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� APPLIC `' ION FOR CONSTR�TION <br />PERMIT <br />fn. ev.rprsen <br />CITV OF <br />everett <br />BUILDING DEPARTMENT <br />259•8810 <br />TO BE COMPLETED IN INK— PLEASE PRINT <br />� everetl <br />e <br />�� Q <br />/JiCHREf,TORDESIpNEF M�IL�DDRE59 CIIY 2iP PHONE I <br />vcncnuwn�nn���� � ................... �... __ .._.._ <br />Ur�. n � <br />MECNAHIG4GONTPACTOR MAIL�OpRE55 CI1Y 2iP PMONE LIGENSE• <br />RUMBIN�COHTMCTOR M�IL�O�RE55 GIIY LP VMONE LIGENSE• <br />❑ NEW � ADDITION ❑ �LTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOOOSTOVFjFRPL INSERT ❑ BUIL�ING RELOCATION <br />1ENIJ/T IMPROVEMENT OR INTEPIOR REMO�L OHLV h fANUCT PERSON �NO PNONE Np. <br />CONTN/�CTPPICEOFWOHKp�wC�liu9fD0~ V��• ���l.n'� ��[l�Sd/1 / ���dC <br />DEB�RIBEM/ORK�NPSOUANEFOOTAOEIHVOIVED f�F �VSO E�c/f �NS �7 IO �� <br />���cuTlni.,�_.�..•n.l_�O_.,IL �....1iJ. <br />LOT� BIOCN�,L,jj_ OF . <br />�. � .f� _ <br />CLUM�INO <br />OR ITEM <br />WATEp Cl <br />BATHTUB <br />LAUNDRVTRRY <br />CLOTMES WASHER <br />BACKFLOW PREV�NTER9 <br />ROOF DRAIN3 — RAINLEADEPS <br />SINK ISERVICF — ARR. FTC 1 <br />SUB <br />Z S3 <br />FIREBPRINNLENSREOUIRED ❑YES XLNO <br />�3M <br />�b N <br />❑ YES <br />� <br />I HEREBY CERTIFY THAT I HAVE READ AND E%AMINED THIS APPLICATION AND <br />KNOW 7HE SAME TO BE TRUE AND CORRECT. ALl PRO� ISIONS OF LAWS ANC <br />OR�INANCES GOVERNING THIS TVPE OF WORK WILL BE COMPLEiEO WITH <br />W H ETHER SP ECI FI E D N EREI N OR NOT. THE GRANTI NG OF A PERMIT DOES NOT <br />PRESUME TO GIVE AUTHOfiITY TO VIOLA7E OR CANCEL THE PqOVISIONS OF <br />ANY O7HER STATE OR LOCAL LAW REGULATINCa CONSTRUCT�ON OR THE PER• <br />FORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BV THE OWNER OF <br />7HIS PROPERTV TO PERFORM Th�E WORK FOR WHICH APPLICATION 13 MADE <br />AND I COMPLV WITH THE STATE CONiRACTORS LAW 1827 HCW AND <br />296.200 WAC. <br />SIONA!UNEOFCONI(UCIOROf1AUl110R2E0�GEHT D�TE`� /�/ �I(] <br />�j / J 4 � <br />X�g.,M,_�.,_ ' Jl� /��I. //-,,r <br />• � nNiSptYB�5iNE55LiC�ElB IIO�N BUSMESSN�ME <br />MECMIINICAL <br />FORCED AIF SYSTEMS— flT <br />UNIT HEATEFiS— B.T.U. M <br />CLOTHESDRVERS <br />VENTILATION FAN <br />RANGEHOOD <br />MEiAL FIFEPLACE 8 CHIMNEV <br />FIREPLACEINSERT <br />HEAT PUMP <br />FAN <br />FEES <br />BUILDING <br />PLUMBING <br />MECMANICAL <br />OTHEF <br />STATE BU�LDING SURCHARGE <br />STAiE ENERGV SURCHARGE <br />PUBLIC WORHS <br />TOTAL <br />SU870TAL <br />PERMIT <br />M <br />� / (['e <br />VALUATION <br />