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fhe Everpreen <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />259-0810 <br />��:.'�II r�i :'�� <br />l.�PPLICi�;'r10N FOR CONSTRt�..:T10N <br />PERMIT <br />TO BE COMPLETED IN INK— PLEASE PRINT <br />FNCNILEGTOROESIGNEH MAIIFDORE55 O�LV ZIP PIIONE <br />�� <br />cverelt <br />� <br />UENEflALCONTRrGTOR MAILADOlIE55 CITY I.IP PHONE LICENSE• <br />cuss or wunn <br />❑ NEW ❑ ADDITION LTERATION ❑ REPAIR ❑ OEMOLITION ❑ WOO�STOVE/FRPL INSERi ❑ 17UILDING RELOCATION <br />TEN�NIIMPROVEMENiORIMEPIOfiREMODELONLV �CONLACiPEI150NANDP110NGN0. <br />LONTN�CT FRICE OF WOfiK _ <br />lOT BIOCK OF <br />PLUMBIN6 � <br />NO. TYPE OF FIXTUHE OR ITEM FEE <br />KITCHEN SINI<8 DISP. <br />DISITYlASHER <br />LAUNDRYTRAY <br />ROOF <br />TOTAL S <br />NIT S <br />�L FEE $ <br />inCK SIpESETBRCK <br />VACANTSItE <br />❑ YES ❑ NO <br />:YOROUP NO.OFDWELLII <br />�mes osMc eccwao <br />nv <br />❑N <br />FIqESPRINKLERSNE�UIqED ❑YES ❑NO <br />I HEfiEBY CERTIFY THAT I HAVE READ AND E%4MI,N ED THIS APPLICAiION AND <br />KNOW THE SAME TO BE TRUE AND CORREC7. ALL PROVISIONS OF LAWS AND <br />ORDINANCES GOVERNING �HIS TYPE OF WORK WILL BE COMPLETEU WITH <br />W HETHER SPECIFIEf: HEREIN OR NOT.7HE GRANTING OFA FERMIT DOES NO7 <br />PFESUME TO GIVE pUTHORIN 70 VIOLATE OR CANCEL TI1E PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTIOIJ OR THE PEF� <br />FORMANCE OF CONSif7UCTION. THAT I AM 4UTHORIZE� BV Tf IE OW NEP OF <br />THIS PROPER7Y TO PC-17FORM THE WORK F JR W HICH APPLICATION IS MADE <br />AND I CO�dPLY WIiH THE STATE CONTfIAGTORS lAW 1027 f7CW AND <br />zss.zoo wnc. <br />516NAtUPEOFGCFiRRL10POHPUI110RIZEDAGENT ORiE <br />�\ <br />X c���� c�e. 1 3b g _ <br />APPIICRNtS iYBU5WE5SLIG NSEIlO.ANOOUSINESSNR E <br />MECHANICAL <br />NO. TYPE OF EOI <br />A/C—NHNDL('i UNI7S— <br />M <br />ME7AL FIREPLACE&CHIMNEV <br />FIREPI.ACE INSEPT <br />HEAT PUMP <br />GAS PIPING <br />E%HAUSTFAN <br />FEES <br />BUILDING <br />PLUMBING <br />MECHANICAL <br />OTHER <br />STATE BUILDING SURCHAIiGE <br />S7ATE ENERGV SURCHARGE <br />PUBLIC WORKS <br />70TAL <br />EA <br />)TAL $ <br />T $ <br />FEE S <br />Fee <br />FEE <br />—�' <br />