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me Evoro�aen <br />GTY OF <br />everett <br />BUILDING DEPARTMENT <br />259-8810 <br />/�APPLICpT10N FOR CO��STRUCTION <br />PERMIY <br />TO BE CCJMPLETED IN INK— PLEASE PRIN7 <br />everett <br />� <br />4RCMREGtORpE51GNEH MRILRODflE55 CIIY ZIP PHCNE ��— <br />���� �tsoc.. �F+�Uz✓rn4ir� �v4 Cuz.-�/� 9�To3 3r"3-ii�y <br />GENEPRL NTN�CTOR MMLADOFESS � CIiY 21P PMONE ZICENSE• <br />MECNGNIGLCONiRACTOR MRIL��OPE55 CIiY Z:P PMONE �ILENSE• <br />1'WMBIN6LONiRAGTOfl MRIl�O�RESS GIIY ZIP PNONE �ICENSE• <br />❑ JEW ❑ ADDITiON ❑ ALTERAT�ON ❑ R[PAIR � DEMOLRION ❑ WOOOSTOVE/FPPLINS[RT ❑ BiJILDINGRELOCATION <br />GONTP�CT PRICE Of WORK <br />�OT BLOCN OF <br />PLUMBlNG <br />WATER <br />UFINAL <br />DRINKING <br />BACKFLOW PRE1 <br />ROOF DRAINS— <br />SINK ISERVICE — <br />SUB TOTAL <br />PERMIT <br />TOTAL FEE <br />❑ YES ❑ NO <br />FEE <br />s <br />I HEREBY CER �IFY THAT I HAVE READ AND EXAM W ED THIS APPLICATION AND <br />KNOW 7HE SAM E iO BE TRUE AtJD CORREC7. ALL PROV15lON5 0F L AWS AND <br />ORDINANCES GOVEI7NING THIS TVPE OF WORK WIIL [3E COMPLEIED WITH <br />W HETHtR SPECIFIEfI HEREIM1 OR NOT. THE GRANTIIJG OF A PEHAIIT OOES NOT <br />PRESUME 70 GIVG <�UTHONIN TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANV OTH ER STA7E OA LOCAL LAW REGULATING COMSTRUCTIO� OR THE PER� <br />FORMANCE OF CONSTRUCTION. TNA' I AM AU fHOHIZED BV 7HE OW NER Of <br />THISPRUPERNIOPERFORMTHEWORKFORNIHICHAPPLICAT10Yl` '4DE <br />AND I COMPLV WITH THE STATE CONTRACTORS LAW 1827 RC� .ND <br />296.200 WAC. <br />SIGNRTUAEOFCONTP�CiORORAUtNOR2EDAGENi O0.TE <br />MECHANICAL <br />UNIT HEATERS— E <br />CLOfHES DRY@RS <br />VEN7ILATION FAN <br />RANGEHOOD <br />EOUIPMENT <br />S— H.P. <br />S—BT.U. MEA <br />CHIMNEV <br />O YES O NO , <br />NOAFDWELLINQUNIIS BUILCINO <br />PLUMBING <br />esMt occw+o <br />� Y MECHANICAL <br />ON <br />MEIGHiLIMItATION OTHEFl <br />STATE BUILDING SURCHAFiGE <br />STATE ENERGV SURCHARGE <br />� PUBLIC WORKS <br />70TAL <br />FEE <br />VALUATION <br />