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i� <br />M� Everproen <br />CITV OF <br />everett <br />BUILDING DEPARTMENT <br />259•8610 <br />r� . <br />APPLI�dT10N FOR CONSTR�CTION <br />PERMIT <br />TO BE COMPLETED IN INK— PLE�4SE PRINT <br />�qGHITEGTOH�E516N[R M�R�DORE55 C�IY Z�P PIION[ <br />everett <br />e <br />OENERALGONiRAC10A _ M�Il�0�RE55 C�fY ZIP PIIONE LICENSE• <br />PIUMBIHGGONiMCiOfl M�IL�UDBESS CIIY 21P PIIONE UGENSE� <br />❑ NEW ❑ ADDITION ❑ ALTERATION ❑ I7EPAIR � DEMOLITION ❑ WOODSTOVE/FRPL INSERi ❑ 6UILDING fiELOCATION <br />f VRIGE OF WOPK <br />WOPN�N SOU� Ef001�0E1 <br />9WEOFBUR INO —S <br />!ti D 1 <br />$�fGRJJIP��nTIDN CF PR//O��P'E'R'�IY ISNOY <br />/0+�9ioLK w I OF <br />PLUMBINU <br />TYPE OF <br />d DISP. <br />URINAL <br />DRINKIN6 FOUNTAIN <br />FLOOR DHAIN <br />BACKFLOW PREVENTERS <br />POOF DRAINS — RA�NLEADERS <br />SINK ISERVICE — OAR. ETC.1 <br />SUBTOTAL 5 <br />PERMIT E <br />TOTAL FEE E <br />RE�RSETB�LK 510[SElO�LN <br />LOIAREA VACAN151iE <br />❑ YES O NO <br />OCCUPANGYGOOUP NOOiOWELLII <br />HOAF STONIES BSMi. OCG LO�D <br />❑V <br />❑ N <br />��ewnruMirer <br />p YES ❑ NO <br />1 H EREBY CEFTIFY THAT I HAVE READ AND EXAMINF.D THIS APPLICATION AND <br />KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS AND <br />ORDIPIANCES GOVERNING 7HIS 7YPE OF WORK WILL BE COMPLETED WITH <br />W HETMER SPECIFIEO H EREIN OR NOT. TNE GRANTING OFA PERMIT DOES NOT <br />PRESUME TO GIVE AUTHORI7V TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL lAW REGULATINCa CONSTRUCTION OR THE PER• <br />FORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BV THE OWNER OF <br />THIS PROPEtiTI' TO PERFORM THE WORK FOR W HICH APPLICATION IS MADE <br />AND I COMPLV WITH THE S7ATE CONTRACTORS LAW 1827 ACW AND <br />296200 WAC. <br />SIf.NnTU OI ONIRACE NAUi110PRED NI O�TE —��/�� <br />0 <br />X �iu,_��1 ��r.,r,�.� <br />�PPUCANLS ILYBUSINESSII E 5 NO.�NDBUSINESSN�ME <br />MECHANICAL <br />FEE NO. TYVE OF EOUIPME <br />A/C — AIHNOLG UNITS — H.P. <br />FORCED AIR SYS7EMS — 6T.U. <br />UNITHEATERS—B.T.U. M <br />CLOTHESDRYERS <br />VENTILATION FAN <br />METAL FIREPLACE! <br />FIREPLACEINSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAl151 FAN <br />SUB TOTAL <br />PERMIT <br />TOTAL FEE <br />FEES <br />BUILDING <br />PLUMBING <br />M�?CHANICAL <br />OTHER <br />STATE PUILOING SURCIIARGE <br />STATE ENERGY SUfiCIi�RGE <br />PUBLIC WORKS <br />TOTAL <br />ree <br />VALUATION I FEE <br />��� <br />