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APPLICATICr.�I FOR CONSTRUCi�..�N PERMIY <br />TO BE COMPLETED IN INK—PLEASE PRINT <br />(hB Everpreen <br />GITY OF <br />everett � �-- <br />BUILDING DEPARTMENT <br />259-8810 <br />O DEMOLITION ❑ COMBINATIO <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />a <br />everett , <br />e <br />� i <br />i <br />N ❑ BUILDING ❑ MECHANICAL �'LUMBING ❑ SIGN '� <br />AIL AUDPE �N � J!O � Z�/�J e/J'� ✓ � PJ�ONE � <br />owr+� / . _ � ��2.Q�J'� � ♦r .� C "��'�-TT � ���-3 .�s3-7G �U l <br />TENANT MAILA DFESSv ��TY Z�P PHONE � <br />ILPDORESS CITY ZIP PNONE ` _' <br />�RLHITECiOR DESIGNER A�9_� �'l�rC L� ��0 3 3 3. ���/ �J '� <br />�'MS�/S�w �Firi A � Tl <br />QENER CON7HACTOR AUII�ODRESS CIiV ZIP PMONE LICENSEI <br />,E� .�.�o,� 3zso-� ..<6r�,..s .�fb i3/2�k �2,M.�...ol 9�o�a ; <br />MEGH�HIG�LCONTPACTOR MAILAODNESS CIN ZIP PHONE LICENSEI <br />D <br />PLUMBINOCONTAACTOR MAILA�DAESS CITY ZIP PHONE IICENSE• � <br />� ! <br />CIASS OF WORK <br />❑ NEN' ❑ ADDITION ❑ ALTERATION I.1 REPAIR I I DEMOUTION ❑ WOODSTOVE/FRPL INSERT ❑ BUILDING RELOCATION <br />CON.TACT PERSON AND PHCNE NO. � <br />� <br />. <br />Ld�� � � � <br />IEWL DESCH�P110N OF PROPERTV (SIAWN BELO1 <br />LOT BIOCK OF <br />/S o <br />SUB <br />FOR OFFICE USE ONLY: <br />APEA <br />'AF CONST. ACNAL <br />OF STOFIES <br />LORD <br />I HcREBY CERTIF' THAT I HAVE READ AND EXAMINED THIS i; <br />APPLICATION AND KN�.Y THE SAME TO BE TRUE AND CORRECT. ALL �; <br />PROVISIONCa OF LAWS AND ORDINTNCES GOVERNING TIiIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHEfi SPECIFIED HEREIN OR , <br />NOT. THE GRANTING OF A PERMIT DOES NOT PHESUME TO GIVE . <br />AUTHOAITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY '� <br />QTHER STATE OR IOCAL LAW AEGULATING CU�JSTFlUCTION OR THE j; <br />PERFORMANCE OF CONSTRUCTION. THAT 1 AM AUTHORIZED BY THE � <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH p� <br />APPLICATION IS MADE AND I COMPLY W11'H THE STATE �� <br />CONTRACTORS LAW 1027 RCW AND 296200 WAC. Y <br />SIGNATUflEOFCONiHACTORORAUTHORIZEDAGEN7 DATE <br />� <br />t <br />APPUCANTSCI BUSINESSLICENSENO.ANOBl15ME AM� �r <br />i• <br />FAN <br />� <br />iF.SETB�LN PUNLHECNNUM9EN <br />:ANT SITE FEES <br />BUILDING <br />vnxcv xoawrtwnau•ns <br />^a'�P PLUMBINO <br />SEMEN7 MECHANICAI � <br />iGHTLIMIr�T!v;r PDDITIONALPL��•::HECK <br />_, OTHER <br />STATE BUILDING SURCHARG <br />CITY OF EVERETT PUBLIC WOFXS <br />LOCALSAL'cS — <br />TAX CODE IS 3'105 'a'A� <br />� <br />i I <br />8 CHIMNEY ' ' <br />: � — �, <br />' i <br />4. <br />, <br />� <br />� <br />--�— <br />� j. <br />i �. <br />i <br />� �' <br />I; <br />SUB TOTAL $ ' �; . <br />PERMIT $ � <br />TOTALFEE $ ' , �. <br />FEE REGEIP7N0. •— <br />VALUATION FEE �. <br />� C <br />i� <br />}`. <br />O � �— .. <br />i <br />i � <br />i <br />i <br />i <br />i <br />� � <br />� <br />I � <br />i <br />E � �. <br />.. <br />i <br />i <br />� ;�; <br />i 3° �^ , <br />.. . --. , -,ti,^:-'. <br />