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the Everpraen <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />259-8810 , _ � <br />... ,- <br />APPLIG�_.'ION FOR CONSTRI..;T10�+1 <br />PERMIT <br />TO BE COMPLETED IN INK - PLEASE PRINT <br />0 <br />G SS%/L <br />C1A550FWOpM. <br />� NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL IIJSERT ❑ 8111LDING RELOCATION <br />� TENANTIMPqOVEMENTOflINiERIOPPEM00ELONLY �pNTACTPEPSONArvpPMOHENO <br />ICAMHACTPflICEOFWONK <br />y, �����• <br />LEWI �5 flIPTIONOFPROPEBtt�SNW <br />IlOT BLOLN OF <br />PLUM6ING " <br />NO. TYPE OF � I% <br />� f y WATERCLOSET�TOILE <br />(ra BATHTIIfi <br />�Z LAVATORY�WASHBASI <br />SHOWER <br />� KITCHEN SIN4�8 UISP. <br />(� DISHWASHER <br />LAUNDRYTRAV <br />/p CLOTHES WASNEA <br />ROOF DRAINS — <br />SINK ISERVICE — <br />� ALLO1'AO:.EUCIOAL <br />OY <br />❑N <br />IfIPESPPINN�Efl5RE0UIBE� O YE3 fI N0 <br />FEE <br />a <br />s <br />s <br />everetl <br />e <br />I I IEREDY CERTIFY THAT I H 4VE READ AND EXAMIN ED THIS APPLICATION AND <br />K�OW'HE SAldE 70 BE iRUE AND CORRECT. ALL PpOVISION50F LAWS AND <br />ORDINANCES GOVERNING TlIIS NPE OF WORK WI�_L BE COMPLETED WI7H <br />Wf1E7fiER SPECIFIEDHEREIN OR NqT.THE GRANTINGOFAPERMITDOES NOT <br />PRESUME TO GIVE AU7HORI7Y TO VIOLATE OR CnP;CEL THE PROVISIONS CF <br />ANY OTIIER STATE OR LOCAL LAW REGU�ATING CGNSiRUCTION OR THE FER� <br />FORNANCE OF CONSTRUCTION. THAT I AM AUTHOflIZED BY TH� OWNER OF <br />THIS PFOPER7Y TO PERFORM THE WGRK FOR WHICH APPLICATION IS MADE <br />AND I COtdPLY WITH THE STATE CONTR CTOAS LAW 18.27 RCW AND <br />29G200 WAC. <br />SIGNALOR[OFCONtf�9GJOfiONhUl11 RII RG i D�i[ <br />X�L/ �+ <br />.�'/a'� , �� 2� - �S / <br />MECHANICAL <br />NO. <br />A/C — A/HNOLG UNITS — HP. <br />FORCED AIR SVSTEMS— B.T.U. M <br />UNITHEATERS—B.T.U. M <br />CLO7HES DFiYERS <br />VENTILATION FAN � <br />f7ANGE HOOD <br />WATER HEATER <br />wOOD STOVE <br />METAI FIREPLACE 8 CHIMNEY <br />I �{EATPIIMP <br />GnS PIPING <br />— E%f1AU5T �AN <br />rur�cNccK <br />❑ YES ❑ NO — <br />NOOFOWELLIN6UNIi5 BUILDING <br />PLUMBING <br />OCC LOAD <br />MECHANICAL <br />MEIGMTIIMR�TION OTHER <br />S7ATE BUILDING SURCHARGE <br />STATEENERGYSURCHARGE <br />PUBLIC WORKS <br />TOTAL <br />FEE <br />FEE <br />FEE <br />