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Ihe EverO�een <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />259•BB10 <br />APPLICATION F�DR CO�iSTRUCi�AN <br />PERIlAIT <br />TO BE CQMPLETED IN INK — PLEASE PRINI' <br />OWNER MRILADOfiE55 GItY ZIP PHONE <br />I�r.�.. _ _. ... o. _r .�1�I�R7 A.1� !'c -f.Y�M RC�1��(�Ic ��{���i��n �nU�'���U� <br />��/���rr ��v��ac C vtia�r <br />ARGMIiECTOR0E51GNER MAILADOIiE55 LIIY ZIP PHONE <br />OENEFALCONTRACTOR MFILAUONE55 GTY ZIP PMONE �ICENSE• <br />MEGM�NIC�LCONiP�CTON MRILPOONE55 GITY 21P PMONE LIGENSEr <br />PLUMBINOGONifl�CTOR M�ILROOf1E55 CITY 2R FHONE 4CENSE• <br />❑ANEW �O ADDITION ❑ ALTERA710N ❑ REPAIR ❑ DEMOLITION L WOODSTOVFJFRPLINSERT ❑ BUILDINGRELOCA7ION <br />WORIC <br />�or e�ocK oF <br />71.�G I �1 <br />PLJMBING <br />NO. �— <br />SHOWER <br />KITCHEN SINiC 8 <br />YT:k\1 <br />DRINKIMO FOUN <br />FLOOR DRAIN <br />BACKFLOW PRE� <br />ROOF ORAINS— <br />FIPE <br />PIXTUHE <br />TOTAL <br />❑ YES ❑ NO <br />ov <br />❑N <br />I HEREBY CERTIFV THAT I HAVE READ AND EXAMINED THIS APPLICATION ANO <br />KNOW THE SAMETO BETRUEAND CORRECT. ALL PROVISIONS OF LAWSAND <br />ORDINANCES GOVERNING IHIS TIPE OF WORK WILL BE COMPLETED WITH <br />WHETHER SPECIFIED HEREIN OR NOT.TkiEGRANTING OFA PERMIT DOES NOT <br />PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW F'EGULATING CONSTRUCTION OR THE PER- <br />FORMANCE OF CONSTRUCTION. TI1AT I AM AUTNORIZED BY THE OWNEN OF <br />THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE <br />AND 1 COMPLY WITH THE STATE CONTRACTORS LAW 1827 RCW AND <br />296.200 WAC. <br />SIGN�TUREOFCON7MG10ROIIAUIIIORIZED?GENT OATE <br />APPLICANiSCI__� NSEN . I I <br />� <br />. MECHANICAL <br />FEE NO. TYPE OF EOl <br />A/C — A/HNOLG UNITS — <br />FORCED AIR SYSTEMS— <br />UNIT HEATERS— B.T,U. <br />CLOTHES DRYERS <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATEfl <br />WOODSTOVE <br />METAL F�REPLACEB CHII <br />a <br />a <br />O YES ❑ NO <br />SUB TOTAL <br />PERMIT <br />TOTAL FEE <br />BUILDING <br />PLUMBING <br />MECHANICAL <br />OTHEfl <br />STATE BUILDING SURCHARGE <br />STATE ENERGY SUPCHARGE <br />PUBLIC WOFKS <br />TO7AL <br />FEE <br />