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2i:z:�r.S.a_,Y, �..:s;c�.r:.! �r - ....._ ,.�.. �.. ,,.. .: c�_r., ...:s_�. +..x .:,o�;c.is�,. :;r.r�..• <br />fhe Ewrprosn <br />CITV OF <br />everett <br />BUILDING DEPARTMENT <br />259-8810 <br />,^,t n.'� �:1 <br />APPLICb r10N FOR CONSTRI�i'�:TION <br />PERMIT <br />TO BE COMPLETED IN INK— PLEASE PRINT <br />everett <br />e <br />IIRGHIIECfORUEBtONER MAILAODRESS G7Y 21P PHONE � <br />lIENEIULCANTR�CfOX O • LRV 21P PHONE IIGENSE• <br />162fi E. Marine Vlew Dr. <br />MECMANICAIGOMTRACTOR CITV ZIP PHONE �I�T����� <br />25A•2441 <br />n rn n�w�.�......�.... <br />� ��.� -��1`'.� �ZiUt� �� ll" C��t.P nP�r .. <br />CU1.99 0F VqPK ,�� <br />❑ NEW ❑ ADDITION UY ALTEMTION ❑ REPAIR ❑ DEMOLITION _❑ WOODSTOVFJF9PcuN8ERT ❑ <br />LOT BLOCR OI <br />��J�7 �_ <br />PLUMBIN6 <br />yp, TYPE OF FUfTUNE OR <br />WATER CLOSET (TOILEi) <br />BATHTUB <br />LAVATORY(WA9H BASIN) <br />SHOWER <br />KITCHEN SINKB DISP. <br />�� <br />I MEREBY CERTIFY THAT I HAVE READ AND E%AMINED <br />...�n�u rue aeue rn nc rm �c sNn CARRECT. ALL PR� <br />AND IRCOMP YTWITH HE 9TATE CONTRACTORS�LAW�1827VRCW�AND <br />296200 WAC. <br />SIONATUREOFCONTP�GTOROflAUTHONIZEDAOENT ��TE <br />X �-1 YQ.-L'.l�J �.�-�' �l/ Ff9 <br />APPLICAN SCITYBUSINES LIG�' NSENO.�NDBlI51NE55N�ME <br />MECHANICAL <br />FEE NO. TYPE OF EOUIPN <br />A/C — A/HN�LG UNITS — H.P. <br />FORCED AIR SVSTEMS— B.T.I <br />UNIT HEATERS— &T.U. M <br />CLOTHESDFYERS <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATEii <br />WOOD STOVE <br />METAL FIREPLACE 8 CHIMNE <br />PERMIT 5 <br />TOTAL FEE S <br />pEAH3EfH�CK SIOESEfBACK <br />LOTAREA VACANTSffE <br />❑ YES O NO <br />OCCUPANGYQROUP NO.OF�WELUI <br />NO.OFSTORIES BSM(. OCC.IOAD <br />❑Y <br />❑N <br />HEIGHT LIMIT�i <br />n res ❑ no <br />e <br />HEAT PUMP <br />GAS PIPING <br />EXHAUST Ff <br />FEES <br />TOTAL FEE S <br />BUILDING <br />PLUMBINO <br />MECHANICAL <br />OTHER <br />STATE BUILDING SURCHARGE <br />STATE ENERGY SUNCHARGE <br />PUBLIC WORKS <br />TOTAL <br />