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i <br />, <br />; <br />Ihs Ewryrsen <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />259•8810 <br />APPLICd� ION FOR CONSTRU►�TION <br />PERMIT <br />TO BE COMPLETED IN INK- PLEASE PRINT <br />everett <br />� <br />V� <br />� M�ILAODRESS pIY Z�� PNONE 4CENSE• <br />Z5°iz� 'ii3"" K�f.s. �;¢�-! ��a3z 3ss-tsaG F«�oRszb=� <br />� _..., e�o ownHe 4CENSE • <br />KVNBINOGONTP�GTOR MAIL�ODPE55 ptY 21P PHONE LICENSE• <br />❑ NEW ❑ Ab�iTION ❑ ALTERATION VJ�REPAIR ❑ DEM/::ITION ❑ WOOOSTOVFJFPPL INSERi ❑ BUILDING RELOCATION <br />TEN�NT IMPROVEMENT OR INTERIOR REMODEL ONLY � �OM�GT PE��SON �ND PIIONE NO <br />muin�CTPPICEOFYONK � \. UOd. O O <br />LOT�— BLOG1c OF <br />PLUMBINU <br />NO. TYPE OF FI;(TUHE <br />WATER CLOSET�TOIIHn <br />BATHTUB <br />IAVATORY(WASH BASIN) <br />SHOWER <br />KITCHEN SINKB DISP. <br />DISFiWA9HER <br />LAUNDRYTRAY <br />CIOTHES WASHER <br />URINAL <br />DRINKIN6 FOUNTAIN <br />FLOOR DRAIN <br />BACI<FLOW PREVENTERS <br />pOOF URAINS— RAINLEAL <br />c�u¢iCFGVICF—RAR FTC. <br />FlRE <br />TOTAL <br />❑Y <br />❑N <br />❑ YES ❑ NO <br />V J�i �� <br />I HERESY CERTIFY THAT I HAVE READ AND EXAMINF.D TM�S APPLICATION AND <br />KNOW THE SAME TO BE TRUE ANO CORRECT. ALL PROVISIONS OF IAWS AND <br />ORDINAhCES GOVERNING THIS TVPE OF WORK WILL BE COMPIETED WITH <br />WHETHER SPECIFIED HEREIN QR NOT.THE ORANTING OFA PERMIT DOES NCT <br />PPESI�ME TO GIVE AUTHORITY 70 VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHER STA1E OR LOCAL LAW FEGULATING CONSTRUCTION OR THE PER� <br />FORMANCE OF CONSiRUCTION. THAT 1 AM AUTHORIZEU BY THE OWNER OF <br />ANID P COMP YTW THRTHE STATE CONTRACTyORSHLAWL B2T7�RCW AND <br />296200 W4C. <br />SIONr7UBEOFGONIRAC1080FAUT110PILEDAOENi DATE <br />X� . ...�_ �� - .� Q 8/� /� � <br />MP i NLSCIiYBU5�Nf55lIG[NSENO.�NDBUSINESSNAME � <br />MECHANICAL <br />FEE NO. n'PE� <br />A/C — A/HNOLG UP <br />FORCED AIR SYSTE <br />UNIT HEATERS— 8 <br />CLOTHESDRYERS <br />VENTILATtON FAN <br />RANGEHOOD <br />WATER HEATER <br />WOOD STOVE <br />METAL FIREPLACE <br />FIREPL�CElNSER' <br />HEAT PUMP <br />GAS PIPING <br />S <br />❑ VLS O NO <br />— H.P. <br />— 6T.U. M EA <br />M <br />PERMIT S <br />TOTALFEE E <br />FEES <br />BUILDING <br />PLUMBING <br />MECHANICAL <br />OTHER _ <br />SiATE BJILDING SUfiCHARGE <br />STATE ENERGY SURCIIAH'3E <br />PUBLIL' WORKS <br />TOTAL <br />�•:� i-,�" ��. \ ':....i �{�.; ' <br />� <br />rcc <br />FEE <br />