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the Everyreen <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />259-8810 <br />,' <br />APPLIC�.f10N FOR CONSTR�:::TION <br />PERMIT <br />TO BE COMPLETED IN INK -- PLEASE PRINT <br />. �, '. �. �. S�� .�� <br />evere�l <br />e <br />ApCHITECTOR�E5IGNEN MnILA��RESS CIIY 21P P110NE <br />GENERALCONTR�CTOR MnILADONESS CITY ZIP PHONE LILENSE• <br />MECM�NIC�LCONTH�GTOR MqLA0URE5S CItY 21P PMONE LICENSE• <br />PLUMBINOGONTP�GTOR M�I�RDDRESS CITY ZIP PNONE LIGENSE� <br />NFW ❑ ADDITION ❑ ALTERATION ❑ PEPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL INSERT ❑ BUILDING RELOCATION <br />CANTfl�CTPPICEOFWOPk Cf_� aDG D� <br />DEuGNI6E WORK �NO SOUARE FOOT�GE INVOLV D <br />I,.,[ 1 <br />N��.l �O/2C//'� !dH <br />PROPOSED USE OF BUILDINO <br />S� . � <br />LE6�1. DESCP O 1 O ROPER ISMOWN B OF � FCM FOl R <br />l0T BIOLK OF <br />PLUMBING <br />NO. 7 <br />WATER CL <br />BATHTUB <br />LAVATORY <br />SHOWER <br />KITCHEN : <br />DISHWA51 <br />LAUNDRY <br />�JS� ,S� <br />OF FI%TURE OH ITE <br />f (TOILE� <br />iH BASIN) <br />8 DISP. <br />FLOOR DRAIN <br />BACKFLOW PREVEN <br />NOOF DRAINS— RAI <br />ALLOWA6LE/�CTU�L <br />FEE <br />SUBTOTAL S <br />PERMIT S _ <br />TOTAL FEE S <br />iSETBnCN SIOESETB/•CN <br />�qEq VACRNTSITE <br />❑ YES ❑ ��� <br />UPANCYGROUP NOOFOWEILII <br />JF STOPIES BSMT. OGC LOAD <br />❑v <br />� N <br />REOUIRED ❑ YES <br />I HEFiEBY CERTIFY THAT I HAVE READ AND EaAMINED THIS APPLICATION AND <br />KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAN'S AND <br />ORDINANCES GOVERNING THIS NPE OF WORK WILL BE COMPLETED'NITH <br />W HETHER SPECIFIED HEREIN OR NOT. THE GRANTING OFA PERMITDOES NOT <br />PRESUME TO GIVE AUTHORITV TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW REGULATING CON5T9UCTION OR THE PER• <br />FORMANCE OF CONSTRUCTION. THAT I AM AUTHORI2ED BV THE OWNER OF <br />THIS PROPERTV TU PERFORM THE WOFiK FOR WHICH APPLICATION IS MADE <br />AND 1 COMPLY WITH THE STATE CONTRACTORS LAW 7827 RCW AND <br />296200 WAC. <br />SIGNATUREOFCONTRA ORONRIiTHOflIZEURGENT DRTE <br />X �� - �_ <br />/f'PLIGFNTS ITYBUSINESSIICEN PND9 SINESSNAME <br />MECHANICAL <br />NO. <br />A/C — A/HNDIG UNITS — <br />FORCED AIR SYSTEMS— <br />UNIT HEATERS— B.T.U. <br />CLOTHES DRYERS <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />8 <br />HEAT V'UMP <br />GAS PIPING <br />EXHAUSTFAN <br />TOTAL <br />FEES <br />BUILDINCa <br />PLUMBING <br />MECHANICAL <br />OTHER <br />STATE BUILDING SURCHARGE <br />STATE ENERGY SURCHARGE <br />PUBIIC WORKS <br />TOTAL <br />M EA <br />5 <br />FEE <br />