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� <br />me e�a,o,ee� <br />CI7Y OF <br />� everett <br />BUILDING DEPARTMENT <br />. 259'8810 . . <br />,: •>. <br />E ir� r:�:' <br />APPLICi�'�ION FOR CONSTIRI:::T10N <br />PERMIT <br />TO BE COMPLETED IN INK — PLEASE PRINT <br />' � �.o� ��� �N� � �' W�� r �� :2�r�.N PHON�� 1 <br />TENANI MRIL�DOB[SS �--� pry 21P PMpNE <br />MCHrtECTOqDESiGNEP unIL�00RE55 GiIV 21P PMOIIE <br />� `� � �� 5�,��,;,�/ <br />0 NER�ICONiq LOfl M�IL��OPE55 Ciiv Zi� PIiONE <br />MECHBNICRLCONTMCiO MRILADDPE55 CrtY Z�P PIIONEG <br />PLUMBINOGONiF� iOR �JJ1�Mp�/fi SI�!!/� )✓ ��_�D � U fD�OSlIL <br />CiIY ZIP PNONE <br />CU:SOF WOPN <br />1 � NEW ❑ ADOITION ❑ ALTERATION ❑ REPAIR ❑ OEMOLITION ❑ WOODSTOVE/FRPL INSERT ❑ BUIl01NG RELOCATION <br />TEN�NT IMPRWEMENi OR INi[t110R PEMOp[L ONLY �ONiRCI VEfi50N pN0 PHONE NO <br />CONINACT PRICE OF WORM <br />LOT BLOCK Oi <br />PLUMBINO � <br />NO. TYPE OF FI% <br />� ��'L. WATERCLOSET(TOILE <br />� �, BATHTUB <br />� Z LAVATORY�WASH BA51 <br />' SHOWER <br />! KITCMEN SINKB DISP. <br />. � DISHWASHER <br />� LAUNDRYTRAY <br />:I� �Ti <br />�, u�wieo��naue� <br />PERMIT <br />❑ ves n No <br />❑Y <br />❑N <br />� <br />a <br />s —'� <br />a <br />sioe setoncK <br />VACANi SIIE <br />❑ YES ❑ NO <br />I HEREBY CERTIFY THAT I HAVE •'�[AD AND EXAMIN ED THIS APPLICATION AND <br />KNOW THE SAME TO BE TRUE P 4D COfiRGCL ALL PROVIS�ONS OF LAWS AND <br />ORDINANCES GOVERNING TH!5 TYPE OF WOfiK WILL BE CONPLETED WITH <br />WHETH ER SPECIFIEb HEREIN GR NOT. THE GRANTING OFA PERMITOOES NOT <br />PRESUME TO GIVE AUTIiCRITV TC+VIOLATE OR CANCEL THE PROVISIONS OF <br />ANV O7HER S7A7E OR LOCAL LAW RGGULA7ING CONS7RUCTION OR THE PER• <br />FORMANCE OF CONSTRUCTION. THAT 1 AM AUiHOR¢ED BY THE OW NER OF <br />THIS PROPERN TO PEfiFORM THE WORK FOF WHICH APP�ICATION IS MADE <br />ANO I COt9PLY WI7H THE STATE CONTR C7UR5 LAIi' 1827 RCW AND <br />296.200 WAC. <br />SIGNAIURCOFCONI OqORAUt RI AO DALE <br />X 9-21-�" <br />UCRNTSCIII'OUSMESSLI NSEN .qN OIISM[SSN�ME <br />MECHANICAL <br />NO. TYPE OF EOUIPMENT FEE <br />'— A/C—A/HNDLGUNI73—H.P. <br />" FORCEDAIRSYSTEM=—B.T.U. ME0. <br />^ UNITHEATERS—BT.0 M <br />CLOTHES DRYERS <br />— VENiILATION FAN <br />� RANGEHOOD <br />WATEF HEATER _'� <br />� WOODSTOVE <br />METAL FIREPLACE 8 CHIMNEY <br />FEES <br />BUIIDING <br />PLUMBING <br />MECHANICAL <br />OTHER <br />STATE BUILDINCa SURCIIARGE <br />STATE ENFRGY SURCHARGE <br />PUBLIC WORKS <br />TOTAL <br />S� <br />s <br />a <br />ECEIPT N0. <br />FEE <br />�i/ � <br />