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fh� Ewrpreen <br />CITV OF <br />everett <br />BUILDING DEPARTMENT <br />269-8810 <br />APPLIC�"��ION FOR CONSTR ''��TION <br />PERMIT <br />TO BE COMPLETED IN INK— PLEASE PRINT <br />everett <br />e <br />Ep MMl�00RE55 GIIY IIP PNONE <br />LAF'R/F/�,E H. A/I�r.,��. 2I3� H/�HNMIAiF ��r�i,,� 9glo� zs�-� ysa <br />7ENµI M�ILII�DRESS GITY 21P PHONE <br />MCHREGTONOESIONER M��I�DDRE55 CIiY ZIP FNONE <br />OENFRAICONTMIICTOP MMLADDNESS CIIY '.IP PHCNE UCEN9E• <br />�t/RGOna ��n �-►3�K�4+��f.,o 2st ') s'sa N171�3�c'�lz.�e,y <br />,(y1I1N1�µ�pNTq�Gipp MML��DflE59 CIIY ZIP PNONE LICENSE• �� <br />PLUMlINOCANTMCTOR M�II�DORE59 GiY 214 {'HONE L�CENSE• <br />❑ NEW ❑ AODITION ❑ ALTEMTION � REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPLINSERT ❑ BUILDINORELOCATION <br />CONiRACTPRICEOiNVRK 'y IJ�Qpu � <br />p!lCIM![ MVIIN �HO DOVME FOOT�OE INVOIVED L <br />1E14�F APA�cv�,rrr (F,bp,a� 4�htl <br />UlEOF �1111MN0 <br />n�vifi. ir+- N o„s+t <br />�EpK p!lCqNfpN OF PpOPERTY�SMOWNlELOW OR �TT�CH FOUR G01 <br />L /` <br />LOT�vlIOCI(�S3 OF FA/�F�CLO L N1L <br />L�io <br />KUM�INO <br />L— <br />I HEREBY CERTIFV THAT 1 HAVE READ AND E%AMINED TMIS APPLICATION AND <br />KNOW THE SAME TO BE TRUE AND CORRECT. ALl PPOVISION30F LAN9 AND <br />ORDINANCES QOVERNING THIS TYPE OF WORK WILL BE COMPLETED WIiH <br />WHETHER SPECIFIEDHEREIN OR NOT. TME 6RANTINOOf IIPERMR DOES NOT <br />PRESUME TO GIVE AUTHORITV TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANYOTHER STATE OR LOCAL LAW PEQULATINO CON9TRUCTION OR iNE PEiF <br />FORMANCE OF CONSTRUCTION. THAT I AM AUTHORRED BV THE OWNER OF <br />TH�S PROPEHN TO PERFORM THE WOqK FOR WHICH APPLIC�TION IS M�DE <br />AND I COMPLV WITH iHE STATE CONTRACTOR9 LAW 1827 RCW AND <br />298200 W.4G <br />8qN�NREOF�ONTMCTONON�IITHOR12ED11OENT D�TE <br />X �a� 9� 6 � �'-YS <br />•PPL �NT9CITYBUSINE59LICEN9ENO.ANOBUSINE99N�ME <br />MECNANICAI <br />UIVI I 11CA1 CMJ � Q I <br />CLOTHESDHYERS <br />VENTILATION FAN <br />HANGEHOOD <br />WATER HEATER <br />WOOD STOVE <br />METAL FIHEPIACE d <br />HEAT <br />FAN <br />No P� � <br />SUBTOTAL S � 1r ��� <br />PERMIT E �I <br />TOTAL FEE S <br />ISETBI�CK SIOESEII <br />WEA VAC�Ni: <br />❑ YES <br />Ov <br />pN <br />fIRESPFINNLERSREWINfJ ❑YES ❑NO <br />STATEENERGYSURCHARGE <br />PUBL�C WORKS <br />TOTAL <br />S <br />S <br />S <br />