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M� Evsrproen <br />CITV OF <br />�verett <br />BUILDING DEPARTMENT <br />269-8810 <br />,;:,: : <br />APPLICI�;►�f ION FOR CONSTRli�T10N <br />�ERMIT � <br />TO BE COMP�ETED IN INK— PLEASE PRINT <br />everett <br />e <br />ANCMITECTOHDESI�NER M�IL�OORES5 CITY ZIP PHONE <br />OENEMLCOMTRACTOR MM���DRE59 CITY 21P PNONE LICENSE� <br />, RII:A&NOCONTiUCTOF MNLA�DRE35 GITY ZIP PIIONf: LIf.EN9E� <br />� CUI7SOFV�ORI( <br />'� ❑ NEW ❑ ADDiTION ❑ ALTERATION ❑ REPAIR ❑ UEMOLITION ❑ WOODSTOVE/fRPL INSERT ❑ BUILDING RELOCATION <br />� lE1MNTIMPNOVEMENTOFIMERIOXHEMOOELONLY CONTAGiPER501lANDPHONENO. <br />f xr ���au�id;A9 a-r��R <br />� oexnivnoN ov vnovenrv�sNowN ei <br />� <br />LOT BLOCN Of _ <br />1 <br />1 <br />� Wl.UMSINO " <br />j NO. NPEOFfl%TUREOR <br />i WATERCL09Ef�TOILEq <br />i B1ITHTUB <br />i UVATORYryVASHBASIM <br />SHOWER <br />KITCMEN SINKB DISP. <br />� U18HWASHER <br />i UUNDRYTRAY <br />CLOTHES WASHER <br />� URINAL <br />' DRINKINQ FOUNTAIN <br />� FLOOR DMIN <br />I <br />! BACKFLOW PqEVENTERS <br />� ROOF DRAINS— RAINLFADER: <br />� SINK�SERVICE—BAR,ETG) <br />,I <br />. � <br />FFONT SF.TB/�CK <br />• U4E20NE <br />, IYPEqFCAN9T. <br />ILLOVMBIEI�GTU <br />91ZE OF BLOQ <br />� i1RESPRINKLERS <br />SUBTOTAL S <br />PERMIT 5 <br />TOTAL FEE S <br />IEAFSEiB�CN SIDESETB�CN <br />OTARfA VRCRNTSIiE <br />p YES u r+o <br />K:UPANCYGROUP NO.OFDWELLII <br />IO.OFSTOPIES BSMi. OGGLORO <br />❑Y <br />ON <br />MEIGFL LIMIIAi <br />YES � NO _ <br />I HEREBY CERTIFYTHAT I HAVE READ AND E%AMINED THIS APPLICATION AND <br />KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF UWS AND <br />ORDINANCES GOVERNING THIS iVPE OF WORK WILL BE COMPLETED WITH <br />WHETHER SPECIFIED HEREIN OR NOT. THE GRANTIN60FA PERMITDOES N�iT <br />PRESUME TO GIVE AUTHORIN TO VIOLA7E OR CANCEL THE PROVI310N3 C.� <br />ANV OTHER STATE OR LOCAL LAW REGULATIN6 CONSTRUCTION OR THE PER- <br />FORMANCE OF CONSTRUCTION. THAT I AM AUTHORI2ED BY TME OWNER OF <br />THIS PROPERTf TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE <br />AND I COMPLY WITH THE STATE CONTRACTORS LAW 1827 RCW AND <br />296200 WAC. <br />SIONRURE FCONTPGCTCRORRUTHO EO• O�TE � L � <br />x �� `� G���r� � 3 - 9 <br />�PPLIC�NTS CITY BUSINE55 LICENSE NO. / ND BUSINE59 N�ME <br />MECHANICAL <br />TYPE OF EOUIPI <br />ynu�u uni�a— n.r <br />AIR SYSTEMS— 6T <br />1TER5—&LU. M <br />WATER HEATER <br />WOOD STOVE <br />METAL FIREPLACE 8 <br />GAS PIPIP <br />EXHAUST <br />SUB70TAL 5 <br />PERMIT S <br />70TAL FEE 5 <br />FEE RECEIFfNO. <br />VALUATION FEE <br />BUILDINC� <br />PLJMBING <br />MECHANICAL <br />OTHER <br />STATE BUIL��NG SURCHARGE <br />STATE E�ERGY SURCFiARGE <br />PUBLIC WORKS <br />TOTAL <br />