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M� Ev�rpnm <br />CITY OF <br />everett <br />BUILDiNO DEPARTMENT <br />258-8810 <br />� ��� � ,�: , <br />APPLICATION FOR CONSTRU��ION <br />PERMIT ' <br />TO BE COMPLETED IN INK — PLEASE PRINT <br />51� <br />everett <br />e <br />v�` � W ViLI.� l.C(l�o IL�� E`i�T,NR,� i�% �' eGUiNGL� (�CILIJ� Pc../r I��lV �`{' � �_ <br />MCNRECTORDEBqNER IM�L�O�RESS CIIY 21F PNONE <br />OENEMLCONTR�CTOR MMlA0DFE55 CITY ZI^ PHONE LICEN9E• <br />❑ NEW ❑ ADDITION <br />� BLOCN OF <br />a <br />❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVEIFRPL INSERT ❑ BUILDINO RELOCATION <br />� SUBTOTAL S <br />PERMIT S <br />TOTAL FEE S <br />FIqNTbETd1GK RFAR8ETB�CK SIDESETB�GN <br />WE20NE LOTMEA V�C�NTSITE <br />❑ YES O NO <br />ryPEOFCAN9L OCCUPANCYp{IpUP NO.OFDWELLII <br />ILLLOW�aLEMCN�I <br />SREOFBlO(L NO.OFBTORIE9 B9MI. OCGlOAD <br />❑r <br />O N <br />HE�OHT IIMIT�t <br />RRE9PRINNLEHSPEOUIIiEU �YE9 ONO <br />APPLICATIONACGBT PLANS�PP0.9Y <br />�/l� �� l <br />1 HEREBV CERTIFV THAT I HAVE FEAD AND E7fAMINED THI9 APPIICATON AND <br />KNOW TME 9AME TO BE TRUE AND CARRECT. AlL PHOH1910N90F IA4V8 AND <br />ORDINANCE3 OOVERNINO THIS TYPE OF WORK WILL BE COMPLEIEO WITN <br />WHEfHER SPECIFIED HEREIN OR NOT.TNE6RANTIN(30FAPEfiMITDOEB NOT <br />PRESUME TO �IVE AUTHORITV TO VIOLA7E OR CANCEL THE PROVI810NB OF <br />ANY OTHER STATE OR LOCAL LAW REODUTINO CONSTRUCTION ORTME PEM1 <br />FORMANCE OF CONBTRUCTION. THAT I AM AUTHORIZED BV THE OWNER OF <br />THIS PROPERTYTO PERFORM THE WORK FOR WHICH APPLICATION 19 MADE <br />ANO I COMPLV WITH THE $TATE CONTRACTOR8 lMM 1E27 Rf,1N ANO <br />2B8.2W WAC. <br />SIQNQ REOFCONTRACTORORAUfHp112E0 ENT D�TE �� <br />IIPPLICAMDGiYlU9 L E• . OBU91NE881UME . <br />MECHANIGL <br />RANOE <br />WATER <br />WOOD <br />METAL <br />HEAT PUMP <br />OA9 PIPIN� <br />EXHAl1ST FAN <br />BUILUINd <br />Fi.UMBiNG <br />MECHANICAL <br />OTHER <br />STATE BUILOINO SURCNARaE <br />STATE ENERQY SURCHAROE <br />PUBLIC WORKS <br />TOTAL <br />M <br />FEE <br />M EA <br />