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Me Ewrpraen <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />259-BB10 <br />� <br />wrrrv 1.� <br />� ,—. <br />APPLICA�ION FOR CONSTRI..;T10N <br />PERMIT <br />TO BE COMPLETED IN INK— PLEASE PRINT <br />� <br />.�.t-� y» s� <br />everett <br />e <br />PLUMBINOCONTPACTOR MAILADORESS CITY 21P PMONE LICENSEa <br />❑ NEW ❑ ADDITION <br />WOflK <br />ALTERATION <br />C <br />LOT BLOCK OF <br />PIUMBIN6 <br />T— <br />OR ITEM <br />KITCHEN SINKB DISP. <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PFEVENTERS <br />ROOF DRAINS — RAI NLEADERS <br />SINK(SERVICE— BAR. ETC.1 <br />SUB TOTAL <br />PERMIT <br />TOTAL FEE <br />o����, :� — Z <br />BLDO. NO.OFSTORIES &SM <br />IOZO � �cN <br />� <br />REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL INSERT ❑ BUILDING RELCCA710N <br />��O � p �� GON�P�ONFNDPNOpIEPN;Mf.�r <br />U <br />8 <br />$ <br />❑ YES <br />Z� <br />T LIMITFTION <br />.�X�a'T'�G. <br />I HEREOY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPIICAT�ON AND <br />KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS AND <br />ORDINANCES GOVERNING THIS NPE OF WORK WILL BE COMPLETED WITH <br />WHEiHER SPECIFIED HEREIN OR NOT.THE GRANTING OFA PERMITDOES NOT <br />PRESUME TO GIVE AUTHORI7Y TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANYOTHER STATE OR LOCAI LAW REGULATINCa CONSTRUCTION OR THE PER• <br />FORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BV THE OWNER OF <br />THIS PROPERTYTO PERFORM THE WORK FOR WHICH APPLICATION IS MADE <br />AND I COMPLY WITH THE STATE CONTRACTORS LAW 1827 RCW AND <br />29 lAC. <br />SIGN TURE ONTH TOR IMORIZEDAGENT DATE <br />X �3% � <br />APPLi NT YB NESSL NO.ANDBUSINESSNRME <br />MECHANICAL <br />NO. TYPE OF EOUIPMENT FEE <br />A/C — A/HNDLG UNITS — H.P. <br />FORCED AIR SVSTEMS— BT.U. M EA <br />UNITHEATERS—flT.U. M <br />RANGEHOOD <br />WATER HEATER <br />WOOD STOVE <br />METAL FIREPLACE t <br />FIREPLACEINSERT <br />HEAT PUMP <br />GAS PIPING <br />SUBTOTAL $ <br />PERMIT $ <br />1 I 1(� I 13 <br />� FEES VALUATION <br />BUILDING � Q(� <br />PLUMBING <br />MECHANICAL <br />OTHER yG,�p_���C�S <br />STATE BUILDING SURCHARGE <br />STATE ENERGV SURCHARGE <br />PUBLIC WORKS <br />TOTAL <br />