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Ihc Evsryreen <br />CIf1'O° <br />everett <br />BUILDING DEPARTMENT <br />259•8810 <br />�� <br />APPLIC�fIVN FOR CONSTRt �TIOI+1 <br />PERMIY <br />TO BE COMPLETED IN INK— PLEASE PRINT <br />�NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOO�STOVE/FRPL IM1SERT ❑ BUILDING RELOCATION <br />TENANTIMPROVEMENTOfl INTEFIOR FEMODEL ONLY CONiACT Pf:F50N FND PHONE NO. <br />CONTRRLT °flICE OF WOflK <br />OE PIG/E WORKFN SOUAREfOOTAGEINVOLVED <br />-� �'�IVY,1�� �.� <br />LOT._— BLOCK OF <br />k��C� �(� Qle�� <br />�� PLUMBING <br />. NO. TYPE OF FIXTURE OR <br />WATER CLOSEf (TOILEfj <br />BATHTUB <br />� LAVA� ORY (vVASH BASIN) <br />SHOWER <br />. KITCHEN SINKB DISP. <br />DISHWASHER <br />LAUNDRYTRAY <br />� CLOTHES WASHER <br />UFINAL <br />DaINKINCa FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />ROOf DRAINS—RAINLEADERS <br />SUB TOTAL <br />PFRMIT <br />TOTALFEE <br />❑v <br />❑N <br />FIRESPRWYlCF5RE0U1FED ❑ YES ❑ NO <br />��� <br />��rrm <br />,: . <br />cv^rett <br />1 �� ;P <br />� , �: <br />. <br />I f itliE�Y CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND <br />KNOW THE SAME TO B[ TRUE.IND CORRECT. ALL PROVISIONS OF LAN'S AND <br />ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLETED WITH <br />W HETH E(i SPECIFIED HEFEIN OR NOT.THE GRAN7ING OF� PERMIT DOES NOT <br />PRESUME TO CaIVE AUTHORIN TO VIOIAi E OR CANCEL THE PRUVISIONS OF <br />ANY OTHER STATE OR LOCAL I.AW FEGULATING CONSTRUCTION OR THE PER• <br />FORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE UWNER OF <br />THISPROPERNTOPERFORMTHEW RKfORWHICHAPPLICATIONIStAADE <br />A9pN{D� �I ^C,�O PLY WITH T TAT CONTRACTORS LAW 1827 RCW AND <br />SI IGNATI�RRO�GONTiAGT $OPAUi 10 ED/GENT �PTE <br />IJIEC}1ANICAL <br />NO. TYPE OF EOUIPMENT <br />A/C—A/HNDLG UNITS— H.P. <br />FORCED AIR SYSTEMS— B.T.U. M EA <br />UNIT HEATERS— B.T.U. M <br />CLOTHESDRYERS <br />VENTILATION FAN <br />RANGEHOOU <br />WATER HEATER <br />�YOOD STOVE <br />METAL FIFEPLACE 8 CHIMNEY <br />FIREPLACEINSERT <br />HEAT FUMP <br />GAS PIPING <br />EXHAUSTFAN <br />rn�nn i a� i e FEES <br />❑ YES ❑ NO <br />NO.OFDWELLINGUNITS BUILDING <br />PLUMBING <br />OLG LOAD <br />MECHANICAL <br />HEIGHTLIMIiATION OTHER <br />STATE BUILDING SURCHARGE <br />STATE ENERGY SURCIIARGE <br />PUBLIC WORKS <br />TOTAL <br />PERMIT <br />TUTALFEE <br />FEE <br />VALUATIDN <br />5 <br />FEE <br />