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fM Ev�rymn <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />���.�. <br />pppLlC 4�ION FOR CONSTRIt►' TION <br />PERMIT <br />T�D BE COMPLETED IN INK— PLEASE PRINT <br />/ad <br />everett <br />e <br />/�RGIIITEGT OR �E810NCR <br />MAIL�DDRE55 C11Y ZIP PHONE <br />CITV 21P PHONE LICENSE• <br />OENEMLGONTR�GTOF MNL�OORE55 � <br />❑ NEW ❑ ADDITION <br />ALTERATION ❑ REPRIR ❑ DEMOLITION ❑ WOODSTOVFJFRPLINSERT ❑ BUILDINaRELOCAT�ON <br />LOT BLOGK OI <br />PLUM�INO <br />SINK <br />DRAIN <br />19 <br />FIRE <br />i � <br />l <br />YES O NO <br />❑r <br />❑ N <br />❑ YES ❑ NO <br />I HEREBY CERTIFY THAT I HAVE READ ANO EXAMINED THIS APPLIGAnOn nrvu <br />KNOW THE SAME TO BE TRUE AND CAARECT. ALL PROVISIONS OF UWS AND <br />ORDINANCES GOVERNING THIS NPE OF \VORK WILL BE COMPLE7ED WITH <br />� ESUMETOGIVEAUTHORIN OVOIOLATEORCANCELTHEEP niNSI�ONSOF <br />ANY OTHER STATE OR LOCAL LAW RECaULATIN� CONSTRUCTION OR THE PER• <br />FORMANCE OF CONSTRUCTION. iHAT I AM AUTHOr7RED BY THE OWNER OF <br />ANID PRCOMP VTW TMR HE STATE CONTRAC ORSMLAWL B27 RCW AND <br />286.200 Vr'AG <br />SION�iURECFGONiR�GTO�ORAUTMOP12ED�0ENT O�TE <br />x�P,. ��?,� I/I—rl�c� <br />AVPLC�N GTYBUSiNE ��GENSENO.�NOBUSINE35N�ME <br />MECHIINICAL <br />NO. T/PE OF EOl <br />A/C — AIHNDLG UNITS — <br />FORCED AIR SYSTEMS — <br />UNIT HEATERS — B.T.U. <br />CLOTHES ORYERS <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />WOODSTOVE <br />METAL FIREPLACE d CHI <br />FIREPLACEINSEiiT <br />HEAT PUMP <br />GAS PIPING _ <br />F'PL <br />BUILDING <br />PLUMBING <br />MECHANICAL <br />OTHEP <br />STATE BUILDING SURCHARGE <br />STATE ENERGY SURCHARGE <br />PUBLIC WORKS <br />TOTAL <br />r•eE <br />�,� <br />