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t�e Everflreen <br />CITY OF <br />everett <br />BUILDING DEPARTI <br />APPLICAi'ION FO�R CONSTRIi.:TION <br />PERMIT <br />f:T� <br />IENANT MAllA0DNE55 GTY 21P PNONE <br />ARGHREQOflOESIGNER AIAIL�DDRE55 GITY ZIP PHONE <br />cverett <br />e <br />m....�..._--223�9 �-s �'�es�- ��ll �c�p�2.��n��'..S.��NS.� <br />MUMBINOGONTHACTOfl M�ILApDflESS CIIY ZIP P�— ULENSE• <br />C� fA�$ LC11�y��L�--'�I J�FL;? CLR',�� <br />CLti550FNVPK <br />❑ NEW ❑ ADOITION ❑ ALTEMTION ❑ REFAIR ❑ DEMOLITION ❑ WOODSTOVE/FflPLINSERT ❑ BUILOINGPELOCqT10N <br />WOPK <br />lOT BLOCK OF <br />PLUMBIN� <br />URIN4L <br />DR�NKINO FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />ROOF DRAINS — RAINL[ADERS <br />SINK ISERVICE — BAR. ETC 1 <br />SUB TOTAL <br />PERMIT <br />TOTAL FEE <br />iIRESPPINNlER5pE0UIRED ❑YES <br />ITEM I FEE <br />❑ YES u No <br />I HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS APPLICATION AND <br />KNOW THE SAME TO BE TRUE AND CORHECT. ALL PROVISIONS OF LAWS AND <br />ORDINANCES GOVERNING THIS NPE OF WORK WILL BE COMPLETED WITH <br />W HETHER SPECIFIED HEREIN OR NOT. THE GHANTING OFA PERMITDOES NUT <br />PRESUME TO GIVE AUTHORIN TO VIOLATE OF CANCEL THE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PER• <br />FORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BV THE OWNEH OF <br />THIS PROPERN TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE <br />AND I�PLV WITM THE STATE CONTRACTORS LAW 1827 RCW AND <br />298.2 A . <br />SiGNMfUflE CONLP�QOfVONAUi110RIZE0�GENIw DAiE <br />MECHANICAL <br />NO. TYPEOFEOUIPMENT <br />A/C—A/HNDLG UNITS— H.P. <br />FORCED AIR SYSTEMS— B i.! I. M EA <br />UNITHEATERS—B.T.U. M <br />CLOTHES DRYEfiS <br />VENTILA710N FAN <br />RANGEHCOD <br />NEAT PUMP <br />GAS PIPING <br />EXHAUST FA:1 <br />t i)v1:i: ir.� i�.l <br />0 <br />5118TOTAL S <br />PERMIT S <br />TOTAI FEE S <br />JMBEP FEE RE <br />FEES VALUATION <br />' NOAFOWElLINOUNlT9 BUILDING <br />PLUhIBING <br />BSMT. OLG LOAO <br />o r MECHANICAL <br />❑N <br />HE�GHTLIMIT�TION OTNC'fl <br />STATE BUILDING SURCHARGE <br />STATE ENERGYSl1RCIlARGE <br />PUBLIC WORKS <br />TOTAL <br />