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tAs Erorprosn <br />CITV OF <br />everett <br />BUILDING DEPARTMENT <br />259•8810 <br />. �� ��' � <br />APPLIC��ION FOR CONSTR�TION <br />PERMIT <br />TO BE CUMPLETED IN INK — PLEASE PRINT <br />�pCHiTECTORDE5i0NER M�Il�DD11E55 CIIY ZiP PNOHE � <br />OENERALCONiR�CiOR M�IL�ODRESS ptY ZIP V��ONE IJCENSE• <br />,�,e,,v=n _ <br />MEGN�NIC�LWNiR/.CTOR MML�D�RESS CIiY 2P VNONE 4CENSE <br />PLUM&NOfAHiR�CTOR b�ML�DOPESS CIIY ZIP PNONE !�GEN5E• <br />C1I3,40F WORN <br />❑ NEW ❑ ADDITION ❑ ALTEi1ATION ❑ REFAIR ❑ DEMOLIiION ❑ WOODS70VFJFRPL INSERi ❑ BUILDING RELOCATION <br />� '�%�C')`��' <br />CONTR�CT P(110E OF WOPK <br />pElC �BEV/OPN�N090U�REfOOi�6EINVOLVF <br />! �1n� F�p��6 �` <br />eouseorei � a <br />� �i A�al� �Ark� 1�/ <br />lOi BLOLN OF <br />I� <br />PLUMBINO <br />TYPE OF <br />WATER CLOSET (Ti <br />BATHTUB <br />TRAY <br />CLOTMFS <br />URINAL <br />'LOW PREVENTERS <br />DRAINS — RAINLEA <br />iERVICE — BAR. ETf <br />SUB TOTAL <br />PERMIT <br />TOTALFEE <br />FIRE9PRINKLERSf1EO111RE� ❑YE: <br />❑Y <br />❑ N <br />O YES ❑ NO <br />I HEREBV CERTIFY 1 HAT I H..JE READ AN U EXAMINED iH15 APPUCATION AND <br />KNOW THE SAME TG BE TRUE AND CORREC7. ALL PROVIS�ONS OF LAWS AND <br />ORDINANCES GOVERNING T111S TVPE OF WORK WILL BE COMPIETED WITH <br />WHETMER SPECIFIED HEREIN Oti NOT. THE GRANTINOOFA PERMIT DOES NOT <br />PRESUME TO GIVE AUTNORITY TO VIOLATE OR CANCEL THE PROVISION$ OF <br />ANY OTHER STATE OR LOCAL LAW REGULATIN6 CONSTRUCTION OR THE PER� <br />FOFMANCE OF CONS7RUCTION. iHAT I AM AUTHOFIZED BV iHE OWNER OF <br />THIS PROPERiV TO PERFORM THE WORK FOR WHICH APP! ICATION IS MR�E <br />AND 1 COMPLV WITH iNE STATE CONTRACTOFS LAW 1827 FCW AND <br />296200 WAC. <br />S�GNALUR[OFCONiMGI0�OP6111 qIZED�0EN1 UATE <br />�PPL �N19G YP�E55 �CENSENOANOBU51NE55�• �O/V ( <br />�N;!� <br />MECHANICAL <br />A/C — W FINDLG UNITS — H.P. <br />FOACED AIR SYSTEMS— &T.U. <br />UNITHEATERS—B.T.U. M <br />CLOTHES ORYERS <br />VEN7ILATION FAN <br />RANGE HOOD _ _ <br />WATER HEA7ER <br />WO00 STOVE <br />MEiAL FIREPLACE 8 CHIMNEV <br />FIREPLACEINSERT <br />GAS PIPING <br />E%HAUSTFF <br />BUILDING <br />PLUMBING <br />MECHANICAL <br />OTHER <br />STATE BUILDMG RURCHARGE <br />STATEENERGVSURCMAFGE <br />PUBLIC WORKS <br />TOTAL <br />M EA <br />a <br />S <br />