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fh� Everynen <br />�,�oF <br />everett <br />BUILDlNG DEPARTMENT <br />269•BB'10 <br />'_i l� . <br />APPLIC' �TION FOR CONSTR�CTION <br />P�RMIT <br />TO BE COMPLETED IN INK- PLEASE PRINT <br />�� � � - <br />�MCHRECfORDEBIONER MNLAOOHE59 GITY 21P FMONE <br />��'� �I <br />evere[t <br />e <br />❑ NEW,^O ADDITION ��TION ❑ REPAIR ❑ DEMOLITION ❑ WOO�STOVFJFRPLINSERT ❑ 6UILOIN�PEIOCPTION <br />IENNlTIMPROVEMENTOR�I�fj19AFION%�REMO�ELONLY� fANTACTPEPSONNNpPHONENO <br />CONTRAgC�TPRIMCE.OFWOpR�I(�` ( �'�L�O � / <br />^� pIFCl/� V^ D-1 I l I�TAQ/V Y�I I EO `1Y Wl.l W�J .l'�� <br />�p7 BIOLN OF <br />PLUMBINO <br />f�7F9:1 <br />SUBTOTAL 5 <br />PERMIT S <br />TOTAL FEE 3 <br />❑r <br />❑N <br />FIREBPPINNLERSFEOUIHED ❑VES ❑NO <br />o ves o no <br />� <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND <br />KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS AND <br />ORDINANCES GOVEPNING THIS TYPE OF WORK WILL BE COMPLETED WITH <br />WHETHER SPECIFIED HEREIN QR NOT.THE GFiANTINd OFA PERMITDOES NOT <br />PRESUME TO GIVE AUTHORIN TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANYOTHER STATE OR LOCAL LAW REGULATINO CONSTRUCTION OR THE PER• <br />FORMANCE Of CONSTRUCTION. THAT I AM AUTHORI2ED BY THE OWNER OF <br />THIS PROPERN TO PERFORM TI1E WOfiK FOR WHICH APPLICATION IS MADE <br />AND I COMPLY W�TH THE STATE CONTRACTORo LAW 1827 RCW AND <br />296200 WAG <br />SIONRTUHEOFCONTRRCTOFORFUTHORI2EDA3ENT D�TE <br />X o►�ka � �.� . � y <br />RNi9CITYBUS E55 i NS NO.PNOBUSINESSNAME <br />MECHANICAL <br />NO. TYPEOFEOUIPI <br />q/C — A/HNDLG UNITS — H.P <br />FORCED AIR SYSTEMS— fiT <br />UNITHEATERS—flT.U. M <br />CLOTHE:iDRVERS <br />VENTILA�'ION FAN <br />RANGE!�nOD <br />WATER HEATER <br />WOOD:iTOVE <br />METAL f1REPLACEB CHIMNI <br />FIREPL4CEINSERT <br />HEAT PUMP <br />GAS PIF'ING <br />EXHAl151' FAN <br />SU6 <br />BUILDINO <br />PLUMBING <br />MECHANICAL <br />OTHER <br />STATE BUILDING SURCHAqGE <br />STATE ENERGYSURCHARGE <br />PUBLIC WORKS <br />TOTAL <br />5 <br />