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��/ <br />the Everyreen <br />CITY OF <br />everett <br />BUfLDING DEPARTMENT <br />259•8810 <br />�" : <br />APPLIC�fION FOR CONSTRb�T10N <br />PERMIT <br />TO BE COMRLETED IN INK— PLEASE PRINT <br />� <br />A <br />p. o: <br />. � � <br />C�LA/9B OF <br />li�f NEW ❑ ADDITION ❑ ALTERATION ❑ pEPAIR ❑ DEMOLITION ❑ WOODSTOVFJFRPL INSERT ❑ BUILDING RELOCATION <br />TEN�NT IMPPOVEMENi OR INTEPIOR PEMODEI ONLY CONTRCT PERSON pND PNONE NR <br />c�n. n�tr / l O f <br />�! �(� <br />LOTLL_ BIOCK OF <br />PLUMBING <br />V�--y <br />7. I WATER <br />URINAL <br />ORAINS— <br />cFwvir.c— <br />O YES <br />OR ITEM <br />e �erett <br />� <br />� <br />, <br />I HEREBY CERTIFY THAT I HAVE FlEAD AND EXAMINED THIS APP! IC4TION AND <br />KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS •�)F LAWS AND <br />ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMFLETED WITH <br />W HETHERSPECIFIEU H EREIN OR NOT. THE GRANTING OFAPERMIT DOES NOT <br />! , PRESUMETOGIVEAUTHORINTOVIOLATEORCANCELTHEPfiOVISIONSOF <br />ANY OTHER STATE OR LOCAL LAW REGULATIkG CONSTRUCTION OR THE PER• <br />� FORMANCEOFCONSTRUCTION.THATIAMAUTHORIZEDBYTHEOWNEROF <br />THIS PROPEtiT'TO PERFORM THE WORK FOR WHICH APPLICATION IS MAUE <br />AND I C�MPLY WITH THE STATE CONTRACTORS LAW 7827 RCW AND <br />• 286200 WAC. <br />SIGNATUPEOFGONTRNCTOROFAU7NOFREOAGENT DATE <br />� <br />� pPP�IGANTSGITYBl151NE55LICENSENO.RNDBU51NE55NAME <br />MECHANICAL <br />NU. <br />—�_ <br />FOflCED AIR SYSTEMS— flT.U. M <br />I UNITHEATERS—B.T.U. M <br />� CLOTHESDRYERS <br />VENTILATION FAN <br />— RANGEHJOD <br />WA7Efi HEATC-R <br />— WOODSTOVE <br />)TAL 5 i <br />T S <br />FEE 5 <br />: � �O SIOESETBnCN - <br />���- 6 <br />V�ff�NT51TL <br />, �� C)OfE3 0 NO <br />p-?� / <br />i�O�ES BSMT. OCG LORD— <br />� or <br />ON <br />MEIGNT LIMITFTII <br />a.r.� �� <br />� <br />�- <br />GAS PIPING <br />EXHAUSTFAN <br />BUILDING <br />PLUMBING <br />MECHANICAL <br />OTHER <br />STATE BUILDING SURCHARGE <br />STATE ENERGY SURCHARGE <br />PUBLIC WORKS <br />TOTAi. <br />FEE <br />Z �a �J1p <br />FEE <br />C�,3 y"I <br />. ;� <br />