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Ihe Everpreen <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />259-8810 <br />APPLICATION FOR CONST�uCT10N <br />PERMIT <br />TO BE COMPLETED IN INK- PLEASE PRINT <br />everett <br />e <br />ST7�1 � ��Ty ZIP PMONE . <br />ANGMRECfOH0E51GNEfl M�IL�ODNE55 <br />GENER�LCON7p�GiOH AIAIUI�DRE55 G1Y ZIP PHONE 4CENSE• <br />$E'2(1i-� �11�N �1C �G f3nc� 5269 LY/UAIW � �go�6 776-883� `$E'izlufNK�y7�: <br />MECM�NIGALCANTflALTOfl MAILADOBE55 GITY ZIP PHONE L'LENSC <br />GLUMBINOCONTR/.GTOfl IA�IL�DORESc � CITY 21P PMONE .. �.� VCENSE• <br />GUSS OF WONK <br />NcW ❑ AODITION ❑ ALTEpATION ❑ PEPP�R ❑ DEMOI�TIDN � WOODSTOVFJFRPLINSEflT ❑ BUILDINGRELOCATION <br />IENI.NTIMPflOVEMENtOflINp�PIOPPEMOOELONLY � CANTRGTF[NSON�NOPMONENO. <br />�T' in e�.n °°� � IIArJ 1/i. �FLR.Vf� ��l�f��t /VE�l.� �f�C <br />LOT BLOCN OI <br />vr+aecr �ooness <br />/,; � zn ,�i, .Gz G1Z L�C'�J L..� y <br />?LUMBING <br />CLOTHES <br />ROOF <br />ALLOWABLEI�LTWL <br />FIHE SPPINNlEflS <br />.•]y <br />ITEM <br />(iJA'L.� J/(.N <br />I HEREBY CERTIFY THAT I HAVE FEl D AND EXAMIN=il f HIS APPLICATION AND <br />NNOW THE SAME TO BE TRUE AND f.ORRECT. ALL PROVIS�ONS OF IAWS AND <br />ORDINANCES IiOVERNING THIS NPE OF WORK WILL BE COMPLETED WITH <br />WHEf HER SPECIFIED HEFiEIN OR NOT.THE GRPNTING OFA PERMIT DOES t!QT <br />PPESUME TO GIVE AllTHORIN TO VIOLATE OR CANCGL THE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PEP• <br />FORMANCE OF CONSTiiUCTION. THAT I AM AUTHORIZED BY THE OW NER OF <br />qNID IRCOMPL�TW THRTHE S A E CONTRACTORSHLAWL1B2T7ORCW AND <br />286200 WAC. <br />SIGNALUBEO GONTRACTORORA/T f1RE�AGENT O�TL <br />X ��%�n,_�'"I �l ��(/ �0 %26 �9 <br />MECHANICAL <br />FEE NO. 7YPEOFEO�:_PI <br />A/C — A/HNDLG UNITS — H.F <br />FORCED AIR 3VSTEIdS— 6T <br />UNITHEATERS—B.T.U. M <br />CLOTHESDRYERS <br />VEN7ILATION FAN <br />FANGEHOOD <br />SUBTOTAL 3 <br />PERMIT E <br />TOTAL FEE 5 <br />pEARSET9ACK SIDESETOAGN <br />�OTMEA VACANTSITE <br />❑ YES C� NO <br />OLCUPANCYG90UP HOAFOW[lLll <br />NOOFSTOFIES &SMi. OGGlOAD <br />ur <br />❑N <br />neim�r istqi <br />❑ YE9 ❑ NO � _ . <br />METAL <br />PUMP <br />8 <br />SUB <br />TOTAL <br />BUILDING <br />PLUMBING <br />M[CHANICAL <br />OTHER <br />ST4TE BUILDING SURCNARGE <br />STATE ENERGY SURCHARGE <br />PUBLIC WORKS <br />TOTAL <br />VALUATION <br />