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'�e Everpreen <br />.ITY OF <br />everett <br />BUILDING DEPARTMENT <br />259•d870 <br />APPLICATION FOR CONSTRI`.:TION <br />PERMIT <br />TO BE COMPLETED IN INK — PLEASE PRINT <br />evcrctt <br />e <br />OWNEfl MpII��ORE55 CIfY ZIP C110NE <br />S-%P�1 P i�br"- �r'� V.ZSS I�I �.V P✓�1- G%S�—�.�-)� '%Z%� <br />tEN�NT-T- M�IL�DDPF55 L�1Y ZIP PIIONE <br />�{ICNITECT0110E516NER M��L�UDRE55 CitY 2iP PHONE <br />�ENER�LCANiRAGTOR M�R�OU�E55 G�IY 2iP PNONE �IGtNSE� <br />�AECHANIL�LCANiP�CTOR M�IL�DD11E55 LRY ZIP PNONE LICENSE♦ <br />�IO�l(%Q i <br />vi3�'�NaeoHr on +n�a�ooress r.nr zm m�or+e uecHse. <br />❑ NEW ❑ AODITION ❑ ALTEflATION ❑ REPAIR ❑ OEMOLITION ❑ WOODSTOVE/FRPL INSERT ❑ BUILDING RELOCATION <br />CAN7IUCT POItE OF WORK <br />LOT. BLOGK OF <br />PLUMBINO <br />WATER <br />TRAY <br />URINAL <br />DR�NKINO FOUN1 <br />FLOJR DRA�N <br />BACKFLOW PREV <br />ROOF DRAINS — <br />arvK �svavirc _ <br />or <br />oN <br />FIREBCpINNLERDqFWIREO OYES ONO <br />0 <br />5 <br />1 HEREBY CER7IFV THAT I FIAVE REA� AND EXAMINED THIS APPLICATION AND <br />KNOWiHESAMETOBETRUEANOCORRECT.ALLPROVI510NSOFLAWSAND <br />ORDINANCES COVERNING THIS TYPE OF WORK WIL� BE COMPLETED WITH <br />WIIETHER SPECIF�ED HEREIN OR NO7. THE GHANTINO OF A PERMI7 DUES NOT <br />PFESUME TO ��VE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHEri STATE OR LOCAL LAW REGULATINC CONSTRUCTION OR THE PER• <br />FORMANCE OF CONSTRUCTION. THAT 1 AM AUTHORIZED BV THE OWNER OF <br />THIS PROPERiV Tq PERFOFM THE WORK FOR WHICH APPLICATION IS MADE <br />AND t COMPLV WITH THF STATE CONTRACTURS lf.'N 1827 RCW AND <br />298.200 WAG .�� ^ �� <br />SIGNANIIEOFCONiP�GI000H1C1110NZCD�OENT O�IE � <br />•PPLICAHISC'�SIIGENSE OENUOU51 9N�ME � <br />MECHANICAL <br />UNIT HEATEFS— 9 <br />CLOTHES DRYERS <br />VENTILATION FAN <br />RANGEHO00 <br />fIREPLAGEINSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN <br />BUILDINO <br />PLUMBING <br />MECHANICAL <br />OTn:7 <br />STATE BUILDING SUfiCHARGE <br />STATEENEROYSURCHAR�E <br />PUBL�C WORKS <br />TOTAL <br />M <br />PERMIT S <br />TfJTAL FEE S <br />FEE <br />