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� � <br />APPLICAi ION FOR CONSTRI►.:TION <br />PERMIT <br />Ihe Everp�een ��p�e�� <br />CITY OF � <br />everett <br />BUILDING DEPARTMENT <br />259•8810 TO BE COMPLETED IN INK — PLEASE PRINT <br />OWNEF MAILADOPE55 GITV ZIP PNONE <br />"-u <br />MRILAODRESS CITY ZIP PMONE <br />/�2�i�.✓s /�vi� .s�cFs' ��� 9' �G�rr�r �y �vc�c--r l yz - �/%.s D <br />.__...___'__.,.........�.. .uu nnnoocc Crtv ZIP PMONC <br />GENERAIGONTRPCTOR MAILADDRE55 CITY 21P PMONE LICENSE+ <br />❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSiOVE/fRPL INSERT ❑ Bl11LDING FELOCATION <br />PRICEOF WORK � J . //�'� <br />LOT BLOCK OF <br />lJClrl PVUI�CJJ <br />�� 9 � �����-- a�� <br />PLUMBING <br />i0. TYPEOFFIXTUREORITEh <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINKB DISP. _ <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />ROOF DRAINS — RAINLEADERS <br />SUBTOTAL S <br />PERMIT 5 <br />TOTALFEE 5 <br />_�o,. � �.,.,..,��..,.,... ,_"'._.. <br />£°j.? S .� � <br />C _' SkQf qEq,' � � VACFNTSITI <br />G!`��� ❑ ves ,L <br />JC> <br />ALLOWABLE/ACTUAL <br />❑v <br />❑ N <br />ERSREOUIRED ❑ YES ❑ NO I �� � <br />� <br />FEE <br />I HEREBY GERTIFYTHAT I HAVE READ AND EXAMINED THIS APPLICATION AND <br />KNOW ?HE S�ME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS AN D <br />ORDINANCES GOVERNING THIS NPE O� WORK WILL BE COMPLETED WITH <br />W HETHER SPECIFIED HEREIN OR NOT. THE GRANTING OFA PERMIT DOES NOT <br />PRESU ME TO GIVE AUTHORI7Y TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTH ER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PER- <br />FORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BV THE OWNER OF <br />THIS PROPERN TO PERFORM THE WORK FOR W HICH APPLICATION IS MADE <br />AND 1 GOMPLY WITH THE STATE CONTRACTORS LAW 18.27 RCW AND <br />296.200 WAC. <br />StGNFTUREOFCONTRAGiOPOFAUTNORI2EDPGENT DA7E�` –�0�� <br />��G���` <br />MECHANICAL <br />TYPE OF EOUIPMENT <br />DLG UNITS— H.P. <br />i SYS7EMS— B.T.U. M EA <br />UNIT HEATERS— 8 <br />CLOTHESDRYERS <br />VENTILATION FAN <br />WATER NEATER <br />WOOD STOVE <br />8 CHIMNEV <br />FIREPLACE I <br />HEAT PUMP <br />GAS PIPING <br />SUBTOTAL <br />PERNIT <br />8;� (va� <br />FEES <br />BUILDINCa <br />PLUMBING <br />MECHANICAL <br />OTHER <br />STATE BUILDING SURCHARGE <br />STATE ENEFiGY SURCHARGE <br />PUBLIC WOFiKS <br />TOTAL <br />5 <br />ree <br />0 <br />� <br />