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Ihe Everpreen <br />GTY OF <br />everett <br />BUILDING DEPARTMENT <br />259�8810 <br />APPLIC�.fION FOR CONSTRI.:.TION <br />PERMIT <br />TO BE COMPLETED IN INK — PLEASE PRINT <br />CIN PIIONE <br />��,�o s_—�,5� _ �S5 % <br />IIP 1'�ION[ <br />AOCHITECTORDESIGNER M�Il�ODO[55 ��t� <br />�•�cu•i� <br />e <br />GENERALCONTP�LTOP MML�ODRE55 GIY DP PIION[ IICCNSE• <br />�L L NT CTOR M�IlA0pPC55 CIIY ZIP 1'110NE IICENSE• <br />..... .__ —_— __." _.. _.. __. __ _ _' . . _ ___—_'._. _.' __._.—__—_ <br />PWIABINOCONTH�LTOR MAl1.ApfdCSS f,I1P ZIP PIIONE lIC[NSE• <br />G1A550FNORN --_— . --_ __ __..___ -- <br />❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR DC170LITION ❑ WOODSTOVE/FPPL INSER7 ❑ BUILDING RELOCATION <br />TEN�NTIMPPOYEMINTOPIMCPIONREMO�EIONIY � LONLCIP[RSON4NDPIIONENO <br />CONiN�CTPRICEOf WOR6: __-I _.. _ ___ --" "_'__"_- ___'__-- - --_--____ <br />lOT1LL.LBIOLN OF _�-�Sj�..I�.I�/-`=/��. <br />rf.L_1-1L- _'� ___ <br />rnaecr/,r^,Op�r.��. � � l. �r'-'' A `� {��IIF'� <br />W <br />PLUMBINO <br />TYPE OF FI%T41�7e on iiern <br />WATER CLOSET � i OI LET1 <br />BATM7UB - - _-_ _ ._ .. <br />d OISP. <br />��UNURYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTA <br />FLOOR DR41N <br />ROOF ORAINS - <br />auv reeovirc _ <br />_ _ " _ .. _. ___. . _ . . ..._ _ —__'____--__' _—_ <br />I I IEHEBY C[RTIFY TIIAT I HAVE READ AND E%AMINED THIS APPLICATION AND <br />NNOVJ TIiE SAME TO BE TRUE AND CORREC7. ALL PROVISIONS OF LAWS ANO <br />-- ORDINANCES GOVERNING THIS TYPE OF WORK WILI BE COMPLETED WITH <br />WHf 7 HER SPECIFlED HEHEIN OR NOT. THE GRANlING OF F PERMIT DOES NOT <br />. PRESUMETOGNEAUTMORITVTOVIOLATEORCANCELiHEPROVI510NSOF <br />�-=J ANYOTIIERSTATEORLOCALLAWREGULATINGCONSTRUCTIONORTHEPER� <br />FORMANCE OF CONSTRUCTION. THAT I AM AUTHORI2ED BV THE OWNER OF <br />1 HIS PROPER7Y TO PERFORM 1HE WORK fOR WHICH APPLICATION IS MADE <br />-- AtJD I COMPLY WI7H TIIE STATE CONiRACTORS lAW 7827 RCW AND <br />29G 2U0 WAC. <br />SiGNAIUfiFOFCONIHeUu1�D11PUI:lORiLL0�G1:Nf OME <br />,Y/ICANISf,II��({,/��( .K)•ryl'tl1151�NC N�� �/ �� <br />MECHANICAL <br />FEE NO. TYPE OF EOUIPMENT <br />A/G - MIINDLG UNIIS -- 11 P <br />PoRC[I)AIRSYS1C�iS-DTU MEA _ <br />. __.. ..._. .. _ <br />UNITIIEAILHS UT.II M _ .. ... <br />CI.O111G5 [7HVLNti . . . � <br />VENLLAIION FAN <br />'_ _'_- ___ -_ . . .flANGEHOUD _ _ --___--__---' <br />-- — -�-��WATERNEATER ��-� -- <br />WOOD STOVE <br />ME1AL FIREPLACF 8 CHIMNEY <br />FIREPLAC[INSEfiT <br />� IIEATPUIdP <br />- — _-� - ---- _ - �- - GAS PIPING � <br />- _'___ '- "_' ___ ____ ___- <br />EXHAUSTFAN <br />"-_ __-_ ___-__ ."-_ _ _" __ ____ <br />_-- _ <br />SUBTOTAL _ __E_ '___'____ ____ _ -_"_ __.._..______'_._'SUBTOTAL'.___$_ -__ <br />PERMIT S _"_'_'PERMIT __"___b ___ <br />-'_'-_._. ___....'__ _--_.. <br />TOTAL FFE S TOTALFEE $ <br />�LIOWABLE/ACLWL <br />❑Y <br />❑ N <br />FIRESPR�NNLERSRWUIREO ❑ YES ❑ NO <br />WLPM SITE <br />❑ Y[5 Ll f!O <br />UUILDING <br />PLUMBING <br />MECHANICAL <br />OTHEF <br />S1ATE BWLDWG SURCHARGE <br />STA1�E EN[RGY SURCIIARGE <br />PUBUC WORKS <br />TOTAL <br />FEE <br />!_ - <br />