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IAs Everproen <br />CITY OF <br />everett <br />BUILDING CEPARTMENT <br />.,�,. ..o.., <br />/�''� <br />ppPLICAir'IAN F RRUC�T NSTRU�.�1'ION <br />!P <br />TO BE COMPLETED IN INK— PLEASE PRINT <br />evcrett <br />e <br />���Y Z�p PMONE <br />MGHREGTOROESIpNEP MAI�ADDPE55 <br />� � � � 1G'/LLCSP/LVrDi D �uF IICENSE• <br />�ENE1N�wninwwvn <br />��TY Z�p PNONE 4GENSE � <br />MEGMANICALCONTMCTOR MMlAU0RE55 <br />RUMlINOCONTRACTOP MAILAOONESS <br />CITY 21P PHONE �IGENSE • <br />CLA88 OF WOPK <br />❑ NEW ❑ AD�ITION ALTERATION ❑ REPAIR ❑ DEMOIITION ❑ WOODSTOVFJFFALINSERT ❑ BUILDINORELOCATION <br />CONI�CT PERSON �NO PMONE NQ <br />TlNIJITIMPROVEMENTORINTERIORREMODELONL� � /�� ' <br />.3.SOcc �J�- /1/i�iY��7 rt',s,�'it.�) �353 -y.zs <br />CONTMOT PRICE Of WORK - <br />OElGRIBE WOHN AND BOW�E FOOTROE invu�vev <br />L0T1� BIOCK OF <br />PLUMBIN� <br />DRAIN <br />DHAINS — <br />F-%C lYY�u•invi <br />I HEflEBV CERTIFYTHAT I HAVE READ AND E%AMINEDT� �IS APPLICATION AND <br />S/,DfNC � KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVIS�ONS OF LAWS AND <br />ORDINANCES GOVERNING iHIS NPE OF WORK WILL BE COMPLETED WITH <br />BELOWOAATTACMFOUACOVIES� WHETHERSPECIFIEDHEREINORNOT.THEGRANTINOOFAPERMITDOESNOT <br />�� ST T/ON C qNYOTHERSTATCORLOCAL AW EIGULATINGCO STRUCTIONORTHEPERF <br />FORMANCE OF CONSTRUCTION. THAT 1 AM AUTHORIZED BY THE OWNER OF <br />AND PRCOMP VTWITHRTHEMSTA EWC�JNTRACTORSHLAWL782T7�RCW AND <br />296200 WAC. <br />S�GNPTUPEOFCONTPRCTORGR�UtNORRE� �QEN( O�TE <br />X)i <br />/ .]"" _ -,l� /%�.49„ � /7 _ /�I_ Vi� <br />PERMIT s <br />TOTAL FEE S <br />N REAflSEiB�CN SID <br />� / � / <br />�oT�A� d �2` <br />"� /� z° <br />7, OCCUPANCVOROUP NO <br />:.�.��:n� R- 3 <br />Nf.OFSTORIES vMT, a <br />Sf "Y <br />❑N <br />NE <br />;nSaEou�RED ❑YES �JHO <br />� ' <br />A4T SIIE <br />EB O NO <br />MECHANICAL <br />NO. TYPE OF E�UIPN <br />A/C — A/HNOLG UNITS — H.P. <br />FORCED AIR SYSTEMS— &T: <br />UN�T HEATERS— &T.U. M <br />CLOTHESDRVERS <br />VFNTILATION FAN <br />1 ; <br />fYilJ <br />FYR9 <br />BUIIDING <br />WELLINO UNI19 <br />� . PLUMBINO <br />w <br />N� MECHANICAL <br />uMiunor+ OTHER <br />STATE BUILDINCa SURCHAFGE <br />STATEENERGYSURCHARGE <br />PUBLIC WORKS <br />TOTAL <br />. �.ar� . _ . ... , . , . . .. .. <br />S <br />S <br />' <br />¢SO.us CGwsT <br />FEE <br />