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f�e Everproen <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />259-BB10 <br />APPLICATIOI� FOFY CON�'Y'i�liCYION <br />PEFtMIT <br />TO BE COMPLETF_D IN INK- PLEASE PRINT <br />�RCMRECfORDE5IGNER MARAODR65 CrtY ZIP P�fONE <br />rvc�cl� <br />� <br />PFNEfULCQNTPACiOR MAIL��ORE55 ElUIP61EENt (i�y I"C LITY 2iP ��PH�I ��� � I I�/, �LE <br />NRTIlAIII oA3 (���t�.c�ry�y-� � <br />MEGHANIC�LCONTRAGTOR MAILApD . p�pq �IGYY Y• CITY ZIP PIIOIIE LIGENSE• <br />Evelett� W��n 9B201 I D � � <br />a��..mu��num.r.no vu��nnnFas tiiP1 LRY ZIP PIIONE liCNSE• <br />❑ NEW ❑ ADDITION �ALTERATION ❑ flEPl.IR ❑ DEMOL�TIUM ❑ WOODSTOVE/FRPLINSERT ❑ Bl11LDINQ�RELOCATION <br />fANT1UGTPiiICEOF WORK <br />lOT BLOCN OF <br />PLUMCIN6 <br />SHOWER <br />KITCHEN SINK 8 <br />DISHWASHER <br />LAUNOFYTRAY <br />Ue� <br />FIXTUPE OR ITERS <br />SUB TOTAL <br />PERMIT <br />TOTAL FEE <br />❑ NO <br />❑Y <br />❑N <br />�� <br />❑ Y[5 U NO <br />.Y_ <br />I HEPEBY CER7IFV 7HIQ I HAVE READ ANO EXAMINF.D THIS APPLICATION AND <br />KNOW TME SAME TO BE Tr7UE ANO CORRECT. AL� FROVISIONS OF LAW i AND <br />ORDINANCES GOVERIJING TIIIS TYPE OF WORK WILL BE COMPLETED WI�H <br />WI IE7 HEIi SPECIFIED HEREIN OR NOT. THE GRANTING OF A PER'v11T DOES NO7 <br />PPESUME TO GIVG AUTHORIN TO VIOLATE OR CANCEL THE PFOVISIONS OF <br />ANY OTH ER STAT E OF LOCAL LAW REGULATING CONSiPUCTION OR THE PEfi� <br />FOFMANCE OF CONSTRUCiION. THAT I AIA AUTHOFIZED OY THE OWNER OF <br />THIS PFOPEHTY TO PEFFORM TI1E WORK FOR WtiICH APPLICATION IS MADE <br />AND I COMPLY WITM TIIE STATE CONTRACTOfiS LAW IB27 RCW ANO <br />296200 WAC. <br />SIGtlAiUli[OfCOIIIPAGiORORnUIIIORIZ[OAGENi �RE <br />X " <br />���,�r;�� -,� <br />APPIICANIS'CIIYOUSIN[SSIIC NSE�IOANp0U51NE55lAME <br />MECHANICAL <br />NO. TYPE OF EOUIPMENT <br />A/C— NHNULG UNITS— H P. <br />FORCED Alq SYS7EM5— BT.U. <br />UNIT I1E�TEfiS— �.T.U. M <br />CLO7HES DRYERS <br />VEN7ILATIqN FAN <br />WOUD STOVE <br />METAI. FIREPL <br />FIREPLACEIN <br />HEAT PUtdP <br />GAS PIPItJG <br />[%HAUSTFAN <br />� SUBTO7AL <br />PERMIT <br />TOTAL FEE <br />PIAHLMELRNIIMVEF �EE <br />FEES VALU <br />BUILDING <br />PLUMBING <br />MECHANICAL <br />OTHEH <br />STATE UUIl01NG SURCIiARGE <br />STATE ENERGY SURCHARGE <br />PUBLIC WORKS <br />TOTAL <br />FEE <br />FEE <br />