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M� Ewrproen <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />269•8810 <br />',1 <br />APPLICi�.f ION FOR CONSTRliCT10N <br />PERMIT <br />TO BE COMPLETED IN INK— PLEASE PRINT <br />everet. <br />e <br />❑ NEW ❑ ADDITION ❑ ALTERATION <br />IEN�NT IMPROVEMENT Ofl INTEPIOR PEMODEL ONLY <br />ppN7p,�GTPRICEOFWORK / civ (/ <br />DEBCRIlE W�RK AND SOU�RE FOOTAOE INVOlVEO <br />/L - . �� . _ .. . � <br />�pT_[L BLOGI(� OF <br />1?:�._.��'F, n� ...�_ <br />PLUMlING <br />URINAL <br />DRINKINO FOUN <br />FLOOR DRAIN <br />BACKFLOW PIiE� <br />ROOF DRAINS- <br />/�ILOW�BLE/ACTU�L <br />O YES ❑ <br />ov <br />❑N <br />� <br />REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPLINSERT ❑ BUIIDINORELOCA710N'��r�`-' �'-� � <br />1 HEREBY CERTIFY THAT I HAVE READ AND E%AMINED THIS APPLICATION AND <br />KNOWTHESAMETOBETRUEANDCORRECT.ALLPROV1910N90FLAW9AND <br />ORDINANCES GOVERNIN6 THIS TYPE OF WORK WILL BE COMPLETED WI7H <br />W HETHER SPECIFIED HEREIN OR NOT.THE �RANTINOOFf. PERMITDOE9 NOT <br />r � PFESUMETOOIVEAUTHORIttTOVIOLATEORCANCELTHEPROVISION90F <br />ANV OTHER STATE OR LOCAL LAW PEGUTATINO CONSTRUCTION OR THE PEi! <br />FORMANCE OF CONSTRUCTION. THAT I AM AUTHOFIZED BY THE OWNER OF <br />THIS PROPERTY TO PERFORlA THE WORK FOR WHICH APPLICATION IS MADE <br />AND I COMPLY WITH THE STATE CONTRACTORS LAW 1827 RCW AND <br />298200 WAC. <br />s, __ ,,,i./ _ 516NRUNEOfCONTH�CTORORAUTHORIEE0A0EN� D�TE ��' I� �� <br />a <br />o ves ❑ r+o <br />4V� /'i PLIG�BUSINESSLILE AI <br />MECHAN�CAL <br />NO. TYPEOFEOUIPI <br />A/C — NHNDL6 UNITS — H.P <br />FORCED AIR SYSTEMS— &T <br />UNITHEATERS—B.T.U. M <br />CLOTHESORYERS <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />WOOD STOVE <br />METAL FIREPLACEB CHIMNI <br />FIREPLACEINSERT <br />HEAT PUMP <br />GAS PIPING . <br />Bt11LDIN6 <br />PLUMBING <br />MECHANICAL <br />OTHER <br />STATE BUILDINO SURCHARGE <br />STATE ENER6Y SURCHARGE <br />PUBLIC WORKS <br />TOTAL <br />rsn <br />�` 1 <br />'• 1 <br />� <br />D <br />