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t�e Everyreen <br />CITY OF <br />e��erett <br />BUILDING DEPARTMENT <br />259•8810 <br />� <br />t.... , <br />APPLIC�ION FOR CONSTR `� 710�1 <br />PERMIT <br />TO BE COMPLETED IN INK— PLEASE PRINT <br />7� Pa <br />�� <br />everett <br />� <br />G53���'�i � <br />�RCHITECTORDESIGNER MOILAODRE55 CITY ZIP PMONE <br />OENEMLCONTBACfON MA�LADOPESS GITY ZIP PHONE LICENSE• <br />�` �. �.�-<— M�u�� �Ra �'r Z. <br />PLUMBINOCG:`TRACTOE MAILpD�RESS G17Y ZIP PHONE 4GENSE♦ <br />K <br />❑ AODITIDN ❑ ALTERATION ❑ flEPA1R ❑ DEMOLITION ❑ WOCDSTOVE/FRPLINSERT ❑ BUIL�INGRELOCATION <br />J <br />LOT_`3— BLOGK OF <br />S f� <br />rna� ECTAC�RES <br />.: PLUMBINO <br />NO. <br />WAfI <br />BATt <br />LAVA <br />�'9H0 <br />� KITC <br />DISF <br />. � eni <br />l�o� � a9- �1� <br />�i5o <br />PREVENTEflS <br />JS — RAI NLEp <br />��� <br />172F1 �P I <br />s�z 6Aa.9G�3 <br />FIRESPRINNLERSFEOUINED ❑YES <br />)TAL S <br />i $ <br />FEE $ <br />.K sioeseren <br />/ 5 <br />_ \ VACANTSITI <br />7�.�� ❑ YE9 � <br />T� <br />3POUP NO.OFDWE <br />ES BSMi. OCGIORD <br />ar <br />I HEREBY CERTIFY THAT I HAVE READ AND ExAMINED THIS APPLICATION AND <br />KNOW THE SAME TO BE TRUE AND CORREGT. ALL PROVISIONS OF LAWS AND <br />ORDINANCES GOVERNING ' HIS TYPE OF WORK W ILL BE COMPLETED W ITH <br />WHE7HER SPECIFIED H EREI4.OR NOT.THE GRANTING OFA PERM�TDOES NOT <br />PRESl1ME TO GIVE AUTHORIN TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHER S7ATE OR LOCAL LAW REGULA7ING CONSTRUCTION OR TNE PER- <br />FORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE C1W NER OF <br />THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS Mf.DE <br />AND I COMPLY WI7H THE STATE CONTRACTORS LAW 1827 RCW AND <br />296.200 WAC. <br />SIGNRTUHEOFGONTqRC70RORAUTHOtiREOAGENT DATE <br />p� YTS G/�INE��NSDE NO. AND BUSINESS N�/�/� � <br />i <br />MECHANICAL <br />NU. TYPEOFE�UIPMENT <br />A!C — A/HNDLG UNITS — H.P. <br />FORCED AIR SYSTEMS— &T.U. M EA <br />UNITHEATERS—&T.U. M <br />�- CLO7HESDRYERS <br />� VENTILATION FAN <br />Z RANGEHOOD <br />WATER HEATER <br />WOOD STOVE <br />METAL FIREPLACE 8 CHIMNEY <br />FIREPLACEINSEFT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN <br />BUILDING <br />,I,INO UNITS <br />"L PLUMBING <br />MECHANICAL <br />fNTION OTHER <br />STATE BUILDINC' SURCHARGE <br />5?ATcENERGYSURCHARGE <br />PUBLIC WORKS <br />TOTAL <br />,.�_ ,,. ,.;_ .,:. . � ,.,..r._.:, ..- :i... ..,...,.,.;: �., �''- <br />)TAL $ <br />i g <br />FEE $ <br />y� flECEIPf�� � <br />n i -��i <br />��� <br />ALUATION FEE <br />(, (o 08 <br />! /'� .— <br />