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`- �►PPLICATIORI I-JR <br />`".E".,°,"° CONSTR�3CTION <br />cin oF , <br />everett PERMIT <br />evaen <br />� <br />TO BE COMPLETED IN BLACK INK— PLEASE PRINT <br />BUILDING DEPT. <br />259-8745 ❑ COMB�NATION ❑ BUILDING ❑ MECHANlCAL ❑ PLUMBING ❑ SIGN <br />owrian n+eiuonness cnr zir n�orie <br />Flenry Middendorf 5621 Lowell Road Everett 98201 353-7659 <br />qpC IITECTORDESIONER MRILA�OBE59 CITY ZIP PNONE -- <br />OE4EP�LCONiR�LtOR MAIL�DORE59 CI1Y 21P PIIONE LICENSE• <br />Everett Bldrs. Inc. 5606 Et�ergreen Way Everett 98203 353-7161 <br />MEGHRNICeLCONTPACTOq M�ILAOD8ES3 CItV 21P PIIONE IICENSE• <br />EV-'�3t-EB -'3-11I3 <br />FLUMBINOCONTR�CLOR M�IIADORE9D CITY LIP PNONE �ICEN9E• <br />❑ NEW y�+ ADDITION ❑ ALTERATIl7N ❑ REPAIA ❑ DEMOLITION ❑ WUODS'fOVE/FRPL.INSERi ❑ BUILDIF:G RELOC.4710N <br />V�LUAiION OF WOBK �COST OF M�TERI�L9 PLU9 L�BO{i) <br />6.534.00 <br />�ESCPiBE WOPN <br />12� x 26' rough in addition <br />�EO�L <br />Lot #6 I�.urel Heig:�ts Division #9 <br />5621 Lowell Road <br />�-�' <br />��l�L4i1 <br />Eberett, Washington <br />I HEREBY CERTIFY THAT I HAVE I1cAD AND EXAMINED THIS �P- <br />PLICATION ANU KNOW THE SAME TO BE TRUEANDCORREC7. �LL <br />PROVISIONSOF LAWSAND QRDINANCES GOVERNING THISTYPE <br />OF WORK WILL 6E COMPLETED WITH WHETHEq SPECIF'IEO HERE• <br />IN OR NOT. THE GRANTING OFA PERMIT DOES NOT PRESUAIE TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEI THE PROVISIONS OF <br />ANY OTHER STATE Ofl LOCAL LAW REGULATING CONSTRUCTION <br />OR THE P[F;FORMANCE OF CONS�RUCTION. <br />81pNATUREOf�GONTRACTORORAUTHORZEDAOENT DATE <br />X �J d ; � ; h'� <br />THIS PORTIOtJ TO BE CUMI'LETED BY BUILDING DEPT. PERSONNEL <br />NO.OF <br />VACnNT�"11E <br />OYES f�NO <br />NO.OF OWEI <br />4TION/CGBY PLANSCHECKEDBY APPR. <br />1 "� r ! <br />V� <br />r <br />� ����--�-Tl�tl%,� �r����i_ f\��11C� <br />:�;r���„_ ,.,,�.,'.'r <br />NUMBER <br />BUILOING <br />awMoiNa <br />MECNANICAL <br />OTNER <br />PENALTY <br />TOTqL <br />S <br />S �so I��_��P, No glJ 3� <br />V�LURTION I FEE . <br />�0 <br />�on�n�. SEPA ai;d disciclionary permit <br />requircments. <br />oY� �,�� �" a7 g'� <br />Plannin� Dept. <br />J <br />