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\ F '�rol <br />ApP'LIC�ION FOR CONSTRI'rLT10N <br />PERMIT <br />Ihe Everpreen evere[t <br />CITY OF <br />everett e <br />BI;ILDING DEPARTMENT <br />259-8810 TO BE COIIIPLETED IN INK— PLEASE PRINT <br />OWNEfl MAILApORESS CITY ZIP PHONE �9 y �p , <br />ro � .� .. � . . / _ .. _ � � UnL inn�.l�./-e.r�. �,.._ �.Jtl/.. �4N([/� / �Qi% .�yb ��flrt / <br />ARCHITECTOROESIONER MAl1.�DORE55 CITY ZiP PHONE <br />OENEMLCONTP�CTqR MARq0�flE5S CITY Z�P PMONE LICENSE• <br />-r D � A-r.t u ( r.,n , n i). �-1 c� I_ �,✓� �/.c, L-t�'D `Vl•¢eJ wW.r Lvh..��]�a37 T%Z//rNC//7�' <br />PLUM&NOCONTR�CTOP MAILAODRE55 CITY Z�P PMONE LICENSE• <br />❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVFJFRPL INSERT ❑ BUILDINO RELOCATION <br />[ANTRACT PRICE OF WORK <br />DEBCN�BEWOR �ND�O HEFOOT�OEINVOLVED J <br />Ll�L� , 1 ` <br />, <br />PROP09EDU E FBUILUIND <br />4��� <br />LE(ULOE RIPTIONOFPROPEPtt�SMOWNBELOWONr1TT� <br />LOT BLQCN OF <br />PLUMBIN6 � � / <br />VO. 'fVPE OF FIXTUHE <br />WATER CLOSET ROILEn <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINKB DISP. <br />FLOOR DRAIN <br />BACKFLOW PF <br />ALLOWABIE/ACTWI. <br />FIPESPRINKLERSREOUIREO O YE9 O N <br />FEE <br />3 <br />S <br />S <br />I H EREBV CEFTIFY THAT I HAVE READ ANU EXAMINED THIS APPLICATION AND <br />KNOW'HE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS AND <br />ORDINANCES GOVERNING THIS 7YPE OF WORK WILL BE COMPLETED WITH <br />W HE7HER SPECIFIED H EREIN OR NOT. THE GRANTING OFA PERMIT DOES NOT <br />PRESUME TO GIVE AUTHORI7Y TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHER STATE OR LOGAL LAW REGULATING CONSTRUCTION OR THE PER� <br />FORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE OWNER OF <br />THIS PROPERNTO PERFORM THE WORK FOR WHICH APPLICATION IS MADE <br />AND 1 COMPLY WITH THE STATE CONTRACTORS LAW 1027 RCW AND <br />z96.2ao WA�. ,�,�f � j <br />SIONRTUNEOFCONTRFCTORORAUTHC:-.�iEDR�ENT ORTE / <br />RPP4CANi5G BI'iINESSLICENSENO.PNOBIISINE55NRME <br />MECHANICAL <br />FIREPLACE <br />PUMP <br />O YES O NO <br />BUILDING <br />NO.OF DWElLINO UNITS <br />PLUMBING <br />BSMT. OCG lORO <br />o r MECHANICAL <br />ON <br />MEIGHTLIMITATION OTHER <br />STATE BU�LDING SURCHARGE <br />STATE ENERGY CURCHARGE <br />PUBLIC WORKS <br />TOTAL <br />— H.P. <br />— B.T.U. M EA <br />SUBTOTAL <br />PERMIT <br />TOTAL FEE <br />$ <br />$ <br />7 <br />