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fns Erorpreen <br />CffY OF <br />everett <br />BUILDING DEPARTMENT <br />259•B810 <br />APPLIt�AT10N FOR CONSTI"t�OCT10N <br />PERMIT <br />TO BE COMPLETED IN INK- PLEASE PRINT <br />ONNER i ...............,.., <br />(ii�. dc9_,C��cnt��_3i U.i��„��• <br />hH�NT M�il �DORES� <br />��s�--�3� s <br />ARCNILEGTOROc51ONFR MMLAppNE55 G�LY .IP PHONE <br />everett <br />� <br />OENEN�tCOM1H�C10N M�IUD�RESS GItY • IiP FHONE LICEN9E• <br />❑ NEW ❑ ADDIiION ❑ ALTGRAfl0�/ ❑ REPAIR ❑ OEMOLiT10N <br />Of WORK <br />lUT BLOCN Oi <br />PLUMBINO <br />KITCHEN <br />� OISHWA: <br />LAUNDR' <br />CLOTHE: <br />URINAL <br />DRINKIW <br />FLOOR C <br />BPCKfL( <br />ROOFDF <br />SINK (SE <br />' FRONTSETB�GK <br />BIZE OF BlDO. <br />ZIP PIIONE UGENSE • <br />\YOODSIOVE/fRPL INSEf1T ❑ BUILDING RELOCATION <br />I NERE6Y CERTIFY 7HAT I HAVE REAO AND EXAMINED THIS APPL�CA710N AND <br />KNOW THE S�ME TO BE TRUE AN� CORREC7. ALl PROVISIONS OF LAWS AND <br />OI:DIhA�JCES GOVERNING THIS TVPE OF V/ORK WILL BE COMPLETED WITH <br />W HE iNER SPECIFIED HEREIN OR NOT. iNE GR%.NT W � OF A PERMIT DOE¢ NOT <br />PRESUME TO GIVE AUIHORIiY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHER STAT E OR LOCAL LAW PEGUTATING CONSTRUCTION OR THE PER- <br />FOFMANCE OF CONSTRUCTION. Tf�AT I AM AUTHORIZED BV THE OWNER OF <br />TMIS PROPERIY TO PERFORM THE WOP.K FOR WHICH APPLICATION I$ MADE <br />AND I COMPLV WITH THE SiATE CON7RACTORS LAW 7fL27 RCW AND <br />286.200 WAC. <br />S�GN�IU�EO�CONIR�CTORON�U➢��NZE��GENi O�tE <br />X�l i� X_ I� u� Gj -�!-� <br />APPLIC�lIiSG1iY SINCSSUf,[NSENO.�NODUSMESSNAME <br />MECHIINICAL <br />YPE OF FU(NRE OR ITEM FEE NO. TYPE OF EOUIPMENT <br />�SET (TOILEn P/C — 0.'H NDLG UNITS — H.P. <br />FORCED Alfi SYSTEMS— B.T.U. <br />(WASHBFSINI UNITNEATEfiS—BT.U. M <br />CLOTNES DRYERS <br />iINKB DISP. ! VENTILATION (AN <br />IEH RANGEHOOD <br />TRAY WATER HEATEIi <br />WASHER � �'�'OODSTOVE <br />METAL FIf7EPLACEB Cf11MNEY <br />FOUNTAIN FIPEPLACEINSERT <br />IAIN HEAT PUMP <br />..,.,..,�.�.�.,c GAS PIPING <br />— RAINLEADERS <br />SUBTOTAL E <br />PERMIT S <br />TOTAL FEE S <br />❑ YES O NO <br />APPLIC�I�ONACCBY FLRNS�FVRBV <br />❑Y <br />Ll N <br />❑ YE9 ❑ <br />FEE <br />FEES <br />6UILDING <br />PLUMBING <br />MECHANICAL <br />OTHER <br />STATE BUIl01NG SURCHFHGE <br />STATE EIJERGY SURCHARGE <br />PUBLIC WORKS <br />70TAL <br />FEE <br />FEE <br />_.....:�-.....,,.-�...:.�.:. . . .. .-. . , _.. � �.�.',.v.�r.x::.�,•r.�_.......,�.:•�� <br />