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Ihe EvarOreen <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />259•8810 <br />APPL.IC�TION FOR CONSTR�GTION <br />PERMIZ� D ������ <br />� ., <br />D <br />APR 18 �g� <br />TO BE COMPLETED IN INK— PLEASE PRI <br />everett <br />� <br />.,...._.. .._._..__.._.._ _... <br />. u � <br />i�urc My�LL IaSS• I�iO W. �AHTUtJ �=n�HoiJDS �f�'io2U <br />TENaNT MnILADDPE55 GRY ilP PHONE <br />HEIOJEKk N��ti�EF� 3�SS.� �v�izrrrMR«W�lio:i k�c�zcrt- Gg2ofi <br />ARCNITECTOROESIGNER MAILApOHE55 GTY ZIP PMONE <br />�/�/iARRr=rJ I..A1=0t.� %�f�CH�7�C..1� <br />GENERALCONTRACTOF IAAILADORE55 CITY ZIP PHONE ULEHSE+ <br />Qur:Esi.��,- �DRP. 31�5 L=.l�vc;R��t 64ALL W'J IJI �v<ncTr yf3%��%`d Pc;��rwc I f^7KC: <br />MECHRNIGRLGONTMGTOR MAIIADOP��u CITY ZIP PMONE LILENSE+ <br />i��vM��C MFC.Ia/-1tilC(•1L.�n�C,. i?U.�t3�x532% I.vc;.t)�.:��7GPC�ICo 7i�t=�-+�Ok�fHF�MI�7C��� <br />PLUMBIN6CONTRACTOP MFILAO�FESS CITY ilP PHONE LICENSE• <br />❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVFlFRPL INSERT ❑ BUILDING RELOCATION <br />CANTMCT PRICE OF WORIE <br />LOT BLOCN OF <br />PLUMBING <br />ND. TYPE OF FI%TUHE OR ITEM <br />SHOWER <br />KITCHEN SINKB DISP. <br />CLOTHES WASHER <br />URINAL <br />BACKFLOW PREVENTERS <br />ROOF DRAINS — RAINLEADERS <br />SINKICFGVICF—RGP FTCI <br />PERMIT <br />TO7ALFEE <br />ALlOWABLE/PGTUAI <br />ov <br />❑ N <br />FIRESPFINKLEfi5RE0l11RE� ❑ YES ❑ NO <br />APPri. <br />�� 1...�..J <br />fiC7 <br />S <br />S <br />❑ YES <br />I H EREBY CERTIFY THAT I HAVE READ AN D EXAMINED THIS APPLICATIC�N AND <br />KNOV! THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS AN D <br />ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLE7ED WITH <br />WHETH ER SPECIFIED H EREIN OR NOT. THE GRANTING OFA PERMIT DOES NOT <br />PRESUME TO GIVE AUTHORIN TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR TH E PER� <br />FORMANCE OF CONSTRUCTION. THAT i AM AUTHORIZE� BY THE OW NER 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 />296.200 WAG <br />SIGNATUREOFCONTRACTORORPIIRHOflIZEDAGEVT /q4T E <br />X /.�f�-GG' ✓'J li"r.cL•• ��'C %l�Ci/�� <br />APPLICANTSCITVB INESSULENSENO.PN�BJSINESSNAME <br />�i��?(,.17 C'�,_vMPfL Nff=�J�F�,�1iC.i?1 <br />MECHANICAL <br />FEE NO. TYPEOFEOUIPMENT <br />A/C—lVHN�IG UNITS—H.P. <br />� FORCED AIR SYSTEMS — B.T.U. M EA <br />UNIT HEATERS— flT.U. M <br />CLOTHES DRYEFS <br />VENTILATION FAN <br />(iANGE NOOD <br />METAL FIREPLACEB CHIMNEY <br />FIREPLACEINSERT <br />E%HAUSTFAN <br />BU�LDING <br />MECHANICAL <br />OTHER <br />STATE BUILDING SURCHARGE <br />STATE ENERGY SURCHARGE <br />PUBLIC WORKS <br />TOTAL <br />B TOTAL 5 <br />RMIT S <br />fAL FEE 5 <br />EE NEI <br />VALUATION <br />FEE <br />