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tM Ewrpreen <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />259•8810 <br />/c <br />APPLI�..�►TION FOR CONSThJCTION <br />PERMIT <br />TO BE COMPLETED IN INK— PLEASE PRINT <br />.:.:. _,: <br />everett <br />e <br />ARLHRECTOHOESIGNER MAILF�URE55 CITY ZIP PMONE <br />6ENEPALCONTP�CTOP M�ILAO�flE55 LITY ZIP PMONE LICENSE♦ <br />MECH�NICALGONTR�CTOH M�ILAODRE55 GITY ZIP PHONE LICENSE• <br />/V,�i✓,iil4��. �t/ G �[�0'l�iiG�-/�l.i` F%✓f �l�1�/ lrs'S33/ /:�or1'ii�✓%r/3%l�i <br />PLUMBINpCONiR� R M�IL�O�RESS GTY ZIP PNONE 4CENSE• <br />NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ OEMOIITION ❑ WOODSTOVE/FRPL INSERT ❑ Bl11LDING RELOCATION <br />CONTRACT PRICE OF WORK <br />LOT BLOGN OF <br />PLUMBINO <br />VO. TYPE OF FIXTURE OR ITEM <br />WATER CLOSET�TOILEn <br />BATHTUB <br />LAVATORY�WASH BASIN) <br />SHOWER <br />KITCHEN SiNKB DISP. <br />DISHWASHER <br />�i <br />A <br />SUB TOTAL <br />PEfiM1T <br />TOTAL FEE <br />❑r <br />❑N <br />FINEbPRINNlER5PE0UIPE0 ❑YES ❑NO <br />/�•71\ <br />� <br />S <br />❑ YES LI NJ <br />1 HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS APPLICATION AND <br />KNOW THE SAME TO BE TRUE AND CORRECT. AlL PROVISIONS OF LAWS AND <br />ORDINANCES GOVERNING THIS NPE OF WORK WILL BE COMPLETED WITH <br />WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OFA PERMIT DOES NOT <br />PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHEH STATE OR LOCAI LAW REGULATING CONSTRUCTION OR THE PER• <br />FORMANCE OF CONSTRUCTION. THAT I AM AUTHOR�ZED BY THE OWNER OF <br />THIS PROPERN TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE <br />AND I COMPLY WITH THE STATE CONTRACTORS LAW 1827 RCW AND <br />296.200 WAG <br />SIGNATUR,_ TflAGTORORAlI1110RIZE0AGENi DATE <br />X .l _ 1(. . . _ i /'I . /- ��1 <br />MECHANICAL <br />TYPE OF E01 <br />!VC—A/HNDLG UNITS— <br />FORCED AIR SYSTEMS— <br />UNIT HEATERS— 6T.U. <br />CLOTHESDRYERS <br />VENTILATION FAN <br />WOOD STOVE <br />METAL FIREPL <br />FIREPLACEIN <br />HEAT PUMP <br />GAS PIPING <br />EXHAUST FAN <br />FEES <br />BUIIDING <br />PLUMBING <br />MECHANICAL <br />OTHER <br />STATE BUILDING SURCHARGE <br />STATE ENERGY SURCHARGE <br />PUBLIC WORKS <br />TOTAL <br />TOTAL FEE <br />VALUATION <br />FEE <br />I <br />