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l;i.�tii � <br />. APPLICi�:'�ION FOR CONSTRI�.LTION <br />PERMIT � <br />1 Ihs Ewrpreen <br />CITV OF <br />� everett <br />� BUILDING DEPARTMENT <br />259•8810 <br />� <br />� ON ER <br />, �,,.,. _i n�., � <br />TO BE COMPLETED IN INK- PLEASE PRINT <br />1DURESS � CIIV ^ ZIP <br />cr <br />evcrett <br />e <br />ARCHITECTORDESIONEf1 M�IL�ODRESS CItY ZIP vNONE <br />OENEMLCONTPAGTOR M�II��Of1E55 QtY 21P PHONE UGENSE• <br />X <br />i�� <br />-S'33 <br />❑ NEW ❑ A��ITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRP� INSERi ❑ BUILOING RELOCATION <br />- v4 s <br />.DINO � <br />+ LEdLLUESGPIPfIONOiPROPERtt191101 <br />S <br />� LOT BLOCK Of <br />1• <br />t <br />� <br />vwrsiNo <br />�769:� <br />FLOOR DRAIN <br />BACKFLOW PHEVENTERS <br />ROOF DRAIN3— RAINLEA <br />SINK (SEFVICE — BAR. ET( <br />� � <br />iPONT9E7B�CK <br />.� <br />I <br />� USEZONE <br />TYPE OF fAN9T. <br />, �LLOWABIFJAGTU�L <br />FIqE 9GRINKLER9 REOUIPEO O YES O NO <br />V <br />S <br />cr <br />I HEREBY CERTIFY THAT I HAVE ^�AD AND E%AMINED THIS APPLICATION ANp <br />KNOW THE SAME TO BE TRUE AN� CORRECT. ALL PROVISIONS OF LAWS AND <br />ORD�NANCES 60VERNING TH�S TVPE OF WORK WILL BE COMPLEIED WI7H <br />WHETHER SPEC�FIED I�EREIN OR NOT.THE ORANTINOOFAPEPMIT DOE$ NOT <br />PRESUME TO OIVE AU �HORITV TO VIOLATE OR CANCEL THE PROVISION9 OF <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTFiUCTION OR TME PEfF <br />FORMANCE OF CONSTRUCTION. THAT 1 AM AUTHORIZED BV THE OWNER OF <br />THIS PROPERTYTU PERFORM THE WORK FOR WHICH APPLICATION I$ MADE <br />AND 1 COMPLY WITH THE STATE CONTRACTORS LAW 18.27 RCW AND <br />296.200 WAG <br />SIUNNUREOFCONiFIiCiOROR�UINOR12E0�0ENT O�TE <br />X �/lUc�, w et I rA ). N. I�fi C i <br />FEE NO. TYPEOFEOUIPN <br />A/C — A/HNDLG UNITS — H.P. <br />FORCED AIR SYSTEMS— aT.l <br />UNITHEATEFS—B.T.U. M <br />CLOTHESDRVERS <br />VENTILATION FAN <br />RANGEHOOD <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN <br />6 CHIMNEV <br />O YES ❑ NO -- <br />NOOF�WELLINOUNIIS BUILDING <br />PLUMBING <br />BSMi. OLG LOAD <br />O v MECHANICAL <br />ON <br />IIEIOHTLIMIi�lION OTIIER <br />- STATE BUILDINO SURCHAfiGE <br />STATE ENERGY SURCHARGE <br />� PUBLIC WORKS <br />TOTAL <br />SUB TOTAI <br />PERMIT <br />TOTAL FEE <br />M <br />E <br />FEE <br />