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... .... _. ._: . . .. .. . . .. . .. .._ <br />. .,�.. . _ . _.. ... . . . .. <br />.. : . <br />. �;, <br />APPLIC.+TIOId FOR CONSTRli�T10N <br />PERMlT <br />I�s Ewrproan <br />GTY OF <br />everett <br />BUILDING DEPARTMENT <br />259-8810 TO BE COMPLETED IN INK — PLEASE PRINT � <br />/_'a.oiA..�✓) is/A�J� �X�alil�� �i, ., ..r �ln �1�2.f't'-/% �h'�2�.� � <br />everelt I <br />e� � <br />� <br />TEN�NT MAIL�OORE55 LITY Z�P PMONE <br />ARGHITECTOfl0E51C4ER M�iI�DDF[55 CITY 21P PHONE <br />OENER�LGO�ITPALTOR MALL�D�PE55 CITY 21P P110NE LICENSE• <br />MECN�NIG�LGONTP�CTOP M�IIA�ONESS CIi1' 21P �MON[ LIGENSE• <br />PLUMOINO CANTRAGtOR <br />MAIL�OORE55 CITY ZIP �'NONE LICEN�E♦ <br />i�NJi V� m/nn <br />❑ NEW ❑ ADDITION ❑ ALIERATION G� REPAIR ❑ DEMOLITION _^O WOODSTOVFJoRPcuNSERT ❑ BUILDIN6FELOCATION <br />� �w. ^ <br />LOT � BLOGK OF �LL <br />�j �,tJ. Vi e a D.� , <br />P OJECT� OP[55 ' <br />PLUMBINO <br />NO. TYPEOFFI%TUREONITEM <br />WATERCLOSET(TOILEp <br />BATHTUB <br />LAVATORV (WASH BASIN) <br />SHOWER <br />KITCHEN SINKB DISP. <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />ORINKING FOUNTAIN _ <br />FLOOR ORAIN _ <br />PERMIT <br />TOTAL FEE <br />❑ YE9 <br />❑Y <br />❑ N <br />I HEFEBV CERTIFV THAT I HAVE READ AND EaAMINED THIS APPLIGATION AND <br />KNOW THE SAME TO 8E TRUE AND CORRECT. AlL PROVI510N3 OF LAWS AND <br />ORDINANCES GOVERNING THIS 7VPE OF WORK WILL BE COMPLETED WITH <br />PRESUME TO GIVE AUTHORITY TO OOLAiE OR CAfNCE�I THEEPROV SI�ONS OF <br />ANY OTHER STA7E OR LOCAL LAW REGULATING CONSTRUGTION OR THE PER� <br />FORMANCE OF CONSTRUCTION.7HAi � AM AUiHORIZED �Y THE OWNER OF <br />", �95 PROPERN TO PERFORM THE WORK FOR WHICH APPLICATION iS MADE <br />AND I COMPLV WITH THE STATE CONTRACTORS LAW 18.27 RCW ANO <br />296200 W.4C. <br />SiGNetl1RE CON1P�LiONOR/d1iNORi2[OPGENi D�TE <br />X . � ������ �-►�-�9' <br />APPIICAMS GIl V BUSINESS LICENSE NO PND BUS W E55 NAME <br />MECHANICAI <br />FEE NO. <br />A/C — A/H <br />FORCED/ <br />UNIT 1{EA' <br />CLOTHES <br />❑ YES ❑ NO <br />i UNITS— H.P. <br />'STEMS—BT.U. MEA <br />— B T.U. M <br />FAN <br />�L FIFEPLACE 8 <br />PLACEINSERi <br />PUMP <br />PIPING <br />FEES <br />BUILDING <br />PLUMBING <br />MECHANICAL <br />OTHEFi <br />STATE BU�LDING SURCHARGE <br />STATE ENERGY SURCHARGE <br />PUBLIC WORKS <br />TOTAL <br />TOTAL <br />FEE <br />E <br />S <br />S <br />� <br />