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APPLICATQO�N F�R CONSTRUCTION <br />PEF�MIT <br />Iho EvoiB�aen <br />CITY OF evercll <br />everett � <br />BUILDING DEPARTMENT <br />259-8810 TO BE COMPLETED IN INK- PLEASE PRINT <br />OWNEfI 1.IAILAOONE55 GIIY �IP PHONE <br />�fyZIS LGIYI(�AtiIY 3(�05---��a"'-'' nJL S.L.3Y300 3�ti_l-y1JE �TS�OOh �C:��(=�-U3G0 <br />C �r155� c c_ ���N <br />OENEIULCONifiACtOR MAIUU�RE55 GtY ZIP PIIONE LiC[NGE• <br />IdEC11ANICR�CONfpRCiOR hIFILADDRE55 CIIY ZIP PNONE 4CEN5[• <br />PlUM61NOCONiflRCiOR MAILA0011E55 CITY ZIP PIIONc IIGENSE• <br />❑ NEW ❑ AODITION ❑_l+.LTEfiATION ❑ qEPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL INSEPT ❑ OUILDING RELOCATION <br />ior e�ocK ov <br />PLUMBING <br />TYPE OF FIXTURE <br />WATER CLOSET (TOILEp <br />BATHTUB <br />LAVATORY(WFSH BASIN) <br />SHOWEF <br />KITCHEN SINKB DISP. <br />URINAL <br />DRINI:ING <br />FLCOR OR <br />TRAY <br />PREVENTERS <br />!S—RAINLEA <br />^.F—Reo Frr <br />SUB TOTAL <br />PERMIT <br />TOTAL FEE <br />FIRESPRINN�EP9fiE0UTAE0 ❑YE9 ❑ <br />.� <br />FEE <br />❑ YES ❑ NO <br />I HEf7EElYCERTIFI'THAT I HAVE READ AND EXAMINED THISAPPUCATION AND <br />KNOW TNE SAI.1E TO BE TRUE AND CORRECT. ALL PqOV1510NS OF LAWS AND <br />ORDINANCES GOVERNING THIS TYPE OF WORK WILL 6E COMPLETED WITH <br />WHETHEfiSPECIFIED HEREIN OR NOT.THEGRANTINC OfAPERMITDOES NOT <br />PRESUME TO GIVE AUTHOPIN 70 VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTH ER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR TH E PER• <br />FORMANCE OF CONSTHUCTION. THAT I AM AUTNOr11ZE0 BYTHE OWNER OF <br />THIS f'ROPERTY TO PERFOHM THE WORK FOR W HICH APPLICATION IS MADE <br />AND I COMPIY WITH 7HE STA7E CONTRACTORS LAW Ip27 RCW AND <br />296200 WAC. <br />SIONNTUBEOFLONTRACIORORAU7MORIZEDRGEN7 OAiE <br />X �7 �.- r' /I ' l %_ <br />MECHANICAL <br />TYPE OF EOUIPMENT <br />A/C—A/HNDLG UNITS—H.P. <br />FORCED AIR SYSTEMS— QT.U. M <br />UNITHEATERS—B.T.U. M <br />VENTILA710N fAN <br />RANGEHOOD <br />WATER HEATER <br />WOOD STOVE <br />FiEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN <br />NO.OFDWElLIN0UNI15 BUILDING <br />PLUMBING <br />ns�ac occ �ono <br />� Y MECHANICAL <br />❑N <br />MEIGMTLIMIiR110N OTHER <br />STATE BUILDING SURCHARGE <br />STATEENERGYSURCHAR6E <br />� PUBLIC WORKS <br />TOTAL <br />CHIMNEY <br />FEE <br />SUBTOTAL 5 <br />PERMIT 5 <br />TOTAL FEE g <br />FEE qECEI�TNO. <br />VALUATION FEE <br />