Laserfiche WebLink
f�e Everpreen <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />259•8810 <br />c-�- � <br />APPLIC�TION FOR CONSTR�CTION <br />PERMIT <br />TO BE �PLE7ED IN INK -- PLEASE PRINT <br />AflCHITECTOflDES10NEfl MRILAO�RESS CIiY ZIP PMONE <br />� � f�173� <br />-� � P�1 <br />everett <br />e <br />❑ NEW ❑ ADOITION <br />LOT <br />OF WOHK <br />BLOCN OF <br />' JI �-� <br />PLUMBIN6 <br />FIPE <br />IYi��I <br />CLOSET <br />KITCHEN SINKB <br />URINAL <br />ORINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />ROOF L�RAINS— RAINLEADERS <br />SUBTOTAL <br />PERMIT <br />TOTALFEE <br />YES ❑ NO <br />❑Y <br />❑ N <br />❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL INSERT ❑ BUIL�ING RELOCATION <br />❑ YES ❑ NO <br />1 HEREBY CERTIFV THAT I HAVE READ AND EXAMINED THIS APPLICATION AND <br />KNOW THE SAME TO BE TRUE AND CORRECT. ALL PFOVISIONS OF LAWS AND <br />OHDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLETED WITH <br />W HETHER SPECIFIED HEREIN OR NOT. THE GRANTING OFA PERMIT �OES NOT <br />PFESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PER• <br />FORMAf�CE OF CONSTRUCiION. THAT I AM AUTHORIZED BV THE OWNER OF <br />THIS PROPERTYTO PERFORM THE WORK FOR WHICHAPPLICATION IS MADE <br />AND I COMPLY WITH THE STATE CONTRACTORS LAW 1027 RCW AND <br />296200 WAC. <br />SIGNATUPEOFCONiRaGTOROFAl1iN0 ZEDnGENT DATE � <br />� . �� a <br />AP ANTSLITVBUS ES LICEN ANDBUSINESSNAME <br />MECHANICAL <br />TYPE OF EOUIPh <br />— A/HNDLG UNITS — H.P. <br />ICED AIR SYSTEMS — B.T. <br />i HEATERS— B.T.U. M <br />VENTILATION I <br />RANGEHOOD <br />METAL FIREPL <br />FIFEPLACEIN <br />HEAT PUMP <br />GAS PIPING <br />EXHAUST FAN <br />FEES <br />BU!LDING <br />PLUMBING <br />MECHANICAL <br />OTHER <br />STATE BUILDIN(i SURCHARGE <br />STATE ENERGY SURCHARGE <br />PUBLIC WOflKS <br />TOTAL <br />EA <br />$ <br />S <br />8 <br />FEE <br />FEE <br />0 <br />