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APPLICa �ION FOR CONSTRI..:TION <br />PERMIT <br />fhe Everyroen <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />? 9 fi�`l ; <br />IN INK— PLEASE PRINT <br />everett <br />� <br />MCHITECTOHDE910NER M�iL��ORE55 LITv ,, 21P • PMONE <br />�,,_d�Y������;r�, ��a��.�' �. �� .� h�„ 9�.�.�3 C2C�-yad� <br />�ENEH�ICONT LTOR M�IlA0DPE55 CIiY ZIP PHONE IICENSE• <br />� �.� �c�v a�°73 _n�A <br />MEGMAYICALGONTP�CTOP M�IIA�ORE55 CItY ZIP PIIONE IICENSE• <br />PIUMBINOCONTPAGtOR MAllA0DRE55 GIIY 21P PNONE IIGENSE• <br />QA490FWONK�/ D�[K <br />❑ NEW IQ' �DOITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOOOSiOVE/FRPL �NSERT ❑ BUIl01NG RELOCATION <br />LOT� BLOGN__ OF <br />� f���, o I �'F-��r� <br />.�f,�ti � <br />57�2 �A <br />PRPIECT�OU / <br />b,� � s • eP 1 <br />PLUMBINO <br />LAU�DFY <br />DRAINS— <br />►�� 1 <br />TYPE OF CANST. OCCI <br />euow.e��•c*w ,� <br />91ZE Oi BLD6 NO ( <br />3�Co S� <br />fIPE9VRINNLEH9PE0UIPEU ❑YE9 <br />APPIICRION AGC BY P��� <br />1 � I <br />� ' e <br />4. c T Q� <br />Y5a <br />�1- n. ,��; �:,��.r _ <br />� �t.. ��i', <br />r--' <br />� <br />H,5d-%�d 3 <br />Ll-Di� ,�?41�I1'.�iP 3S5^�57� <br />I HEREBY CERTIFY THAT I HFVF. READ AND E%AMINED THIS APPLICATION ANU <br />KNOW THE FFME TU BE TFUE ANO CORRECT. ALL PflOVI510N8 OF LAW9 AND <br />ORDINANCES GOVERNING THIS NPE OF WORK WILI BE COMPLETEO WITH <br />WHETMER SPECIFIED HEREINOR NOT. THE GRANTING OFA PERMITDOES NOT <br />PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION9 OF <br />ANV OTHER S7ATE OR LOCAL LAW REGULATINO CONSTRUCTION OR THE PER• <br />FORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY !HE OWNER OF <br />TMIS PROPER7Y TO PERFORM THE WORK FOfi W NICH APPLICATION IS MADE <br />AND I COMPLV WITH THE STATE CONTFiPCTORS �AW IB27 RCW AND <br />296 :JO WAC. <br />SIGN�TUFEOFCONIR�CIORON�UINOFIEEO�GEN7 DATE oyv���/�� <br />"I,c�.m-,l: ,� �',nia�c . .i <br />X �'CJKb zi�x''• �ti� k'o•d,D-Yt a4�n.+q. <br />�PPLIG�NT9 CIIY OIISINE55 LIGENSE NO �ND BUSINE55 N�ME <br />MECNANICAL <br />FEE NO. TVPE <br />A/C — A/HNDI.G L <br />FORCED AIR SYS' <br />UNIT IIEATERS— <br />CIOTHES DRVER <br />FEE a <br />;K 910ESEi9;CN <br />3� � <br />V�CANfST <br />❑ YES �NO <br />ONOl1P NOUF�WELLiI <br />IES OS�T OGL LOAO� <br />nr � <br />Yr� <br />4L FIREPLACE 8 <br />PLACEINSEFT <br />f PUMP <br />PIPING <br />aa <br />Bl11LDING <br />IS— BT.U. <br />U. M <br />PLUMBIN(i <br />MECHANICAL <br />OTHER <br />SiATE BUILDING SURCHARGE <br />STATEENERGYSURCHARGE <br />PUBLIC WORKS <br />TOTAL <br />FEE <br />FEE <br />