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�he Ev�rpreen <br />CITY OF <br />everett <br />BUILDING OEPARTMENT <br />269-B810 <br />[�7 <br />Sa m� <br />aicnrtecronoeamn@ <br />_.. . . . � --� <br />APP��ATION FOR CONS""gUCT1AN <br />PERMIT <br />TO BE COMPLETED IN INK— PLEASE PRINT <br />Ma��ooness <br />t �tiur�h .1'��, ��oarc� � %r✓s �tc:.r� <br />hUILADORE55 CIiY Z�P <br />/9a2 Yr%d�son �'�.�fi` 9�.zos_ <br />everett <br />� <br />3s3 -7�zo <br />� �39-�17vt <br />aENEMLCONTNACTOR buanuuecao �-'-� - Qi//NT BC <br />.iarry �a�nr'�a� 32.So7 /�6r�7�rs �re.� ,a/x�E 7.1a..,�.�4 886-z,s'P7 �o4trv <br />MECINNICALCANT TOR �MALADDRES9 CITY ZIP PMONE , UCENSE <br />/Yor�� <br />YLUM&NOCONTMCTOfl /.WLAODRE88 GTY IIP PNONE LICENSE• <br />/�or(e <br />IXABB OF MOR1Kc� <br />❑ NEW .t�l ADDITION L'� ALTERATION L7 REPAIR ❑ OEMOLI710N ❑ W0009TOVE/FRPLINSEHT ❑ BUILDINORELOCATION <br />Tff4WT IMP[IOVlM[NT Ofl IMfifllOfl NEMODEI.ONLY CANTACT PEfl90N AND PHONE N0. <br />*�36 �ao,o-o c�»ter �6 �as'7�Or C3s5 —575/ <br />COry7MCT PRIC! Of WOPK: J _ <br />DEeCPIBL WORKANO OOUME FD�TAOE INWLVEO <br />iPoO/o�e fw,�o�a�S %ay/or �rmaN eF5 - 3(3 6 <br />"7..��,..,,..lo��:y.lQn�r�Tn[Q �Jrl <br />SuNa(ay Sa�oo� S'P�cC <br />LOT BIOCN OF <br />PLVMBINO <br />No. T— <br />r.� <br />FXis <br />K <br />cJ/ <br />�•n <br />PERMIT <br />TOTAL FEE <br />HEAHBETBACK <br />�K 1 S�'/ N <br />�� L <br />CONBT. OGCUPANGY Of1011i <br />ILE/AGTW /� ,� 2 <br />�'� rJ <br />lLDQ NQOF9TOHIE9 <br />d aF ��D � <br />INNLEP9flECU1PED OVEB �NO <br />__� <br />IONFGGBY PUN8APP0.BJ; <br />��j� // <br />� �Y� /1% <br />e�,.v <br />�X/ST� <br />v,�c,wraiTe <br />OYE7 XtNO <br />?G � <br />I HEREBY CERTIFY THAT I HAVE READ AND E%AMINED TFiIS APPLICATION ANf <br />KNOW THE SAME TO HETRUE A�D CORRECT. ALL PROVISIONS OF LAWS AN[ <br />ORDINANCES OOVERNINO THIS TYPE OF WORK WILL BE COMPLCED WITh <br />W HETHER SPECIFIED HEREIN OR NOT,THE ORANTItJ00FA PERMIT OOE9 NO' <br />PRESUME TO OIVE AUTHORIN TO VIOLATE OR CANCEL THE PROVISIONO Oi <br />ANYOTHER STATE OR LOCAL LAW REGULATINO CO�JSTRUCTION OR THE PEF <br />FORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE OW NER OI <br />THIS PROPERTYTO PERFORM THE WORK FOR WHICH APPLICATION IS MADI <br />AND I COMPLY WITH THE STATE CONTRACTORS lAW 1827 RCW AN[ <br />296200 WAG <br />S�UNATUREOFCO MCfORORAUTHOP2EDA0ENT OAiE �' �/� GG7 <br />d � <br />APPLI �VIieGTYBl1SINE6SlICEN9ENQ/J!0 SIN SNAME <br />MECHANICAL <br />No. Tvre or eoi <br />,}, A/C—AIHNDLOUNITS— <br />T Gl1Rf:Ffl AIR SYSTFM3— <br />FIFEPLACEL <br />GAS PIPING <br />E%HAUSTFF <br />BUILDINQ <br />PLUMBIN� <br />MECHANICAL <br />OTHER <br />STATE BUILDItJO SURCHARGE <br />STATE ENEFGY SURCHARQE <br />PUBLIC WORKS <br />TOTAL <br />SUD TG' <br />PERMIT <br />FEE <br />... _. ; ._.. . . . . . . .. . .. _ . �. <br />_ .. .__.. _. , <br />' . .. :� . . _ _ - - \'� - . . . . . . . _ . <br />