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,.. <br />' pppLlC�-r`'ION FOR CONSTR ` TION <br />F�ERMIT <br />tne Everyrean everelt <br />GTVOF � <br />everett <br />BUILDING DEPARTMENT <br />259-8810 TO BE COMPLETED IN INK— PLEASE PRINT <br />OWNEN <br />MNL�DOPEGS GILY 21P PNONE <br />Gta-o s 3�x-� <br />TENMIT <br />MML�DORE55 GLY 21P PMONE <br />6qOMITEGTORDESIGNEN M�IL�DOPE55 CIiY ZIP FNONE <br />Ml CONTPACTOR �� S � � `�� <br />jclCv (��ti�" � <br />vnurvc ./ •,� <br />�P7S-Ufa� /�"/GlJ�%X'/z//"� <br />PLUMBINOCONTHACTOR <br />MML��DRE55 GI1V IIP PIIONE LICENSE• <br />CLA4H of v.vnn <br />❑ NEW ❑ ADDITION ❑ ALTERATION N� REPAIR ❑ DEMOLITIO ; r❑.rWOODONOND,PI oHE oSERT ❑ 9UI�DiNG RELOCA7�ON <br />lOT BLOGK OF <br />TiOJECT RDUAE55 <br />/mDf ir6l�O��� <br />PLUMBINO <br />NO. TYPE OF FI%7URE OR <br />WATER CLOSET�TOILET) <br />BATHTUB <br />LAVATORY �WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISP. <br />DISMWRSHEF <br />LAUNDRVTRAV <br />CLOiHE9 WASHER <br />URINAL <br />DP�NKIN6 FOUNTAIN <br />FLOOR DRAIN <br />5UB <br />❑v <br />oN <br />VES ❑ NO <br />o ves ❑ r+o <br />I HEREBY CERTIFY THAT I HAVE READ AND E%AMINEO THIS APPLICATION AND <br />KNOW?HES�METOBETRUEANDCCRRECT.ALIPROVISIONSOFLAWSAND <br />ORDINANCES (iOVERNING THIS NPE OF WORK WILL BE COMPLETED WITH <br />PR SUME SO GIVE AUTHORIN O V�IOLA E60R CANCEI THE PROV SI�ONS OF <br />ANY OTIIER STA7E OR LOCAL LP'N REGULATING CONSTRUCTION OP THE PER• <br />FORMANCE OF CONSiRUC710N. THAT 1 AM AUTHOqIZE� BY THE OWNER OF <br />ililS PROPER7Y TO PEFFORM THE WORK FOR W HICH APPLICATION IS MADE <br />AND 1 COMPLV WITH THE STATE CONTRACTORS LAW 1827 RCW AND <br />296.200 WAC, 2!P'�/ � <br />$IGNRIUREO(CONIM/9���OROIIp� �OI112EDAOENi U�tE 7� � o� <br />✓� / I/I I !/1/VI.. ./��C��A�iL/ <br />MECNANICAL <br />NO. <br />A/C— WHN[ <br />FORCED AIR <br />UNIT HEATEI <br />CLOTHES DI <br />VENTILATIOI <br />RANGE NOC <br />WATER HEAI <br />WOOD 5T0� <br />METAL FIFE <br />FIREPLACE <br />HEAT PUMP <br />GAS PIPING <br />i UNITS — H.P. <br />'STEMS— B.T. <br />— 67.U. M <br />FAN <br />PLACE 6 <br />INSERi <br />BIIILDING <br />PLUMBING <br />MECHANICAL <br />OTHER <br />STATE BUILDING SURCH�RG[ <br />STATEENERGYSURCHAFGE <br />PUBLIC VJORKS <br />TOTAI <br />FEE <br />FEE <br />II <br />