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APPLIC�. t10N FOR CONSTRI..:TION <br />PERMIT <br />fhe Everpreen everett <br />CITY OF <br />everett e <br />BUILDING DEPARTMENT <br />259•8810 TO BE COMPLETED IN INK— PLEASE PRINT <br />OWNEfl MRILAO�RES+ CITY ZIP PHONE <br /><. _D ('L,_.��,,.r�� ���r �rl�,¢ti �/t. A__/�._... sa.��fL 6�5� S�t/rsl <br />FPGHITECTOPOESIGNER AtRILADOflE55 LRY 21P PMONE <br />�EifEP�yCONTPACTOR MNILA�DfiESS GITY Gu+ w�une uGENSE• <br />j��.p�[ �/r.,�..�„ Fa6 . i�S�zo s�z���9�. �� T��.�,-� 9os�s/G s:��-cs� iPlflsaeci3zcr <br />MECH�NICALCONTfl�CTOR 'MAILApDPESS J CIiY ZIP PIIONE � LIGENSE+ <br />PLUMBINOLONTR�CTOF MAILPOORE55 CITV 21P PHONE LICENSE• <br />. CL/S30F WOHH,p <br />� � NEW fIJ AODITION ❑ ALTEflATION ❑ FEPAIR ❑ DEMOLITION ❑ WOOOSiOVE/FRPL INSERT ❑ BUILDING RELOCATION <br />7EN�NTIMPROVEMENTOflINTERIOflfl�E °OELONLY GONTACTPEHSONRNOPI{ONENO <br />� GONTF�CTPflICEOFWORK �'1S�/1._ n.3 __ �G c0( /,KI'��d��06�5�� —p�� <br />DESGflIBE WORK �ND,S/OLIAflE FOOTAOE INVOLVEO <br />/��kiS�1 �1 � �Y ���1�. %� � r0 . � �� <br />PROPO lISE OF_B/UILOING <br />HdtJ C.hc'realr'�Z 6�u�n.a.,¢ <br />LOT BLOCN OF <br />' Sw.' �'A�- .. �� - <br />E Y,. iP- za -.s� <br />PRO CT��O ESS � / <br />� `��� SG �JPrf <br />PLUMBINC <br />NO. TYPE OF FIXI <br />" WATEFCLOSETITOILE <br />BATHTUB <br />LAVATORV(WASH BA511 <br />SHOWER <br />KITCHEN SINKB DISP. <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHEF <br />� URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />nwr unnmo— <br />SINK(SERVICE— <br />TOTAL FEE <br />nr <br />❑ N <br />FIflESPRINKLE�15RE0UIPED ❑ YES ❑ NO <br />Fi <br />Y� <br />❑ YES ❑ NO <br />FEE <br />I li E7EBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND <br />KNOW ?HE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS AND <br />ORDINANCES GOVEFNING THI3 7YPE OF WORK WILL BE COMPLEfED WITH <br />WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OFA PERMIT DOES NOT <br />PRESUME TO GIVE AUTHORIT' TO VIOLATE Ofi CANCEL THE PROVISIONS OF <br />ANV OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PER• <br />FORMANCE OF CONSTpUCTION. THAT t AM AUTHORIZED BY THE OWNER OF <br />THIS PFOPERN TO PERFORM THE WORK FOR W HICH APPLICATION IS MADE <br />AND I COMPLY WITH THE STATE CONTfiACTORS LAW 1827 RCW AND <br />29fi200 WAC. <br />SIGNFTO � ONTPRC R OR�D AGENT OATE <br />X a-/�-e9'i <br />e��f,eF � ��2 <br />MECHANICAL <br />TYPE OF EOUIPMENT <br />— A/FiNDLG UNITS — H.P. <br />ICEDAIRSYSTEMS—B.T.U. MEA <br />� HFATERS— B.T.U. M <br />CLOTHES ORYER: <br />VENTILATION FAN <br />pANGEHOOD <br />WATER HEATER <br />HEAT PUMP <br />GAS PIPING <br />EXHAUST FAN <br />CHIMNEY <br />SUB <br />TOTAL FEE <br />BUILDING <br />PLUMBING <br />MECHANICAL <br />OTHER <br />STATE BUILDING SURCHARGE <br />STATE ENERGY SURCHARGE <br />PUBLIC WORKS <br />TOTAL <br />c <br />VALUAT101� FEE <br />)i�l� �. <br />�� <br />