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Ne Everpreen <br />GTYOF <br />everett <br />BUILDING DEPARTMENT <br />259•8810 <br />- � <br />APPLIC�.�ION FOR CONSTRVCTION <br />PERMIT <br />TO BE COMPLETED IN INK- PLEASE PRINT <br />everett <br />� <br />OWNER MAILADDR[55 CITY ZiP PMONE <br />?��l'l�a �i,�F s ,�2�A✓6�Aui� At� ,._�v.' 9P.zo3 �^3 - 9s�g <br />TEN�NI M�ILFDUPESS CITY ZIP PMONE <br />� <br />PLUMBINGCONTN�CTOR MAILA�URE55 GTY 21P PNONE �IGENSE• <br />� NEW ❑ ADDITION ❑ AI.TERPTION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL INSERT ❑ BUILDING RELOLATION <br />�7ENANT IMPROVEMENT OR INTEPIOR REMODEL ONLY CONTACT FERSON AND PHONE NO. <br />LOT� BIOCN�_ OF <br />PLUMBIN6 <br />SHOWER <br />KITCHEN SINK 8 DISP. <br />DISHWASHER <br />LAUNDRVTRAV <br />BACKFLOW PREVENTERS <br />ROOF DRAINS— RAINLEADERS <br />CINKICFGVI(:F—tiAR FTl:1 <br />SUBTOTAL $ <br />PERMIT $ <br />TOTAL FEE 5 <br />DNTSETBACe REARSETBACK 510 <br />. <br />EZONE LOTARER VA( <br />� 5 � <br />'EOFWNST pGGUPRNCYGROUP NO <br />.OWABLE/ACTUAL <br />� � �7_ 3 <br />EOFBLOG. NOAFStORIES BSMT. OCi <br />/v7- 3 ° � <br />z ro — �,,,�,�� �E� <br />ESPRINNLERSREOUIRED ❑ VES �IiO � <br />N� <br />3s3- <br />I HEREBV CERTIFV THAT I 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 CANGEL THE PROVISIONS OF <br />ANV OTHEfi STATE OR LOCAL LAW REGULFTING CONSTRUCTION OR THE PER• <br />FORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BV THE OWNER OF <br />THIS PROPERTV TO PERFORM THE WORK FOR \VHICH APPLICATION IS MADE <br />AND I COMPLY WITH THE STATE CONTPACTORS LRW 1B27 RCW AND <br />296200 WAC. <br />SIGNATUREOFCONTFACiORORAUTHORIZEDRGENT �RiE <br />� <br />A ICRITSGITYBt1SME55LICEN ENO.ANOBUSWESSNqME <br />MECNANICAL <br />NO. TYPEOFEOUIPMENT <br />A/C—A/HNDLG UNITS— H.P. <br />— FORCED AIR SYSTEMS— B.T.U. M E0. <br />� UNIT HEATERS— BT.U. M <br />/ CLOTHESDRYERS <br />� VENTILATION FAN _ <br />� / RANGEHOOD <br />METAL FIREPI � CE! <br />FIREPLACEINSE9T <br />HEAT PUMP <br />GAS PIPING <br />E7�HAUST FAN <br />SUB TOTAL <br />PERMIT <br />TOTAL FEE <br />5 � <br />iTE FI <br />❑ NO <br />BUILDING <br />NEILING UNITS <br />� PLUMBING <br />D <br />MECHANICAI <br />I ��w I <br />si�cr � /� =. �i/ �h3t'Yn".-> S <br />V ,C" t ; <br />C�o�:.'�L�S O/= , <br />OTHER <br />STATE BUILDING SURCHARGE <br />STATE ENERGV SURCHARGE <br />PUBLIC WORKS <br />I TOTAL I <br />-, _ <br />KcC;._�il.1CP/iYh�/S W�-�..i L�.... -. <br />35 <br />S <br />5 <br />4 <br />