4003 GRAND AVE 2016-01-01 MF Import

1'r . : `R APPLICI�+�ION FOR CONSTR4i:T10N PERMIT ' Ms Every�een CRV OF everett BUILDING DEPARTMENT 259-8810 � ,- „ „ , . BE COMPLETED IN INK- � �� evcrett e MGHITECTOFDESIONER MMl�Op0E55 GtY 21P PHONE OENER�IGONTR�CTOR M�ILACOPE55 GIY 21P PNONE ��GENSE• MECH�NIGQCONIPACIOR MAILA�DHE55 CrtY 21P PHONE IICENSE• PLUM&NOGONiR�CtOR �u1L��UP[99 CIIY ��` PUONE L�LEN9E• ❑ NEW ❑ �DDITION ❑ ALTERATION ❑ FEPAIR �T OEMOLITION ❑ WOODSTOVFJFRPL INSERT ❑ BUILDIN� RELOCATION PRICE OF WOPK �6X L�BIOLK� OF �� � .j �Rl�[.nw�lOi .� � ( RqJECfMDPE39 ; Aao.� G n.�r 4 �I� PLUMlINO fl NO.T TYFE !( i. , �'' KITCHEN SINK6 DISP. DIBHWASHER UUNDRYTRAV CLOTHES WASHER URINAL DRINKINO FOUNTAIN FLOOR DRAIN ROOF ALLOW�BLE/ACTUAL �GG ❑ YES FEE E E a ❑ YES O NO I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICA710N 11ND KNOW THE SAME TO BE TRUE AND CORRECT. ALl PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS NPF OF WORK WILL Bc COMPLETED WITH WHETHERSPECIFIEDHEREINORNOi.THEGRANTINGOF� PERMITDOESNOT PRESUME TO GIVE AUTHORIN TO VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHER S7ATE OR LOCAL LAW REGULATING CONSTRUCTION OR iHE PER• FORMANCE OF CONSTRUCTION. TMAT I AM AUTHORIZED BY THE OWNER OF THIS PROPERTYTO PERFOFM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE CONTRACTORS LAW 1827 RCW AND 298200 WAC. / �/�� S�GNAT011EOFCONiRAGiOROR�UTNORI2E��GENT D�tE X�' _..� .. -. A _ i' _ MECHANICAL NO. T�= WOOD STOVE METAL FIREPLACE 8 FIREPLACEINSERT PIPING AUSTFAN FEES — H.P. — 9T.1 M SUB TOTAL PERMIT TOTAL FEE �UILDING ' NOAFOWElUN0UN1L5 PLUMBING BSMi. OCCLORO . ❑ v MECHANICAL ❑N HEiG11TLIMIiP110N OTHER STATE BUILDING SURCHARGE STATE ENERGY SUFCHARGE � PUBLIC WORKS TOTAL VALUATION