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q <br />APPLIC�f10N FOR CONSTRU�TION <br />PERMIT <br />th� E�+roro. .� <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />269-8810 TO BE COMPLETED IN INK— PLEASE PRINT <br />OWHEfl � M�IL�OOflE55 GIIY Z�P vNONE <br />S'T � ,�,�.T�/�LL So Zs /�J£�.y..�-�T.v <br />IEN�NT M�IL1100RE35 CIIY ZIP PHOIlE <br />everett <br />e <br />ARCNITEGTORDE910NER M�iL�00RE55 d1Y 21P P��ONE <br />%� �� /�,a,: O � �n r6-� //�//L%l %�� N£_ 1�.! r'T,..�� _�JIo9s�! .CT.f7A'Ld <br />MECN�NICQCONIR/�CTOR M�RnpDRE55 Crtv Z�P {+IIONE IiCENSE• <br />�/Ai� -SL'%Z?.Z /56/7 �/i�T,,� cX RA .�/Yo/i%.arr � -r'eTto�w2eit�E <br />� PLUMB�NOCONIMGTOH M�IL�UDPE55 CIiY 21P PIIONE LICENSE• <br />C� NEW � ADDITION ❑ ALTERATION ❑ REPA�R ❑ OEMOLITION ❑ WOODSTOVE/FRPLINSERT ❑ BUILDINGRELOCATION <br />CONTMGT Pf110E OF <br />LOT BLOCIt OF <br />PLUMBINO <br />No. f— <br />�:raa�� <br />FLOOR DRAIN <br />BACKFIOW PREVENTERS <br />ROOF ORAINS — HAINLEADERS <br />SINKISEqVICE— BAR. ETC.1 <br />SUB TOTAL <br />FIRE9PRINNlER9RE0UIRED ❑YES ❑NO <br />❑N <br />S <br />a <br />E <br />I.1li+�.R[q <br />I HEREBV CER7IFY THAT I HAVE REAO AND E1(AMINED THIS APPLICATION ANO <br />KNOW THE SAME TO BE TRUF AND CORRECT. ALL PROVISION9 OF LAWS AND <br />ORDINANCES GOVERNING THIS TVPE OF WORK WILL BE COMP�ETED WI7H <br />WHETHER SPECIFIED HEREIN OR NOT. THE GRANTINOOFA PERMITDOES NOT <br />PRESUME TO GIVE AVTMORI7V TO VIOIATE OR CANCEL THE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PER� <br />FORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BV THE OWNER OF <br />THIS PROPERiV TO PERFORM THE WORK FOR WHICH APPLICATION IS MRDE <br />AND I COMPIY WITH THE STATE CONTRACTORS LAW 1827 RCW AND <br />296200 WAQ <br />516N�tUNEOfGONIR�CtORORAN11011RE011GENt pRE /� - //)l+„ <br />;� s 7 <br />♦PPII BUS FS�SLR, NSCNO.�NDBUSI�AM`VE�_ <br />MECHANICAL <br />— A/HNDLO UNI7S — H.P. <br />ICED AIR SVSIEMS — flT � <br />1TION FAN <br />HOOD <br />HEAT PUMP <br />GAS PIPING <br />E%HAUSTFAN <br />BUILDINO <br />PLUMBING <br />MECHANICAL <br />OTHER <br />STATE BUILDING SUFiCHARGE <br />STATE ENERGV SURCHARGE <br />PUBLIC WORKS <br />TOTAL <br />SUB TOTAI 5 <br />PERMIT E <br />TOTAL FEE 5 <br />,.. -.�.�� .:... .•,... _ _ .._-, .._._..._.. .._.._ <br />0 <br />FEE <br />