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Iha Everproon <br />��TY OF <br />everett <br />BUILDING DEPARTMENT <br />259•8810 <br />APPLICATION FOR CONSTRl1CT10N <br />PERMIT <br />y���� � � �.. <br />TO BE COMPLETED IN INK — PLEASE PRINT <br />�onn�ss nr zir rnor+e <br />g:. ��� �->>''� k'� (���� Ce�_��=�_U- c�.� �%3`'7_-�3 l�' <br />rnr nv r�wNG <br />__'—____'__--- _--__'_ <br />—"__ __— <br />M�II App�[55 ���T <br />G N[P�. ONnTMGiOR � AUII�DPC45r `�� ��,'�����/� /j-�/— .��� (��_t�ION�� � � � IIGENS[• <br />M GMANICILC � ACTOR ,� ��AIqI�P��S� �• I'� `f�l V y/G� l.. �N �.� LE� i 1' <br />I c-� � <br />_ ________ _�-- �C-ll,_ <br />PIUMB�NGGONIRAGTOR MAILApDAC55 f.11Y ZIP PuONE �U NSE• <br />GL/SSOfN'VRK __ __--_________ <br />❑ NEW ❑ ADDITION ALTERATION ❑ NEPAIN ❑ DE�IOLITION ❑ WOODSTOV[/FfiPL �NSERT ❑ OUIIDING PELOCAT�ON <br />TENANTIMPNWEMENTORINiE iONPCMOOEIONIY I7�) I CONTACTPERSONANUP�IONENO <br />CONTRALTPRICEOiWORW � • � D ��L=.1.1�=���— --'" -- <br />DESGRIB WORK �1�p AR FOOinue invu�vw ` �� I I <br />L�p�( ' !I`� ti1 � P� �� � C' i �� r � c—.L` �-l-�_ _ � - -- -- -------- -- — <br />EousEoroi orr�a � �� � IHEf7EBYCERIIFYTHATIHAVEREADANDEXAMINEDTH15APPLICATIONAND <br />� KNOW TIi[ SAME TO BE TRUE AND CORRECT. ALl PFOVISIONS OF LAWS AND <br />OROINANCES GOVERNING 7NI5 TYPE OF WORK WILL BE COMPLETED WITH <br />LEO�LDESCRiP90NOfPROPERttiSNOYINBELOWOP�TUGMPoURCOPIES� yyHETHERSPECIfIEDHEREINORNOT.TMEGRANtINGOFAPERMITDOESNOT <br />PRESUME TO GIVE AUTIIORIN i0 VIOLATE OH CANCEL THE PROVISIONS OF <br />�aT g�aK oF ANYOTHEHSTATEORLOCALLAWREGUTATINGCONSTRUCTIONORTMEPER• <br />TI�IIS PROPE Tl' 70 VERI"ORM TIiE WORK FOF WIOiICH APP IC TEON IS MADE <br />ANO I COMPLY WITH iHE STATE CONiRACTORS LAW 1827 RCW AND <br />2�J6 200 WAC <br />SIGNAtU COiGONPUGIJNUNaU1��OA�ZE��GENt DQE <br />� ��9 <br />PROJECTADORE55 � � <br />n�PUCA��iSC��uSi [SSICENSEN,� DB�SINE N�ME/�C1 �Z� <br />� � �- _ � � ,L�, <br />� NIFCMANICAL <br />PLUMBING <br />VO. IYPE OF FIXTUHE � <br />WATERClOSE11TOILE� <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISP. <br />DISMWASHER <br />LAUNDRYTFAY <br />GLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAI�: <br />FLOOR ORAIN <br />BACKFLOW PREVENTERS <br />ROOF DRAINS— �AINLEADI <br />SINK ISERVICE— BAR, ETC.) <br />USEZONE <br />/.LIOWABIE,'ACTU�L <br />SIZ[ Oi BLDO <br />FIFE <br />SUB TOTAL <br />PERMIT <br />TOTAL FEE <br />❑ YES ❑ NO <br />❑Y <br />I1 N <br />FEE NO. TYPEOFEOUIPMEN' <br />A/C - A/HNDLG UN�TS - H.P. <br />_�_ FORCEDAIRSYSTEMS-BT.U� <br />UNITHEATERS-B.TU. M <br />CLOTNES DRYERS __ <br />VENTILATION FAN <br />RANGEI100D <br />WATER HEATEFi <br />WOOD STOVE <br />METAL FIREPLACE 8 CHIMNEY _ <br />FNEPLACEINSERT <br />--- �-��- -HEATPUMP —�-���--- <br />-- -� GASPIPING __ _____ _ <br />5 <br />I1 YES ❑ NO <br />TOTAL <br />FEES <br />eui�niNc <br />PLUMBING <br />MECHANICAL <br />OTHEH <br />STATE BUILDINCa SURCHARGE <br />S7ATE ENERGY SURCHARGE <br />PUBLIC WORKS <br />TOTAL <br />