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fh� Erorprosn <br />CITY OF <br />everett <br />BUILDINO DEPARTMENT <br />269-8810 <br />� L �'� <br />APPLI ��''i4T10N FOR CONST ''�'��+UCTION <br />PERMIT . <br />TO BE COMPLETED IN INK— PLEASE PRINT <br />ARGIITECTORDElqNER M�IL�UDRE59 CItY 21P PNONE <br />r�► <br />everetl <br />e <br />•e <br />60 " <br />OENEMLCONTNIICTON M�IL�OORESS GITY ZIP PHONE LICEN9E• <br />M[GIANICALfANTMGTCR MML�DOpE3$ CITY 21P PNONE l'CEN9E• <br />Novf%wcsl� GV.,�a �i�,�� 3��n- �i��. a,�s_ 6•dT 9Yioi 2c5-c't�i .U,,.���� i�� �f <br />. ❑ Nev+ "�'•oomaN ,$C <br />TEWWTIMMpVEMEM0111M NE� <br />OONTMCTPf110EOFN'OPK ��� <br />OFlCRIlEWORK11ND80UMEF T <br />�� �/CG • %�l�l <br />naroeEoueEoseui�aNa <br />l[ML� oFvrlOPenivlsNa <br />� <br />LOT BLOGK OF <br />, <br />� <br />j ����� <br />� � <br />j '� /LUM�INO <br />� NO• TYP! O!' flX71 <br />I WATERCLOSET(TOILEf <br />� BATHTUB <br />" UVATORV(WASH &131N <br />� SHOWER <br />�� "S� KITCHENSINKBDISP. <br />,��i�'1' DI8NWA9HER <br />"t UUNORYTRAY � <br />I ' � + c�on�es w�.vuoa <br />O <br />0 <br />ORINKINO FOI <br />FIOOR OMIN <br />BACKFLOW PF <br />ALLOWABIbACTUAL <br />ALTERRTION ❑ REPAIR ❑ �EMOLITION ❑ WOODSTOV&FRPLINSERT ❑ BUIiDINGRELOCATION <br />SUBTOTAL S <br />PERMIT S <br />TOTAL FEE S <br />O YE9 O <br />1 HEREBV CERTIFVTHAT I HAVE READ AND EXAMINED THIS APPLICATION AND <br />KNOW THE 3AME TO BE TRUE AND CORRECT. ALL PROVI310NS OF WNB AND <br />ORDINANCES GOVERNING THIS TVPE OF WORK WILL Bl: COMPLEIED WITH <br />WHEf HER SPECIFIED HEREIN OR NOT.TMEGRANTINa6FAPERMRD0E8 NOT <br />PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION$ OF <br />ANYOTHER STATE OR LOCAL LAW REGULAT�N6 CONSTpUCTION OR iHE PEFF <br />FORMANCE OF CANSTRUCTION. THAT I AM AUTHORIZED BY THE OWNER OF <br />THIS PROPER7Y TO PERFORM 7HE WORK FOR WHICH APPLICATION IS MADE <br />AND I COMPLV WITH THE 3TATE CONTRACTORS LAW 1827 RCW AND <br />288200 WAG <br />SIQNATUPEOFCONTP�CTORORAUTHORI2EDAC'.NT D�TE <br />x , w u� /.2y S o <br />APPLICANTBCRYBUSINE99LICEN9E .�I/OBUSINE&9NAME <br />MECHANICAI <br />Yi1J� <br />FORCED AIR SYSTEMS <br />UNIT HEA7ER5 — 6T.U. <br />WATER HEATER <br />WOOD STOVE <br />METAL FIREPL/ <br />O YE9 ❑ NO --' <br />' NO.OFDWELlIN011NIT5 BUILDING <br />PLUMBING <br />BSMT. OCG LORO <br />❑ r MECHANICAL <br />❑N <br />HEIOHTLIMIIRtION OTHER <br />STATE BUILDING SURCHARGE <br />STATE ENERGY SURCHARGE <br />PUBLIC WORKS <br />TOTAL <br />