0 OFBUR�iNO <br />LEO�L OESLRIPTION OF PHOPENIY I3110W N BELOV <br />lOT BIGCN OF _ <br />PLUMBINO " <br />i0. TYPEOFfI1(TUNEOfl <br />WATER CLOSETITOILET) <br />BATHTUB <br />IAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINKB DISP. <br />DISHWASHER <br />LAUNDRYTRAV <br />CLOTMES WASHER <br />URINAL <br />ORINKINO FOUNTAIN <br />FLOOR DRAIN <br />�lLOVGBLE/�GTU�L <br />iIHE9PPINNLENS <br />— BAR, ETC) <br />SUBTOTAL 5 <br />PERM�T S <br />TOTAL FEE S <br />PE�PSETB�CN SI�ESEiBACN <br />IOT�FE� VAGNiSITE <br />❑ YES ❑ NO <br />OCCUPANGY6ROUP NOOF�WEIIII <br />HO OL STORIES BSMT OLG IOAD <br />nv <br />❑N <br />HEIG11i IIMIIAt <br />❑ YES ❑ NO <br />WOODSTOVE/FRPL INSERT ❑ BUILUING RELOCATION <br />I HEREBV CER7IFY TNAT I HAVE REAfi AND E%AMINED THIS APPLICATION AND <br />HNOW THE SAME TO BE iRUE AND �.ORfiECT. ALL PROVISIONS OF IAWS AND <br />ORDINANCES GOVERNINO THIS 7Yi'F OF WORK WILL BE COMPLETED WITH <br />W HETHER SPECIFIED NEREIN OR NGT. THE GiiANTING OF A PEfiMIT00ES NOT <br />PRESU ME TO GIVE AUTHORITV 70 VIOLATE OR CAIICEL iHE PROVISIONS OF <br />FNYOT I1ER STATE OR LOCAL LAW REGULATING CONS7RUCT�C>N OR THE PER• <br />FORMANCE OF CONSTRUGTION. THAT � AM AUTHORIZED BY THE OWNER Of <br />THIS Pf10PEF7V TO PERFUFM iHE WORK FOR W MICH APPLIGATION IS MAO£ <br />AND I COMPLY WITH TNE STATE CONTFACTORS LAW 1827 FCW AND <br />296200 WAG <br />SIGNANPEOF.OMR�QOROPAUi110PKED�GENT DAIE <br />� I �� � /s r ��- <br />�PPLIC�MS BUS�NE SLiCENSENOAI p5WE5SNAM <br />MECHANICAL <br />FEF. NO. TYPE OF EOUIPMI <br />A/C — NHNDLG UNITS — HP. <br />FORCED AIR SYSTEMS— B.T.0 <br />UNI7 NEATEPS— BS.U. M <br />CLOTHES DRVERS <br />VENTILATION FAN <br />qANGEH000 <br />WATER HEATER <br />WOODSTOVE <br />Af ETAL FIREPLA :E 8 CMIMNEV <br />FAN <br />eui�oiNc <br />PLUMBING <br />MECHANICAL <br />OTHER <br />STATE BUILDING SURCHARGE <br />S7ATEENERGYSURCMARGE <br />PUBLIC WORKS <br />TOTAL <br />SUB TOTAL <br />PERMIT <br />TOTAL FEE <br />FEE <br />FEE <br />