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fhe Evorgreen <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />259-8810 <br />; `';;;; ;� <br />APPLICA�`IA1�1 FOR CONSTRI,t�iION <br />PERMlT <br />TO BE COMPLETED IN INK— PLEASE PRINT <br />pWNEq MqILA0DflE55 LIIY ZIP PM�NE <br />V`/��S Cc� <br />TENRNi MAILAD�f1E5S CIiY Zlf PHONE <br />SuC'� S �o'� `l `l 05 �vE2c,z¢� ti� .�a � ��sze ; -� <br />AHCHITECTONDESIQNER MAILpDONE55 CIiY ZIP PNONi <br />evcrel� <br />� <br />OENEq�LCONiRACiOR MAILA�ORESS CIfY ZIP PHONE LIC[NSE• <br />��v2T\-1 CoN�`C <br />MECHANICRLCONIRAGiOR MAILAODRE55 CITY ZIP PMONE LICENSE• <br />PLUI.1tlINaCONIPACIOfl MRIIA�Ul1E55 �N CITY ZIP "P181-OyNy�`� �ICENSE• <br />AI.,K� �il.�m�S�w.1L, \'t ��o �'3�� Sa��P iaF .�rt�c���av�i �E q4n`17. c.�-�L� P� ��\ c�� <br />CUSS OF WOPK <br />❑ NEW ❑ ADDITION ❑ AL7ERATION ❑ REPAIR ❑ DEMOL�TION ❑ WOODSTOVFJFRPLINSEHT ❑ BUILDINGREIOCFTION <br />CANTFRCT PFIGE OF WOPk <br />OESCNI EWONNANDSOUAREi00tAGEINVOLVEO <br />cD � �n� _ <br />SED OFBUILOIN6 <br />%.�� �1.� /_% ri.0 <br />LDESCNIPiI PPOP Y�SNOWNBELO�'iOflATTAC11F0UNGOPIES� <br />LOT 9lOCN OF <br />I']SII.T,TdRLe] <br />SHOWER <br />CLO7HE5 WASHER <br />URINAL <br />DRINK�NG FOUNTA <br />Ofl ITEM <br />t HEREBY'!;EFTIFY THAI' I HAVE READ AND E%AMINED T�;!S APPLICATION AND <br />KI IOW THE SAME TO BE TRUE A�J� CORRECT. ALL PROVIS�ONS OF LAWS AND <br />ORDINANCES GOVERNING THIS NF'E OF WORK WILL BE COMPLETED WIfH <br />WHETHER SP'cCIFIED HEREIN OR NOT. TIiEGRAMTING OFA PERMIT DOES NOT <br />PRESUME TO GIVE AUTHORIN TO VIO_ATE OR CANCEL THE PROVISIONS OF <br />ANYOTHER SiATE OR LUCAL lAW RECaULATING CONSTRUCTION OR THE PER� <br />FORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE OWNER OF <br />THIS PROPEflTYTO PERfORM THE WORK FOR WHICH APPLICATION IS MADE <br />AND I COMPLY WITH THE STATE CONTRACTORS LAN' 18.27 RCW AND <br />296200 JJAG <br />SIONATUflEOFCONTflACTOfiORAUiHO(i12ED�0El1T DATE \,`l�`ZI�O� <br />X� l� \ V/�Q,--�...� V�. <br />RPPLICANTS CITY BUSINE55 LICENSE N0. ANO 9USINE55 NRIAE <br />MECHANICAL <br />FEE NO. TYPEOFEOUIPMENT <br />— A/C—A/HNDLGUNITS—H.P. <br />FORCED AIR SYSTEMS— BT.U. M EA <br />— UNIT HEATERS— &T.U. M <br />CLOTHES DRYERS <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />WOOD STOVE <br />METAL FIREPLACE 8 CHIMNEY <br />FIREPLACEINSERT <br />� —� HEAT PUMP <br />GAS PIPING <br />El(HAUST FAN <br />TOTAL FEE $ � `� ^ <br />ISETBACN SIpE5ET13ACK VLANCHECNNIIM1IDER <br />�REA VRCRNTSILE i�EES <br />O YE9 U NO _ <br />1PANCYGPOUP NO.OFUWELlINOU`lli5 BUILDING <br />PLUMBING <br />iFbTORIES &SMT. OCGLOAD <br />o r MECHANICAL <br />ON <br />FIflESPRINKLEflSFE0UIREU ❑YE9 ❑NO <br />OTHER <br />STATE BUILDI�u SURCHARGE <br />STAiE ENERGYSURCHARGE <br />PUBIIC WORKS <br />TOTAL <br />SUB TOTAI <br />PERMIT <br />TOTAL FEE <br />FEE <br />