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fh� Enrprosn <br />CITV OF <br />everett <br />BUILDING DEPARTMENT <br />259-8810 <br />APPLICiION FOR CONSTR�'Q'ION <br />PERMwT <br />everen <br />��,�.,� Pd�M,��239�9 e <br />TO BE COMPLETED IN INK— PLEASE PRINT <br />11qCMITEf.TOFDEB��NER M�IL�O�AE59 ��tY Z�P iMONE <br />OENEN�ICANTR�LTOR M�IL�DORESS GTY 21P PHONE 4CEN9E� <br />MEu�UNICQCOXTFI�GTOR MAIL�DCAE66 CItY i�P VMONE UCENBE• <br />I <br />�W V^❑ ADDITION ❑ �LTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOOD3TOVE/FRPL INSERT ❑ BU�LDINO i7ELOCATION <br />NM1T IMPROVEMENT OR INiER10R REMODEI ONLY CONT�CI PER90N �NO P11pNE NO <br />COMTRACT PR�CE OF WORK <br />�p7 BLOCR OF <br />URINAL <br />aLLOW�BLE/AGTUAI <br />FIPEBPRINKLEF9 <br />� <br />PREVENTERS <br />JS — RAINLEADER; <br />CE — BAR, ETC.) <br />SUB TOTAL 5 D <br />PERPAIT $ <br />TOTAL FEE S <br />REAP6ETB�CR 810EBET&1CK <br />�pT�p� VAGANTBRE <br />❑ YE9 ❑ N9 <br />OCCUPANCYnqpUP NO.OFDWELLINOUNITB <br />NO.OfBTORIE6 89MT. OCGIO�D <br />❑r <br />o r+ <br />HFN3HT LIMIPITION <br />O YE9 O NO <br />0 <br />IHEREBVCERTIFYTNAT � �."ADANDE%AMINEDTHISAPPLIGATIONAND <br />KNOWTHESAMETOB�. ��'��� :ORRECi.ALLPFOVI510NSOFLAWSAND <br />OFDINANCES GOVERIdiL �PE OF WONK WILL BE COMPL[TED WITH <br />WHETHERSPECiFIE�HEf � NOT.7NEGRANTINGOPAPERMITDOESNOT <br />PRESUME 70 GIVE AUTHOHI � � tO VIOLATE OR C�NCEL THE PROVIS�ONS OF <br />AMY OTHER SiAi E OR LOCAI LAW REGULATING CONSTRUCTION OR THE PER• <br />FORMANCE OF CONSTRUCTION. THAT I AM AUTHORI2ED BY THE OWNER OF <br />THi3 PROPERiV TO PERFORM THE WOAK FOR WHICH APPLICRTION IS MADE <br />At'D I COMPLV WI7N THE STATE CONTRRCTORS LAW 1827 RCW AND <br />296.200 WAC. <br />&ON�tUREOfCONIR�GiO�O�i4t1iNORREU�GENt D�tE <br />X � / / i�/'/I �� <br />MECNANICAL <br />UNIT <br />RANGEI100D <br />WATEF HEATE <br />WOO� STOYE <br />ME7AL FIREFL <br />FIREPLACEIN <br />HEAT PUMP <br />GAS PIPING <br />i UNIT'S — M.F. <br />/S7EM5— BT.U. <br />— B.T.U. M <br />I�EES <br />BUILDINO <br />PLUMBINQ <br />MECHANICAL <br />OTHER <br />STATE BUILDINO SURCHARGE <br />STATEENERGYSUACHAflGE <br />PUBLIC WOR•KS <br />TOTA6 <br />TOTAL <br />FEE <br />.o , .\ , <br />. .�.: . ' <br />�.. __�.•--..._...._... . :... <br />_� _�.... <br />.� _._ ....�_. ...-. ,i , , <br />FEE <br />�� <br />� <br />