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rha Everoreen <br />CITV OF <br />everett <br />BUILDING DEPARTMENT <br />259•8810 <br />9'� - oza_� <br />APPLIC. .TL'ONPFEO�MIT NSTRVC�ii � o � � p <br />�� D <br />� � f�� � - 71997 <br />rvere[� <br />.._ eCITY OF EVERETT, <br />TO BE COMPLETED IN INK— PLEASE PRINT Public Works Dept. <br />TEN�Ni•�` �•�.,•�,r,,c�',t�wn,- \a9z.o w1.c, 37` G�: .._?--q <br />MAILADDRE�.S � ���'��� �Y1'�(�9�� <br />-`�^ � G 1 ZIP PHOkE <br />v��l�\�lo N�4SLS�Cc7Ti\J��LS .�C+Z ���c ?`iGVt7T <br />•RCNRECTORDESIGNER MnILpL]q�55 <br />���Y Z�P PMONE <br />GENEP�LCONTRqCTOR MRILr100PE55 <br />CiiV ZIP PMONE <br />`��C��(LT �(,�� �tYlA��� ` � LICENSE�. <br />MECMANIGAICONTR4CTOR M11�ILADDRE55 �g�o1 bCJZ,��.�ry <br />❑ NEW ❑ ADDI710'J <br />WORt <br />LOT BIOGR pF <br />PROJECTIDDRE55 <br />PLUMBINO <br />f <br />NO. <br />t WATF <br />eer� <br />CIiV 21P PIIONE <br />LGENSE s <br />9e�e-_ -T54-.4�m 024'Z3'� <br />ALTE:.ATION ❑ REPAIR ❑ OEMOLITION ❑ WOODSTOVE/FR�L :NSERT ❑ BUILDIN.. QELOCqTION <br />IODELONLY ,,,�....,,_,,,��_.. __ _ . <br />LAUNDHYTRAV <br />CLOTHES WASNER <br />URINAL <br />I DRINKING FOUNTAIN <br />'� FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />ROOF DqAINS— RAINLEADERS <br />SINK (SEFVICE — BAR, ETGI <br />SUBTOTAL g ( <br />PERMIT g <br />TOTAL FEE g <br />FqONTSETBnCK HEANSEiBRCK <br />S�OE SEtBRt <br />USEZONE LpTeHE� WG�NTSITE <br />❑ YES O <br />1VPEO:CqNST, OCCUPANCVGROUP NODFOWEI <br />41L01YR6�E/ACTUAL <br />SRF.OFBL�G NO.OFSiORiES BSMT. OCClOqO <br />OY <br />—. ❑ N <br />FlpESPR�NKIER::R[OUiREU ❑ VES ❑ NO <br />I HEREBV Ct'RTIFV THAT I HAVE READ AND EXAMMED THIS APPLICATION AND <br />KNOW THE SAME 70 BE 7AUE AND CORRECT. ALL PROVISIONS JF LAWS AND <br />ORDINANCES GOVERNING THIS 7VPE OF WORK V/ILL BE COMPLETED WIiH <br />WHETH ER SPECIFIED HEREIN OR NOT. THE GRANTIN� OFA PERMITDOES NOT <br />PRESUME TO GIVE AUTHORI7V TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANYOTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR 7HE PER� <br />FORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BV THE OWNER OF <br />THIS PROPERry TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE <br />AND I COMPLY WI7H THE STATE CONTRACTORS LAW 18.27 RCW AND <br />296.200 WAC. <br />SIGNAiUREOFCONiFRCiOROqqUiHORIZEDAOENi �ATE <br />/FPUC�NiS AiVBUSM�NORNOBUSINESSNA ['�e%� <br />MECHANICAI <br />NO. TYPEOFEOUIPN <br />A/C — A/HNDLG UIJITS — H.P. <br />FORCED AIR SYSTEMS— BT.I <br />UNITHEATERS—B.T.0 �1 <br />CLOTHESDRYERS <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATEF <br />WOOD STOVE <br />METAL FIREPLACE 8 CHIMNEY <br />FIREPLACEINSERT <br />HEAT PUMP <br />GAS PIPING <br />E%HAUST FAN <br />SUB 70TAL <br />PERMIT <br />TOTAL FEE <br />VUNCNECRHUN9Eq FEE <br />FEES VALUI <br />BUILDING <br />PlUM81NG <br />MECHANICAL <br />OTHER <br />STA7E BUILDING SURCHARGE <br />STATE ENERGY SURCHARGE <br />PUBLIC WORKS <br />TO7AL <br />FEE <br />JEE <br />� <br />