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t�e EverO�een <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />259•8810 <br />,.� ; �,� <br />APPLIC��t10N FOR COI�lSTRI�-�:TION <br />PERMIT <br />TO BE COMPLETED IN INK- PLEASE PRINT <br />F' 1 <br />� <br />�PCNITECTOR�ESIGNEN MULA0DPE55 W1Y ZiP PHONE <br />everett <br />e <br />GENER�LCONiPAGiON AI�RAOORE55 GIiY Z�P PNONE UCENSE• <br />MECNANIG�LWNiRAGLOP M�IL�D�BE55 GIIY ZIP PMONE UCENSE• <br />C�C:I��f'1� P� <br />PLUMBINOGONiRAGLOB MnIL�UDRE55 CITY ZP PNONE 4CENSE• <br />CLA39 OF N'ORN <br />❑ NEW ❑ ADDITION ❑ ALTERAiION ❑ REPAIR ❑ DEMOLITION �WOvUSTOVU�i7PLIN5ERT ❑ UUILDINGRELOCATION <br />CONTPACi FRICE Of WOPK' <br />OESFRIB�EWO./RHANpS9U�PEFOOUGEINVOLVF <br />ll� �� Q �( �i.'� �Ci <br />PPOPOSED USE OF BUIlUiNO <br />LE�D�PIPIION OF�OWN BEU <br />LOT BLOGN OF _ <br />I C�'i l� �fi" I�. SS <br />: �t ,iZ F7-T <br />PLUMBINQ <br />N� <br />FIRE <br />7RAY <br />BZo <br />FIXNRE <br />DISP. <br />SUB TOTAL <br />PERMIT <br />TOTAL FEE <br />ISEiBAGN 51 <br />\REA VP <br />U <br />1P,INGYGROUP Ni <br />)FS10FiES 95ML O� <br />❑v <br />❑N <br />HI <br />❑ NO <br />IS r1PPfl. BY <br />I H EREBY CERTIFY THAT I HAVE READ AND E%AMINED THIS APPLICATION AND <br />KNOW THE SAME 70 BE TRUE AND CORREC7. ALL PROVISIONS OF LAWS AND <br />ORDINANCES GOVERNING TIiISlYPE OF WORK W�LL BE COMPLETED WI7H <br />W HETHER SPECIFIED HEREIN OR NOT. TH E GRANTING OF A PEFMIT DOES NOT <br />PRESUME TO GIVE AU ih{ORI7 V TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PER� <br />FORMANCE O� CONSIRUCTION. TMAT I AM AUTHOA�ZED BV 7HE OWNER OF <br />7HI5 PROPERTY TO PERFORM iH E K'ORK FOR W HICH APPLIGATION IS MAOE <br />AND I COMPLY WITH THE STATE CONTRACTOFiS LAW 1827 RCW ANO <br />296200 WAC. <br />SIGN�iU�EOfCONiMC10�(IDPU1110R12EDAGENt DAIG <br />� <br />�� /� <br />��/1N1Gf ��- /_li�1, I. I �}. �'✓� <br />��P�iCArv15 Cil v bU5inE55l IGENSE NO M�� OU51��[SS NAME <br />MECHANICAL <br />FEE — N0� TYPEOFEOUIPI <br />A1C — A/HNULG UNITS — H.F <br />FORCED AIR SYSTEMS— B.T <br />UNIT HEAIERS— B.T.U. M <br />RANGEHOOD <br />WATER HEATER <br />WOOD STOVE <br />METAL �IREPL� <br />FAN <br />SUB TO7AL <br />PERMIi <br />TOTAL FEE <br />BUILDING <br />PLUMBING <br />MECHANICAL <br />OTHER <br />STATE BUILDING SURCHARGE <br />S7ATE ENEFGY SURCIIARGE <br />PUBLI� WORKS <br />TOTAL <br />M EA <br />$ <br />$ <br />$ <br />