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Ihe Ever9rean <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />259-8810 <br />� � <br />APPLICAiION FOR CONSTRVc:TIaN <br />PERMIT <br />TO BE COMPLETED IN INK- PLEASE PRINT <br />ARCNITECTORDESIGNER AIAILAOORE55 CItY 21P PHONE <br />i ur/ L1�n..n <br />7 9 �-«'� <br />evetett <br />� <br />A,cc �io's woRK <br />�?�... ftS,P <br />GENE{iALGONTRACTOR MA0.ADOFESS CITV ZIP PMONE LICENSE• <br />� wAl�,� <br />ME�HANCALCONTRPCTO MAILAODRE55 CItY 21P PMONE LICENSE• <br />PLUMBING WNTPACTOR MAIL4DOPE55 CITV 21P P��ONE LICENSE � <br />I�NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPLINSERT ❑ BUILDING��tLOCATION <br />iFNRNTIMPROVEMENTOFINTERIORR ODELONLV Q� CONTACTP1ER$1ONANpP110NEN0. <br />CAM1�fi1LTVRICEOFWORK �� OOO �� �� I` I��Y l l J ���V� <br />� <br />LO7 BLOCK Of <br />�3 C Z-'9 0� -f� - O,�rb •-000�. <br />515'T <br />PLUMBING <br />WATER CLOSET <br />KITCHEN SINK & DISP. <br />CLOTHES <br />FLOOR DRAIN <br />B�CKFLOW PREVENTERS <br />ROOF DFAINS— RAINLEADERS <br />ci u�r icravirr _ aea crr � <br />SUBTOTAL S <br />PERM1IIT S <br />TOTAL FEE S <br />AGK FEARSEIBACN SIDESETORGN <br />o� �' c' <br />LOTAqEA VA NTSITE <br />—I 75)c�.3ol Y$ ��,0 <br />V — (�.—'J <br />SIZEOFBLDG. NO.OFSTORIES BSMT. OCC.lOAD <br />❑Y <br />2 `/ � � �N —.— <br />NEIGMT LIMITAI <br />FIpESPRINKLERSREOUiRED ❑YES �0 <br />P�nIICPTION PCQ BV PlANSAPPR. BY <br />�-- � �� <br />IHEREBYCERTIFYTHGYiHAVEREAD NDEXAMINEDTHISAPPLICATIONAND <br />KNOWTHESAMETOBETRUEAND RECT.ALLPROVISIONSOFLAWSAND <br />ORDINF,NCES GOVERNING THIS TYPE OF WORK WILL BE COMPLETED WITH <br />W HETHcR SPECIFIED HERCI N OR NOT. THE GRANTING OFA PERMIT DOES NOT <br />PRESUME TO GIVE AUTHORIN TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANV O�fHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR TH E PER� <br />FORMA1iCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE OWNER OF <br />THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE <br />AND I COMPLY WITH THE STATE CONTRAI:TORS LAW 18.27 RCW AND <br />296200 WAC. <br />SIGNATUREOFCONTRACTOP0.�4UTHORiZEDRGENT OATE <br />X '� • <br />�� 3��_ /T�9 <br />APPL� CITV B� L� E NO AND BUSINESS NAME <br />MECHANICAL <br />NO. TYPE OF EOUIPMENT FEE <br />� A/C—A/HNDLGUNITS—H.P. <br />^ FORCED AIR SYSTEMS— B.T.U. M EA <br />^ UNITHEATERS—BT.U. M <br />� CLOTHES ORYERS <br />— VENTILATION FAN � <br />� RANGEHOOD <br />WATER HEATER <br />— WOOD STOVE <br />METAL FIREPLACE & CHIMNEY <br />FIREPLAGEINSERT <br />HEAT PUMP <br />GAS PIPING <br />E%HAUSTFAN <br />� <br />PLAN LNE K NUMBEfl <br />2� <br />FEES <br />SUB TOTAL <br />PERMIT <br />TOTAL FE[ <br />FEE O <br />���ll -- <br />YALUATION <br />BUILDING R 1,a� J <br />PLUMBING <br />MECHANICAL <br />OTHER <br />STATE BUILDING SURCHAFGE <br />STATE ENERGY SURCHARGE <br />PUBLIC WORKS <br />roru <br />S I c.�l I ` <br />'�ECEIPT N0. <br />l�l �� <br />FEE <br />5 C� <br />1 <br />tr � <br />