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fhe Evorpreen <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />259•8810 <br />APPLICATION FOR CONSTRU��'!AN <br />PERMIT <br />TO 8E COMPLETED IN INK— PLEASE PRINT <br />evcretl <br />e <br />OWNCP MR'IR�DliESS GIIY ZIP FH01lE <br />YY7-�S Coa11i�,�:N', 3L-�GS 13a""' QVG 5� . at3UD r�l�Zu_Jut -�i �o[-`(� fo�3-�(3D0 <br />iENFAi MAIL0.00RE•u5 CIIY 21P PNONE <br />�-� A� I 121'Yl Y�`,�l-_1ZS <br />MCHIIEGTOflOESIGNER MAILROORE55 GIiY ZIP PMONE <br />0[NEfULGONiPRCTON MAILAOLRC9 CIIY ZIP PlIONE �ICENSE• <br />MECIIANIC�LGONIfiACTOR MI11LApORESS CITY ZIP PMONE �ICENSE• <br />PLUMOIH4CONTN�CTOH MRIlPO�fiE59 CITY 2iP PMONE LILENSC• <br />❑ NEW ❑ AD�ITION ❑ ALTERATION ❑ REPAIR ❑ DEM1IOLITION ❑ WOOOSTOVFJFRPL INSERT ❑ DUILDING RELOCATION <br />CANTR�GT PFiCE OF WONk <br />L� <br />LOT BIOCN OF <br />PLUMBING <br />LAVATORY�WA51 <br />SHOWER <br />KITCHEN SINKB <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />TOTAL FEE S <br />ov <br />❑ �� <br />FIRE9PNINRLERSPEQWpED ❑VES ONO <br />: i" <br />O VES ❑ <br />i HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND <br />i(NOW THE SAh1E TO BE TRUE ANO CORRECT. ALL PROVISIONS OF LAWS AND <br />JRDINANCES GOVERNING THIS TYPE OF WORK VlILL BE COMPLEfED WITH <br />WHETHERSPECIFIED HEREIN OF�OT.THEGfiANTINGOFAPERMITDOES NOT <br />PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTI �ER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PER• <br />FORMANCE OFCONSTRUCTION. THAT I AM AUTHURIZEO BY THE OWNER OF <br />THIS PROPERN TO PERFORM ThE WORK FOR W HICH APPLIC�ITION IS MADE <br />AND I COMPLY WITH THE STATE CONTRACTORS LAW 1B.27 RCW AND <br />296.200 WAG <br />SIONRTUFEOFCONTOACTCRORAUTHOBIZEOAGENT DATE <br />X ` /���li �,�- �a- a <br />APPI,ICANTS CITY OUSINESS ll :NSE NO. AN� f1U51NE55 NRME <br />MECHANICAL <br />NO. TYPEOFEOUIPMENT <br />A/C — A/H NDLG UNITS — H.P. <br />F(1GCFIl GIG CVMFI,AC� RTI I <br />VENTILATION FAN <br />RANGEHO00 <br />vVA1ER HEATER <br />WOOD STOVE <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN <br />FEES <br />sui�oiNc <br />PLUMBING <br />MECHANICAL <br />OTHER <br />STATE BUILDING SURCHAqGE <br />STATE ENERGY SURCHARGE <br />PUBLIC WORKS <br />TOTAL <br />SUB TOTAL <br />PERMIT <br />TOTAL FEE <br />VALUATION I FEE <br />