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� <br />the Everyreen <br />CITV OF <br />� everett <br />� BUILDING DEPARTMENT <br />258•8810 <br />�;L ,��. <br />APPLIC�f10N FOR CONSTR�►i TION <br />PERMIT <br />everett <br />e <br />�k aS�-��14�/ <br />TO BE COMPLETED IN INK— PLEASE PRINT <br />LJ W N C� � �y Z p PHONE 4CENSE <br />OEYERALCONTR�GTOR MAIL�OORE55 <br />ME� �NIC�LCONTR�GTOR M�I��DORE55 CIIV 21P PNONE LIGENSE• <br />Pll1M&NOCONTN� iOF � MAIL�ODRESS CIIY 21P PMONE LIGENSE• <br />o�..w... ..�...,�.,/ <br />❑ NEW },�1 ADD�TION ❑ ALTERATION ❑ HEPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL INSERT BUiLDING RELOCATION <br />PRICE OF WORIE <br />�pTYl� BLDGK OF <br />v m, r <br />IJEGT ADDPESS <br />PLUMBINO <br />i0. TYPE� <br />WATER CLOSET <br />BATHTUB <br />LAVATORY (WA9 <br />9HOWER <br />KITCHEN 91NK � <br />DRINKINO FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENI <br />ROOF DRAINS— RA�I <br />SINK ISERVICE — BAI <br />SUBTOTAL § <br />PERMIT s <br />TOTAL FEE s <br />fI8AC1t RE�RSETBGCk SIpE51 <br />� �� <br />p LOT�HFA VAGAN' <br />> ❑ YES <br />:ANST. OCCUPANCYGFOUP NO-0P <br />�«,��T�.� R- 3 <br />ILDO. NO.OFSLORIES BSMi. OCCU <br />zIW S. � ( n r <br />I�EiGH' <br />iNBLERSREOUIRED ❑YE9 (yN0 <br />�� <br />FEE <br />I HEREBV CER7IFY TMAT I HnV'_ READ ANO E%AMINED THIS APPLICATION AND <br />KNOW THE SAME TO BE TRI'c AND CORRECT. AlL PROVISIONS OF LAWS AND <br />ORDINANCES GOVERNING 7NIS TYPE OF WORK WILL BE COMPLETED WITN <br />WHETMER SPECII'IED f/EREIN OR NOT. TFIE GRANTINOOFA PERMIT DOES NOT <br />PRESUME TO GIVE AUTHORIN TO VIOLATE OR CANCEI THE PROVISIONS OF <br />ANY OThiER STAiE OR LOCAL lAW REGULATING CONSTRUCTION OR iHE PER� <br />FORMANCE OF CONSiRUC710N. THAT I AM AUTHORIZED BY THE OWNER OF <br />THIS PHOPERTV TO FERfORM iHE WORK FOR WHICH APPLICATION IS MADE <br />AND 1 CO�APLY WITH TNE SiATE CONTRACTORS LAW iB27 RCW AND <br />zas zoo wnc. /�j/ / 1 /�p <br />s�cr+amncorcor+�nnciononnun�omzeoncer+t onrE lso <br />�`1C��-____ t�� •���� <br />♦PPLiG�NISCIIY�USiNESSULENSENO�NDBU ESSNIME <br />MECHANICAL <br />A/C— A/NNDLG UNIis <br />FORCEO AIR SVSiEMS <br />UNIT HEATEFS— B.T.U. <br />CLOTHES DRYERS <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />WOOD STOVE <br />METAL FIREPLACE 8 CI <br />FIREPLACEINSERT <br />GAS PIPING <br />E%HAUSTFAN <br />sui�oiNc <br />ILLING UHItS <br />'Z PLUMBING <br />MECHANICAL <br />iunon O7HER <br />STATE BUILDING SURCHARGE <br />STATE ENERGV SURCHARGE <br />PUBLIC WORKS <br />TOTAL <br />— H.P. <br />— B.T.U. <br />FEE <br />S <br />1 <br />FEE <br />