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tne Everpreen <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />259•8810 <br />. . . _r"l:^r: -,�__r..=.u:•._ ...,, ... .,.,. <br />.. . .._"_. .."'_._ . ...e.�r._�__�.�....._.>. .. <br />�••-- � <br />�►PPLIC��TION �+DR CONSTRzeCTION <br />PERMIT <br />TO BE COMPLETED IN INK— PLEAS'c PRINT <br />OWNEP ...............�,. <br />�.l /�� �S 3 � ��,tie,.�3, J� <br />TENR T MMlAO�flESS I <br />ARCHITEGTONDESIGNEN MAILADDPESS <br />everett <br />� <br />3 .s' 3 - �/� s`�/ � <br />PLUMBINOCONiRAGTON MNILADORESS GITY ZIP PI10NE LICENSE• 1-` <br />CU59 0F WORK <br />NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVFJFRPLINSERT ❑ BUILDINGRELOCATI�!: <br />TEN�NT IMPPOVEMENT OR INTEPIOR PEMODEL ONLY ///--- �//���j������+ CONTALT PERSON AND PNONE N0. . <br />GONTH�CiPPICEOFWOHK ` pSV� �—P l /�J {`✓`�'�l 3 S 3-�iG.r`�_ , <br />UESCRAIBE WONN AND SOUARE FOOTNGE INVOLVED � <br />/I��w [� a L�7 c. 1 .S% .L SG�� ' <br />lOT__.(� BIOCN OF <br />(,,,/ �SU� b <br />PLUMBING <br />NO. <br />WATER CI <br />BATHTUB <br />KITCHEN <br />OF FI%TURE OR <br />ING FOUNTAIN <br />1 DRAIN <br />'LOW PREVENI <br />DRAINS — RAII <br />_cevirc _ we[ <br />REOUIRED ❑ <br />IY, � <br />FEE <br />AL S <br />S <br />:E 5 <br />SIDESEf§ACK � <br />/(� � � <br />VACANT SITE <br />❑ YES I�NO <br />� <br />IOUP NOAFUWELLINOUNIT: <br />� 7 esMr. oca �ono_— <br />�OY <br />o nrrn. o� <br />Od <br />I HEREBV CERTIFYTHAT I HAVE READ AND EXAMINEC-HIS APPLICATION ANO . <br />KNOWTHESAMETOBETRUEANDCORflECT.ALLPROVISIONSOFLAINSAND . <br />ORDINANCES GOVERNING THIS T'PE OF WORK WILL FI' GOMPLETED WITH � <br />WHETHERSPECIFIEDHEREINORNOT.THEGRANTINGOFAPERMITDOESNOT , <br />?R'SUME TO GIVE AUTHORIN TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW flEGULATING CONSTRUCTION OR THE PER• <br />FORMANCE OF CONSTRUCTION. THAT I AM AU7HORIZED BY THE OWNER OF , <br />THIS PROPERTVTO PERFOFM THE WORK FOR WHICH APPL�CATION IS MADE . <br />AND I COMPLY WITH TH[ STATE CONTRACTORS LAW 18.27 RCW AND <br />296.200 WAC. � <br />SIGNATUREOFCONTPnCTORONAUTH P2EDAGENT DATE ,� <br />X �/r/i.� _� . � ,,. r/ /r.c� ' <br />MECHANICAL <br />PE OF EOUIPMENT <br />i UNI75— H.P. <br />lSTEMS — fiT.U. <br />— B.T.U. M <br />WATER HEPTER <br />WOOD STOVE <br />METAL FIREPLACE 8 <br />FIP.EPLACEINSERT <br />� <br />euaowc <br />PLUMBING <br />tv1ECHNNICAL <br />SUB TOTAL _ <br />PERMIT <br />TOTAL FEE <br />FEE <br />�O � <br />VALUATION <br />8 S� <br />STATE BIIILDII�G SURCHARGE <br />STATEENERGYSURCHARGE <br />PUBLIC WORHS <br />TOTAL <br />$ <br />$ <br />5 <br />ree <br />