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� <br />APPLICATION FOR CONSTRUCTION <br />PERiNIT <br />fM Ewrproen <br />CITY OF everett <br />everett e <br />BUILDING DEPARTMENT <br />258•8810 TO BE COMPLETED IN INK— PLEASE PRINT <br />pyHEq M�II�p�NE55 GTY ZIP PnJNE <br />� , I_ � � .,-tin� �_ , i' „ 1.r ,-�._ -r-. ,_. _ r,._� c�C�n �, � 2g�- r-Zl�� JLI i� i <br />AqCNITECTOR0E5�OHEN MnI.�DDRE55 <br />GENER�LCONTP�GTOR MMI�DOPE55 pTY IIP PNOI+c IICENSF.• <br />❑ NEW ❑ �DDITION <br />Cd1TR/iCTAiICEOFWORK . 1 !C <br />p[�p�� WORK AND SOUME FOOT�OE i <br />PIqPOeEDUBEOF��NO � <br />LEML DESCRIPTION (X VROPERTV ISNOV <br />l0T BLOCK OF <br />NI�NMO <br />USE20NE <br />FIRE <br />URINAL <br />FLOOH <br />BY <br />� <br />e <br />TO�AL <br />n res ❑ no <br />[] Y <br />❑N <br />21P PNONE LICENSE • <br />❑ REPAIR � DEMOLITION ❑ WOODSiOVE/FRPL INSERT ❑ BUILDINO RELOC�710N <br />S <br />❑ YES ❑ <br />I HEREBV CEFTIFV THAT I MAVE READ AND EXAMINED THIS �PPLICA710N ANO <br />KNOW THE SRME TO BE TRUE AND CARfiECT. ALL PROVISIONS OF lAWS AND <br />ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLEIED W17H <br />WHETHER SPECIFIED HEREIN OR NOT. THEORANTIN60FA PERMIT DOES NOT <br />PPESUME TO GIVE AUTHORITV TO VIOIATE OR CANCEL THE PRONSIONS OF <br />ANV OTHER STFtE Ofi LnCAL LAW REGULATING CONSTRUCTION OR 7HE PER <br />FORMANCE OF CONSTRUCTION. TMAT I AM AUTHORIZED BY THE OWNER OF <br />THIS PROPERTV TO PEtiFORM THE WORK FOR WHICM APPLICATION IS MADE <br />AND I COMPLY WITH THE ST/.TE CONTRACTORS lAW 18.27 RCW AND <br />296200 WAC. <br />$IGNeTUPE Of CONTRACiOR DH AUIHON2 �OENT DATE <br />�• / �C�ii'� �/r'LC� �1��� <br />� it SpTYBUSI 55 IGENSENO.IINDBU9INESSN�ME <br />MECMANICAL <br />FAN <br />PLACE6 <br />INSERT <br />eui�oiNc <br />PLUMBING <br />MECHANICAL <br />OTHER <br />STATE BUILDING SURCMARGE <br />S7ATE ENERGY SURCHARG[ <br />PUBLIC WORKS <br />TOTAL <br />— H.P. <br />— flT.l <br />M <br />