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Ihe EverO�een <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />259-8810 <br />. . . . . . "t- _... _.:.a.i` ........ _... <br />APPLIC.+TION FOR CONSTR�CTION <br />PERMIT <br />TO BE COMPLETED IN INK — PLEASE PRINT <br />everett <br />e <br />ARCMITEGTOR�ESIGNER IAAILA�ORESS LIT' 21P PIIONE <br />GENERALLONTPRCTOR MnILR00RE5S CITY 21P f'MONE LICENSE• <br />:i <br />❑ NEW ❑ ADDITION <br />CONTR�CT <br />�p7 BLOCK OF <br />PLUMBIN6 <br />b7:lYl�,`.I <br />SHOWER <br />KITCHEN SINK 8 <br />FLOOR DFAIN <br />BACKFLOW PREV <br />ROOP DRAINS — <br />.iuu mcavir.F— <br />TGTAL <br />qLLOWABLE/ACTUAL <br />sREnc:�yc. <br />FIRE9PPINNLERSPEOUIPE� CI YES ❑ NO <br />❑v <br />❑ N <br />I_I RFPAIR ❑ DEMOLITION ❑'NOO�STOVE/FRPL INSERT ❑ BUILOING RELOCATION <br />r V . <br />5 <br />S <br />FEE <br />�y <br />l[ <br />I H EREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND <br />KNOW 7HE SAME TO BE TRUE AND CORRECT. ALI. PROV�SIQNS OF LAWS AND <br />ORDINA�JCES G�VERNING THIS TYPE OF WORK WILL BE COMPLETED WITH <br />W HETHEfi SPECIFIED HEREIN OR NOT. THE GRANTING OF 0. PERMIT DOES NOT <br />PRF.SUME TO GIVE AUTHORIN TO VIOLATE OR CANCEL TME PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PER� <br />FORMANCE OF CONSTfiUCTION. THAT I AM AUTHORIZED BY THE OWNER OF <br />THIS PROPERNTO PERFORM THE WOfiK FOR WHICH APPLICATION IS MADE <br />AND I COMPLY WITH THE STATE CONTRACTORS LAW 7B.27 RCW AND <br />96.200 WAG. <br />SIGNAiUREOECCWiRAC10ROHhIli110RRE0 GENi OATE <br />/ ' � <br />I / <br />��; � .�;�; ,m� � �� <br />♦FPLLAN Y USINESSLICEN N ANOBUSINESSNRME <br />MECHANICAL <br />NO. TVPE OF EOUIPMF <br />A/G — PJHNDLG UNI i5— H.P <br />� FORCED AIR SYSTEMS— B.T.U. <br />UNITHEATERS—B.T.U. M <br />CLOTHES DRYEFiS <br />VENTILATION FAN <br />WATER HEATER <br />WOOD STOVE <br />METAL FIREPLACE ! <br />FIREPLACEINSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN <br />B TOTAL <br />RM.`-- <br />fAL 1"f'E <br />vnCar+tSirE FEES VALUATION <br />❑ ves u uo <br />- BUILDING <br />NO OF DWELLING UN�TS <br />FLUMBING <br />occ ioao <br />MECHANICAL <br />HEIGIITIIMITATION OTHER <br />STATE BUILDING SURCHARGE <br />STATE ENERGV SURCHARGE <br />PUBLIC WORKS <br />TOTAL <br />FEE <br />FEE <br />T I <br />