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rlrs Ererpissn <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />259•8810 <br />APPLIC:ATION FOR CONSTRti.�T10N <br />PERMIT <br />. . , <br />TO BE COMPLETED IN INK— PLEASE PRINT <br />everett <br />� <br />OWNEN iMIIADDNESS GiY LP PNONE <br />1E��µT AWL�DORE54 GTY Z�0 . PMONE <br />ApCNREGrORUESIGNER M�IL110DFESS CITY ZI^ PMONE � � <br />OENERQCANTiUCTOR M�ILfODRE59 pTY ZII' VNOHE 4LENSEi <br />MEGMIIHICAICONTMCTOP AUILAODNESS GIY ZIG FHONE . 4CENSE• <br />- -- -- -•- -__.i A --^^^i-•-. <br />❑ NEW ❑ ADDITION <br />�LTEMTION ❑ REPAIR ❑ DEMOLITtON ❑ WOODSTOVFJFRPLINSERT ❑ BUILDINGRELOCATION <br />lOT BIOGK OF <br />1�2 � �1W� <br />PLUM�INO <br />�1p, TYPF OP FIl(T1RE <br />WATER CLOSETITOILEII <br />' erar+rue <br />LIYATORY (WASH BF.SIM� <br />SHOWER <br />KITCHEN 31NK8 DISP. <br />UISHWASHER <br />IAUNDRY TMV <br />CLOTHES W�SHER_ <br />URINAL <br />DRINKIN6 FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />ROOF DF.41NS — RAINLEAD <br />CIIJR IRFGNf.F- RCR. FTCI <br />•LIOW�BIEIACiU�I <br />❑Y <br />ON <br />PIRESPRINY.LERS <br />? (-706,3(0� -� 53 <br />I HEREBI' CEHTIFY TNAT I HAVE READ AND EXAMINED iH15 APPLICAT�ON AND <br />KNOW THE S�ME TO BE TRUE AND CORRECT. ALL PROVIS�ONS OF LAWS AND <br />ORDINANCES GOVERNING TIIIS iVPE OF WORK WILL OE CUMPLET[D W�TH <br />\YHETNFR SP�CIFIED HEREIN OF NOT.THE GRRNTING OFA PEPMIT DOES NOT <br />PRESUME TO GIVE AUTHOFITV TO VIOLRTE OR CANCEL THE PROVISIONS OF <br />ANV OTHER STAiE OR LOCAL LAW REGULATIN6 CANSTflUC710N OR THE PER� <br />FORMANCE OF CONSTRUCTION. TNAT I AM AUTHORIZED BV THE OWNER OF <br />THIS PROPERTV TO PERFORM THE WORK FOR WHICH APPLICATION IS MRDE <br />AND I COMPLV WITH THE STATE CONTRAGTORS lAW 1827 RCW AND <br />296.200 WAG �' Z Q— Ff'� <br />SI�3NRUNEOFCONTRAGTORONAUTHONIZ[O�GENi DATE S <br />X�SGiY�IGENSE NO.J�EBSN�ME <br />MECHIINICAL <br />FEE � � HO. � TYPE <br />A/C—NMNDLG t <br />FORCED AIR SYS <br />UNIT HEATERS— <br />CLOTHESDRVEP <br />�VENTIUTION FAP <br />RANGEHOOD <br />S <br />O YES O NO <br />6A5 PIPING <br />E%HAUSTFAN <br />f{UILDING <br />PLUMBING <br />MECHAMCAL <br />— H.P. <br />— &T.U. M EA <br />M <br />8 CHIMNEY <br />OTHER <br />S1ATE BUILDINO SURCHARGE <br />STATE ENER6VSURCHARGE <br />PUBLIC WORKS <br />TOTAL <br />TOTAL <br />FEE <br />