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Ihe Everpreon <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />259•8810 <br />,,:,�, <br />APPLIC/���'ION FOR CONSTRIi�:�T10N <br />PERMIT <br />TO BE COMPLETED IN INK— PLEASE PRINT <br />MCMIiECTOROESIGNEF MRI�FOOPESS C�iV 21P PNONE <br />LOT <br />S� <br />ziJ-FJfC. <br />❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOOOSTOVFJFRPL INSEFT ❑ BUILDING PEIOCAiION <br />OF WORk <br />BIOCK OF <br />PLUMBINO �J <br />Np, TYPE Of FIXTUPE OR ITEM <br />WATER CLOSET (TOILEn <br />&1THTUB <br />1:�1Vf.-fORY(WASH BASIM <br />SHO:ticR <br />KITCHEN SINK 8 DISP. <br />ROOF DRAINS— RAIN <br />SINK ISERVICE — BAR, <br />I TUTAL FEE <br />fHONT5ET9nCK RUNSE79aCK <br />U9E20NE LOTARER <br />IYPEOFCONSL OCIXIPRNCYGt10UP <br />AILOWABLEMGTUAL <br />91ZEOFBLOU. NO.OFSTO(VIES &5M <br />❑Y <br />❑N <br />FIRESPRINN�ERSPEOUIpED llYES �VAO <br />�PPL'GALIONRGG.OY PLRNSAPPR.BY <br />�^ � <br />� <br />S <br />❑ YES ❑ NO <br />everett <br />� <br />I HEREBY CERTIFY THAT I HAVE READ AND E%AMINED THIS APPLICATION AND <br />KNOW THE SAME TO BE TRUE AND CORRECT. ALL PFiOVI510NS OF LAWS AND <br />ORDINANCES GOVERNING THIS TYPE OF WOPK WILL BE COMPLETED WITH <br />W HETHER FPECIFIF�t IEREItJ OR NOT.THEGRANTING OFA PERMIT DOES NOT <br />PRESUME TtJ GIVE AUTHORIN 70 VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCT�ON OP THE PER- <br />F0�11+1ANCE OF COh3TRUCTION. THP.T I AM AUTHOAIZED BY THE OWNER OF <br />TH�3 PROPERTV TO PERFORM THE WORK FOR W HICH APPLICATION IS MADE <br />AND I COMPLV WI7H THE STATE CONTFACTORS LAW 10.27 RCW AND <br />296200 WAG `O � ? Gji <br />SIGNQUREOFCONIRACiOBOF�UtHORIZEDAGENi DAIE (y <br />V �(/ <br />A G�NiSCItY6U31 SUCENSENO.RNOBUSMESSNRME <br />MECHANICAL <br />NO. TYPE OF EOUIPMENT FEE <br />A/C—NHNfJLGUNITS—H.P. �3 <br />FORCED AIR SYSTEMS— &T.U. M EA <br />UNIT HE4TERS— B.T.U. �'�Gw I� <br />METAL FIREPL <br />FIREPLACEIN <br />HEAT PUMP <br />GAS PIPING <br />ExHAUSTFAN <br />FEES I VALUATION <br />BUILDING <br />PLUMBING <br />MECHANICAL <br />OTHER <br />STATE BUILDING SURCHARGE <br />STATEENERC�YSURCHARGE <br />PUBLIC WOPKS <br />TOTAL <br />5 <br />S <br />sa.� <br />