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fM Ewrpreen <br />CITY OF <br />everett <br />BUILDING DEPAFITMEN7 <br />259-8810 <br />APPLICa �ION FOR CON$TRIr�:T10N <br />PERMIT <br />TO BE COMPLETFD IN INK— PLEASE PRINT <br />DDIiE55 <br />,� ag, zm <br />' l y z�� l� � CCyyiip.. H' f. � i fi- <br />everett <br />� <br />�Oi �`J 7��/�% <br />•i1CMITECTORDE510NER MA�L�D�RESS CiTY IIP PMONE — <br />OENEP�LCANTR�GTOH MqLApORE55 pTY ZIP P��ON[ '�GENSE• <br />Dcv,n er- <br />NEGH�NIGQCONiR�CTON MMLADDRESS Crtv no ......... .___. <br />PLUMBIN7GONTR�CTON MAIL�DDRE55 CITY ZIP PHONE �IGENSE• <br />❑ NEW ❑ �DDITION ❑ A�TERATION � REPAIR ❑ DEMOLITION ❑ WOOOSTOVE/FFPL INSERT ❑ BUILDING RELOCATION <br />fEN�NiIMPqOVEMENTORIHT qlOti"qjEM/O�7DELON�.� CONTACfPEN50N�NDP110NEN0. — <br />:ONttV�CT PHILE OF WOP� /L (l V <br />LOT BLOCN OF <br />(�a25 IJ i / <br />PLUMBINO <br />V0. TYPE <br />WATER CLOSE <br />URINAL <br />DRINKINO FOUNI <br />F�OOR DRAIN <br />BACKFLOW PREV <br />ROOF DRAINS — <br />SINKISERVIf.F— <br />DISP. <br />� <br />I HEREBV CERTIFV TMAT I HAVE HEAD AND EXAMIN ED THIS APPLICATION AND <br />KNCW7HESAME108ETRUEANDCORREC7.ALLPRnVI510N50FLAW$AND � <br />ORDINFNCES GOVERNING THIS TVPE OF WORK WILL BE COMPLETED WITH <br />WHETHER SPECIF�EO HEREIN OR NOT. THE GRANTiNG OF A PERMITDOES NOT <br />PRESUME TO GWE AUTNORITV TO VIOLATE OR CANCEL TNE PROVISIONS OF <br />ANY OTHER STATB OR LOCAL LAW REGULATING CONSTFUCTION OR TNE PER• <br />FOFMANCE OF CONSTRUCTION. THAT I AM AUTHORIZEO BV TME OWNER OF <br />TMIS PROPEfl7V TO P[RFORM THE WORK FOR WMICH APPLICATION IS MRDE <br />ANO I COMPLY WITH THE STATE CONTRACTORS LAW 1827 RCW AND <br />.^96200 W.4C. <br />S�GN�111R[OFGONIR�GiOf10qAUTNORil[��GENT O�TE I <br />X �� ����'� ?��� � �� <br />RPPI•L�Hi GII BJSwE55LIC[NSENOANOBU SSNeME ' <br />� <br />MECMANICAL <br />OR 17EUi FEE NO. TYPE OF EOUIPMENT FEE � <br />A/C — A/HNDLG UNITS — HP. . <br />FORCED AIR SVSTEMS— B.T.U. M EA '. <br />UNIT HFATERS— 9.T.U. M <br />CLOTHES �FVERS <br />VENTILATION FAN <br />FA�JGE HOOD <br />WATEH HEA7ER � <br />WOO� STOVE <br />METAL FIREPLACE 6 CHIMNEY <br />FIHEPLACEINSERT <br />HEAT PUMP <br />GAS PIPINC <br />RS . E%HAUSTPAN <br />SUB TOTAL <br />PERMIT <br />TO7AL FEE <br />REOl11RED ❑ YE9 Ll NO <br />hl <br />❑ YES ❑ NO <br />' nOOFoweiuruoururs BUILDING <br />PLUMBING <br />BSMT OCG LO�O — <br />� Y MECHANICAL <br />❑N <br />NEIG�RLIMITATION OTHER <br />S7ATE BUILOING SURCI1AqGE <br />STATE ENERGY SURCHARGE <br />� PUBLIC WORKS <br />TOTAL <br />SU9 TOT/.L $ <br />PERMIT g <br />70TAL FEE E <br />FET� Nc� <br />FEE <br />a <br />> �' <br />