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APPLICATI ��'� FOR CONSTRUC::;:ON PERMIT <br />, � �.«a..�, <br />TO BE COMPLETED IN INK—PLEASE PRINT <br />everett � <br />ty BUILDING DEPARTMENT <br />259-8810 <br />! � ❑ DEMOLITION ❑ COMBINATION <br />�� MA4 AOORESS <br />:i � u//t_.S'o� � � � 3� <br />' j ��T AUIL AOORESS <br />MCXITECTORDESIGNER 1MIlAD.^-' .+ <br />HEATING SYSTEM: ❑ �AS O ELECTRIC ❑ <br />❑ BUILDING ❑ MECHANICAL <br />��i7(�nJ� ��Pe ', "�` PI <br />� LITY Z�� � <br />GITY Z�P P� <br />everett <br />e <br />❑ PLUMBING ❑ SIGN <br />� — t33 �.6 �, <br />;'� ����/✓U2�iCso,<E��Q /�tOr — /c��/U� S� cTiMokcy ��' Lr� ` eloPfi(iSiU.f/.��0/�!� <br />'� CITY ZIP PIqNE LICEN9E� <br />��� MECMMIICKCpITRACT011 MARAODRESS <br />.'� K��p�pHTq�ipp tNRADDRE55 G7V ZIP PlqNE LICENSE• <br />❑ NEW ❑ ADDITION ❑ ALTEMTION <br />�...�.��...,.,.�..�....e. 7 i d'�C1 <br />IEO�L DEBCRIPTION OF PROPERTV ISIIONM BELOW pi <br />aT s6� � ��a � s <br />(�a.....v.P•�9.I �' •• o( �j� <br />� ��l�i �(�0 <br />��,�-r�' pq s' <br />---r- <br />�4ti3o �es4 Jr <br />:�. • <br />� SUB TOTAL <br />PERMIT <br />�i TOTAL FEE <br />�FOR OFFlCE USE ONLY: <br />FpprTgEiB�CK RE�RSETBACK <br />� <br />.j ��E LOTARE� I <br />&7EOFBLDO. . ra.OF <br />occw�wcy �wu fi� si <br />JiNS �PPHOVED BY <br />��-�. <br />I I REPAIR ❑ DEMOLITION 17 WOODSTOVFJFRPL INSERT ❑ BUILDINCi RELOCATION <br />CONT�CT PERSON AND PlIONE ND. <br />iL d+v Orxi S <br />1 HEREBY CERTIFV THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. AU. <br />PROVISIONS OF UWS AND ORDINANCES QOVERNINO TMIS TVPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE ORANTINd OF A PERMIT DOES NOT PRESUME TO OIVE <br />AUTHOHITY TO VIOLATE OR CANCEL THE PROVISIONS Of ANV <br />OTHER STATE OR LOCAL LAW REQULATINQ CONS?RUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PEHFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLV WITH THE STATE <br />CONTRACTORS UW 1827 RCW AND 296.200 MMC. <br />SKW��NREOFCONTMCII7NONAUiMORIiEDAOENT MTE <br />x � <br />• CI7Y &1SNIESS LICENSE NO. N!D BUSNIE <br />UNIT <br />SETBIICK <br />DRVERS <br />ON FAN <br />'PUMP <br />PIPINO <br />BUILDING <br />pCpI�IMtr MO aOMFtIiMGUM��S <br />�° pIUMBINO <br />B�SEMENi MECHANICAL <br />MEiOXi LlMlunor+ ADDITIONIIL PLAN CHECK <br />OTHER <br />STATE BUILDINO SURCHARGE <br />CITY OF EYEHEiT PUBLIC WORKS <br />LOCAL SALES <br />TAI( CODE IS 3105 TOT�� <br />� <br />H <br />