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IM1e Evorpraon <br />CIiY OF <br />everett <br />BUILDING DEPARTMENT <br />259•8d10 <br />r.:;�;� � 't � <br />APPLICI.v�rION F4R CONSTRIi..TION <br />PERMIT <br />TO BE COMPLETED IN INK— PLEASE PRINT <br />OWNEFl MAILRUDBE55 GIIY ZII' 1'110NE <br />H.,�,r�.�o�v ,�.asso�. y��s 3rn,�uv� ,u.e. SEq �d/�s s�7-�otrS <br />TEN�NT MRILRDOnE55 GI1Y ZIP PH�NE <br />%fOC-/lVYi 77�0 �V&72G26TL'� 'w'g�i EV��t'7% 983a3 <br />MCMIIECTOROESIGNEH ��LRDOPE55 CIiY 21P PMONE <br />t•vcrCil <br />� <br />OENEMLCOMRRGTOR MAI�AOUfiE59 CIIY 21P PHONE UGENSE• <br />MECHRNIG�LGONiFl�C10fl MAILAUDfiESS GIIY ZIP PIIONE LICENSE� <br />PLUMBiNOCOMRACTOR MRII�DOflE55 GItY ZIP PIIDNE LILENSE� <br />s✓>:eaoo�v,o�.o •trricc��z 77i7 .D�T,eo�T Stv 5�, 9��0� 7G,3-5'Qoo"'�a4a v <br />❑ NEW V❑ ADDITION � ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL INSERT ❑ BUILDING RELOCATION <br />WORK ��I. 7 SD <br />%EN,9M' /MP�aVEHENT [NVAC <br />POSED USE OF BUI�DIHO <br />O�FIGE, GLd55Rootn <br />LOi eLotl( OF <br />reaecr eooness <br />7 �io E (�G/�K2 EEAJ <br />PLUMBINO <br />� NO. � TYPE OF FI%TUFiE OH ITEM <br />WATER CLOSET (TOILE'f) <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISP. <br />' DISHWASHER <br />LAUNDRYTRAY <br />' CLOTHES WASHER <br />URINAL <br />� ORINKING FOUNTAIN <br />� FLOOR �RAIN <br />� BACKFLOW PFiEVENTEFS <br />' onncnoeiuc_oeiwcenvoc <br />; <br />F9�lalZ�]Til�i <br />❑Y <br />❑N <br />flPESPPIHKLERSRE0UIRED OYES ❑NO <br />a� � <br />O VE9 C NO <br />I HERE6Y CERTIFY THAT 1 HAVE READ AND EXAMINED THIS APPLICATION AND <br />KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS AND <br />ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLETED WITH <br />WHETHER SPECIFIED HEREIN OF NOT. THE GRANTINCa OFA PERMIT DOES NO7" <br />PpESUME TO GIVE AUTHOFiITY i0 VIOLATE OR CANCEL THE PROVISIONS OF <br />ANYOTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PER� <br />FORMANCE OFCONSTRUCTION. THAT I AM AUTHORIZEO BY-HE OWNER OF <br />THIS PFOPERN TO PERFORM THE VlORK FOR WHICH APPLICATION IS MADE <br />AND I COMPLY WITIi THE STATE CONTRACTORS LAW 1827 RCW AND <br />296200 WAG <br />SIGNR7UREOFCONINACTOOOflAUiHORIZEDAGENT URtE <br />X ��..�i�_ �iA�:C 'b�9 <br />pPPLIGNT9 GIIY BUSINESS IICENSE N0. AND OUS�NE55 N�ME <br />MECHANICAL <br />N0. TYPEOFEOUIPMF <br />A/C — A/HN�LG UNITS — FI.P. <br />FOiiCED AIR SYSTEMS— 6T.U. <br />UNITHEATERS—B.f.U. M <br />CLOTHES DRYERS <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />FIREPLACE <br />HEAT PUMF <br />SUBTOTAL <br />PERMIT <br />TO1AL FEE <br />FEES <br />BUILDING <br />PLUMBING <br />MECHANICAL <br />OTHER <br />STATE BUILDING SURCHARGE <br />STATEENERGYSURCHARGE <br />PUBLIC WORKS <br />TOTAL <br />M EA <br />5 <br />5 <br />FEE <br />