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APPLIC��ION FOR CONSTRt:��T10N <br />PERMIT <br />I�e EverOresn <br />CITV OF evere�t <br />everett e <br />BUILDING DEPARTMENT <br />259•8810 TO BE COMPLETED IN INK- PLEASE PRINT <br />OWNEH MRIL�ppPEFc �IIY 21P pMONE <br />/�e; T/��� K /,nlT �6�pN�.rr -��53 _a�99 <br />TEN�Nt M�I A 0 ST- GiIY ZIP pHONE <br />ARCNItECTON0E510NER MRI�qpOPE55 GIIY ZiP PNONE <br />PIUMBiNOCONfP�CTOR M�IL��Of1E5S GI1Y ZIP pHONE 4CEN9E• <br />C�yU1990FWVRN <br />OG NEW ❑ ADDITION ❑ ALTEPATION ❑ REPAIR ❑ DEMPLITION ❑ WOOOSfOVFJFRPLINSERT ❑ BUILOINGRELOCATION <br />TEN�NTIMPROVEMENiOXIN1EH10NREM00`�ONIV ''n x�' 1 CON^TPERSpN�NDPH0;EN0 _ <br />.� <br />l0T BLOCN OC <br />PLUMBINQ <br />TYPE OF FUtfURE <br />WATER CLOSET (TOIIEp <br />BATHTUB <br />FLOOR DRAIN <br />BACKFIOW PREVENTERS <br />ROOF DRAIN9 — RAINLEA <br />91NKISFpV�CF-RAC FTI <br />26� <br />'"� r <br />�,.a«������ N <br />'OFBLOQ <br />?Zp SF <br />FEE <br />PERMIT E <br />TOTAL FEE S <br />ISEfB.CN SIC <br />0 <br />FIRESPPINKLEFSPEOUIPEO OYCS � <br />o /6 <br />NCYOppUP <br />�"� ' ! <br />iromes asM <br />/ OY <br />BIN <br />�] YES j?'NO <br />I HEREBV CERTIFV iHAT I HAVE REAO ANU E%AMINED THIS APPLICATION AND <br />KNOW THE SAME TO BE TRUE ANO CORRECT. ALL PROVISIONS OF UW9 AND <br />OROINANCES OOVERNINO THIS 7VPE OF WORK WILL BE COMPLEiEO W�TH <br />WHETHER SPECIFIED HEREIN OR NOT.THEORANTIN60FA PERMIT DOES NOT <br />PRESUME TO �IVE AUTHORIN TO NOLATE OR CANCEL THE PFOVISIONB OF <br />ANY OTHER STATE OR LOCAL LAW REGUTATINO CAN3TRUCTION UR 7HE PER- <br />FORMANCE OF CONSTRUCTION. THAT 1 AM AUTHORIZED BY THE OWNER OF <br />THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATIC�N IS MADE <br />AN� I COMPLV WITH THE S7ATE CONTRRCTORS LAW 1827 PCW AND <br />298200 WAC. <br />SION�TUPEOFCONTPICTOROHRUTHOR12EO��ENT pALE <br />X � <br />APPLI� 9CITYBUSIiE55LICEN9ENO�NDBUSINE93N�ME <br />MECHANICpL <br />NO. TYPE OF EOUIPM <br />A/C — A/HNDLQ UNITS — N.P. <br />_ FORCEO AIR SYSTEMS— 6T.i <br />UNIT HEATERS�- 9T.U. M <br />HEA7 <br />FAN <br />SUB TOTAL <br />� I � ,� <br />FEES VALI <br />�UWEILINOUNiT9 BUILOINO <br />'�� PLUTABING <br />OAO <br />�d MECHANICAL <br />r��t�� OTFIER <br />:I <br />STATE BLILDING SURCHARGE <br />STATE ENERGY SURCFIARGE <br />PUBLIC WORKS <br />TO�AL <br />M EA <br />Ei <br />l � 3al <br />� <br />kb <br />