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Ina Everoreen <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />259•BB10 <br />APPLICIj:�y ION FOR CONSTFt4::T10N <br />PERMIT <br />TO BE COMPLETED IN INK — PLEASE PRINT <br />Cverell <br />e <br />SG4f�c01� Th��5TR1►l rjlp)F.LT <br />TENANT 1.1�I1.1pDFESS CIiY ZIV PHONE 3933 <br />AcRo-TEc..I-� TN� ��zo HARDFS�nl ���. Evr wA. 9vz�� 3-�►8- �rv� <br />Ai1GM1TEGTOR0E51GNEP M�IL�O�PESS GIIY HP PMONE <br />I�lne� NuLI Z2o ,�.�.,�,,..e-aida . 9ii u�ecrena A�c. Sekn�e, w� 9Y�o4 cYz•c43� <br />6ENEMLLONTR4CTOR MML�DDPESS �--' C�1Y ZiP P1104E �ICENSE• <br />tE[.�?n TG�. (N,�ti�T.'Deai'1 �� zo FFn►wesea 21. . E� Wik. 3�8-3933 <br />�uJ <br />o�d. A.►P �.� <br />�Ff I <br />❑ NEW M ADDITION ❑ ALTERAiION ❑ REPAIR ❑ DEMOLiTION ❑ WOOOSTOVE/FfIPL INSERT ❑ BUILDING RELGCATION <br />000.•O <br />V.latcn. (.�,ost�s oFl��rs <br />PiqPOSEDUSEOFBURq a � <br />nnwaL��i.�t SHeP <br />LOT BIOCK Of <br />M�RVFSoa <br />P�UMBINO <br />9HOWER <br />KITCHEN SINKB DISP. <br />DISMWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />� <br />e <br />KIOW�BLEIAGTU�I <br />c <br />3 <br />I HEREBY CERTIFY TH�IT I HA'/E READ AND EXAMINEO THIS APPLICATION AND <br />KNOW TFiE SAME TO B E TRUE AND CARRECT. ALl PROVISIONS OF IAWS AND <br />ORDINANCES GOVEFIIING THIS TYPE OF WORK WILL BE COMPLEfED WITM <br />WHETHER SPECIFIED I iEREIN OR NOT.THE GRANTING OFAPERMITDOES NOT <br />PRESUME TO GIVE AU'i HORIN TO VIOLATE OR CIW CEL THE PROVI&ONS OF <br />ANV OTNER STATE OR LUCAL LAW REGULATINO CONSTRUCTION OR THE PEfF <br />FORMANCE OF CONSTRJCTION. iHAT I AM AUTHORIZED BY THE OWNER OF <br />THIS PFOPERNTO PERF�FM THE WORK FOF WHICH APPLICRTIOh IS MADE <br />AND I COMPLV WITH TiIE STATE CONTRACTORS LAW 1827 RCW AND <br />236.2(HI W4C q <br />SIONAiUNEOFCONiPAGTORONAUiNONIZED�GENi IIAiE � � � I � �� <br />X � <br />�PPIICANTS C17 Y BUSME55 UCENSE N0. ANp BIISINE55 NAME <br />MECMANICAL <br />FAN <br />WATER HEATER <br />_ WOOD STOVE <br />— METAL FIFEPLACE & CHIMNEY <br />r FIREPLACEINSERT <br />sue rora� a � � — <br />PEFM.IT 5 <br />TOTAL FEE E � <br />ISEIBACN SIOESE713ACN <br />1RE� VAC�NTSITE <br />❑ YF9 ❑ NO <br />UPANCYGNOUP NO.OFUWEILINOUNItS <br />>Fsromcs BSIAT. OCClOAO <br />❑V <br />O N <br />BUILDING <br />PLUMBING <br />MECHANICAL <br />OTHER <br />STATE BUILDING SURCHARGE <br />STATEENERGYSURCNARGE <br />PUBLIC WORKS <br />TOTAL <br />