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Ms Evarpreen <br />CITV OF <br />everett <br />BUILDING DEPARTMENT <br />259•BB10 <br />APPLIC�.i ION FOR CONSTRl�vT10N <br />PERMIT <br />TO BE COMPLETED IN INK — PLEASE PRINT <br />OWNER AIAILAUONE55 GtY ZIP PIIOHE <br />� C` 'f- / <br />�%% /�%K� �. [% C[./ �iji��i �YiZ: .�: i� . ]'�� %fV ii(/ /�'/� /Js i' c'. c': k'P� 7 % ' , ✓ .. �J <br />—'_" _ ...ii .nnoccc Cilv ZIP PMONE <br />ABCHITECTOROESIGNEP MAIL��ORESS CITY 21P P110NE <br />rveretl <br />e <br />OENERALCONiIi�CTOR M�IL�ODRE55 CITY 21P PIIONE LILENSE• <br />MECN�NICALCONfPACTOR M�IL�ODRE55 � CITY 21P PIIONE L%ENSE• <br />�`.�5��'/^/i�2�� 3 c?i� f���ii:'ii � f/�e��.•/2t�� i�f'."' '�2 �%('f3CC, C+.St/fit+Ct/�/12�.C! <br />RUMBINOCONTP�GTOF '- MML1100PESS CITY Z�P P��ONE LILENSE• <br />❑ NEW ❑ ADOITION ❑ ALTERATION ❑ REPAIR ❑ OEMOLITION ❑ WOODSiOVE/FflPLINSERT ❑ BUILDINGRELOCATION <br />� � _ <br />PROPOBED U9E OF BUILDINO <br />LOT <br />KUMlINO <br />BIOCN O� <br />BATMTUB <br />7F9:� <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />ROOF ORAINS — RAINLEA <br />SINK ISERVICE — BAR. ET( <br />FIRE 9PRINNLERS REOUIpED <br />TOTAL 5 <br />MIT E <br />iL FEE 5 <br />3ALK smr.seTe�cK <br />W::u1TSITE <br />U Yt5 ❑ NO <br />:YGROUP NOOFOWEI.1.11 <br />]NIES BSMT. OCC LOAD <br />❑Y <br />❑N <br />NEIGMT IIMIT�I <br />NO <br />FEE <br />I HEREBY CERTIFV THAT 1 HAVE READ AND E%AMINED THIS APPLICATION AND <br />KNOW THE SAME TO BE TRUE AND CORRECT. ALL PFOVISION9 OF LAW9 AND <br />Ofi01NANCES GOVERNING THIS T'PE OF WORK WILL BE COMPLETED WITH <br />W HETHER SPECIFIED MEREIN OR NOT. THE GRANTING OFA PEFMIT DOES NOT <br />PRESUME TO GIVE AUTHORITV TO VIOLATE OR CANCEL THE PROVISION9 OF <br />ANY OTHER STATE OR LOCAL lAW REGULATING CONSTRUCTION OR 7HE PER� <br />FORMANCE OF CONSTRUCTION. THAT I AM AUTHOR�ZED BV THE OWNER OF <br />THIS FROPERN TO PERFORM THE WORK FOR WHICH APPLICATION I$ MADE <br />AND I COMPLV WITH THE STATE CONTRACTORS LAW 1827 RCW AND <br />296200 WAC. \ \ � <br />SiGN�tUREOFCONTP�LiOROPAUTNOR12E0AGENT ��TE S � � <br />�,.,��`�„9�,_..� <br />A TSGII OIISINESSLICENSENO�N�BlI51NE55N�ME <br />MECHANICIIL <br />TYPE OF EQUIPMENT <br />— A/HNDIG UNITS — H.P. <br />ICED AIF SVSTEMS — BS.U. S YM EA <br />T HEATERS— B.T.U. M '/.S� <br />CHIMNEY <br />PIPING <br />411ST FAN <br />SUB <br />FEES <br />eui�niNc <br />PLUMBING <br />MECHANICAL <br />OTHER <br />STATE BUILDING SURCHARGE <br />STATE ENEAGV SURCHARGE <br />PUBLIC W017KS <br />TOTAL <br />FEE <br />