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' APPl.IC�;;iION FOR CONSTR1b�T10N <br />P�ERMIT <br />the EvarOreen <br />C�TY OF <br />everett <br />BUILDING DEPARTMENT <br />259-8810 <br />� <br />TO BE COMPLETED IN INK— PLEASE PRINT <br />7�'Ev �c��v i��,—,pr�fv� ix�5 � E�rr.�eL wr E, r <br />�RCNIiEGTONOESIGNEN MAILADDfiE55 CIiY ZiP PNONE <br />evercll <br />e <br />� OENEMLCONTMCiOR MAIL/�Df1E55 �IIY 21P PIIONE UGENS[• <br />� ���coiv z�c�- ����rraN w,�r �,����- �e� <br />MECN�NICAICONiRACTOR MAILpODPE55 GiY ZIP PIIONE LICENSE� <br />cJ,f�t7uEl�L ��i� isoz nKcsr n�r.,� *� Au�vnv �a�i y39ssc>/ U�ru�i1.s, <br />� PLUMOINUGONTNRCtOR MAILpDDPF.55 CrtV 21P PIIONE LICENS[• <br />❑ NEW ❑ ADDITION L�1 ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOO�SiJVEJFRPLINSERi ❑ BUILDINGRELOCATION <br />LOT <br />PLUMBING <br />BLOCK OF <br />TYPE OF FIXTUHE ON <br />SINK& DISP. <br />IAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />ROOF DRAINS— RAINLEADERS <br />TOTAL FFE <br />_ I �oN <br />' FIRESPqINKLEP5PE0UllIEO OYE9 ONO <br />$ <br />$ <br />❑ VE9 ❑ NO <br />FEE <br />I HEFiEBY CERTIFY THAi I FIAVE RC•AO AND EXAMINED THIS APPLICA710N AND <br />KNOW THE SAME TO BE TRUE AND CORFECT. ALL PROVISIONS OF LAWS AND <br />ORDINANCES CaOVEfiNING THIS NPE OF WORK WILL BE COMP�ETED WITH <br />W HETHER SPECIFI ED HEREIN OR NOS, THE GRANTING OFA PERMII� DOES NOT <br />PRESUME TO GIVE AUTHORIIV TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION Oq THE PER� <br />FORMANCC OF CONSTRUCTION. TI1AT I AM AUTHORIZED BY THE OWNER OF <br />THIS PROPERTYTO PERFORM THE WORK FOR WHICN APPLICATION �S MADE <br />AND I CO6:°LY WITH 7HE STATE CONTRACTORS LNW 1@27 RCW AND <br />296.200 WAC. <br />SICNATUBEOFGONTPACtOROfi�UiNORIZEO�GENT OATE <br />NO. TYPE OF EOUIPI <br />A/C — A/HNDLG UNITS — H.F <br />7 FORCEDAIRSYSTEMS—&T <br />UNITHEATERS—&T.U. M <br />CLOTHESDRYERS <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />METAL FIREPLACE <br />FIREPIACEINSER'� <br />HEATPUMP <br />GAS PIPING <br />E%HAUSTFAM <br />FEES <br />BUILDING <br />PlUM81NG <br />MECHANICAL <br />OTHER <br />STATE BUILDING SURCHARGE <br />STATE ENEFGY SURCHARGE <br />PUBLIC WORKS <br />TOTAL <br />SU6 TOTAL <br />PERMIT <br />T07AL FEE <br />\ <br />FEE <br />FEE <br />