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AF�PLIC�.�ION FOR CONSTR4.:TION <br />PERMIT <br />tlu Erororeen <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />everett <br />e <br />259-BB10 TO BE COMPLETED IN INK— PLEASE PRINT <br />OWNEH M�ILADDliE55 GfY ZIP PHONE <br />��� L,/�`SpM Sy2� CUwrLL �D fiVuPf�'�'f `182�3 3'$S- 0��$ <br />7fNANT M�ILADOliE55 GrtY ZIP PMONE <br />jJ�l�, W.\So� S�I28 �oc.�'C�� �9 ku[ar�rr 9820 � -3t5-OgiB <br />Ai1CNIfEGfOX0E8NiNER M�ILADDRESS CITY ZIP PHONE <br />Sim�i <br />pENEMLCONTP�CTON M�I�ADDRESS CITY ZIP PHONE LICEN9E• <br />MECH�NICALCONTN�CTOR M�ILA�DRE55 LITV ZIP PMONE LICENSE• <br />PLUM&NOCO'NTHACTOR MAII�DDRE55 CITV ZIP PMONE LICENSE• <br />❑ NEW ❑ ADCiITION <br />CONTMCT <br />' OESCNIBE� <br />ALTEMTION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL INSERT ❑ BUILDING RELOCATION <br />LpT BLOGK OF <br />, PWMBINO <br />� NO. TYPE OF fIXTURE OR ITEM <br />� WATERCLOSET(TOILEn _ <br />ennirue <br />'� LAVATOFVIWASHBASIN) <br />SHOWER <br />� KITCHEN BINKB DISP. <br />D19HWASHER <br />� UUNDRYTRAV <br />CLOTHES WASHER <br />URINAL <br />� DRINKINO FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />oMF nw�INR — RAINLEROERS <br />❑N <br />FIHE 9PRINKLERS REOl11RED ❑ YES ❑ NO <br />C�i <br />a <br />S <br />S <br />❑ YES ❑ NO <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND <br />KNOWTHESAMETOBETRUEANDCORRECT.ALLPROVISIONSOFLAWSAND �. <br />OR�INANCEF GOJERNIN(3 THIS TVPE OF WORK WILL BE COMPLEiED WITN � <br />WHETHERSPECIfIEDH'cREINORNOT.THEGRANTIN60FAPERMITDOESNOT , <br />PqESUME TO GIVE AUTHORIT/ TO VIOLATE OR CANCEL THE PROVI910N8 OF <br />ANVOTHERSTATEORLOCALLAWREGULATINGCONSTRUCTIONORTHEPER� � <br />FORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE OWNER OF , <br />THISPROPER7YTOPERFORMTHEWORKFORWH�CHAPPUCATIONISMADE ' <br />AND I COMPLV WITH THE STATE CONTRACTORS LAW 1827 FCW AND ' <br />296200 WAC. � <br />SIGNQUREOFWNTR�GtOROPRUIHORRE0A0ENT ORE S_I��g9 , <br />X `� � <br />���% �� --- <br />�PP4C�NTSCITYBl15�� UCE 5 NO.�NOBl1SINESSN�ME <br />MECHANICAL <br />FIREPLACE <br />HEAT PUMP <br />GAS PIPING <br />— H.P. <br />— B.T.U. <br />M <br />SUB TO' <br />PERMIT <br />TOTAL F <br />BUILDIN6 <br />PLUTABING <br />MECHANICAL <br />OTHER � <br />STATE BU LDING SURCHARGE <br />STATE ENERGY SURCHARGE <br />PUBLIC WOFKS <br />TOTAL <br />M EA <br />