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y..� t�.'rv;. <br />� APPLICA�ION FOR CONSTRU�ION <br />PERMIT <br />f • <br />■I <br />tM Ev+ryrN^ everett <br />GTY OF <br />everett <br />BUILDING DEPARTMENT <br />2b9•8810 TO BE COMPLETED IN INK— PLEASE PRINT <br />OWNER MMLIIDDRE55 CITY ZIP PNONE ., <br />1 V,.n la �.�� �� i�TA 1�-IPG 2/ 1�- Nec«.'s �•,� /_= J�1- - ry '3 3e/.L.•e/ <br />MCHRECTOA7ESIONER M�ILAOORE55 CI1Y 21P PMONE <br />OENEMLCOMTRA(:TOA MAII�DORE55 GITY ZIP VHONE " LICENSE• <br />❑ NEW ❑ ADDITION <br />11LTER�TION ❑�7EPAIR ❑ DEMOC110N ❑ WOODSTOYE/FRPL INSERT ❑ BUIL�INO RELOGITION <br />LOT lLOCK�_ Of <br />RUM�INO <br />'2 <br />� � <br />�� V <br />d..7../�-� � <br />ICGUPANGYOROUP <br />R- 3 <br />IO.OFBTORIES B9N <br />/ ❑v <br />YES NO <br />�ur+s �rra ar <br />'{(N <br />�S <br />SIDE SETB <br />� <br />WC�NT ji <br />O VES f <br />I HEREBV CERTIFY TMAT I HAVE READ ANU EXAMINED TMIS APPLICATION AND <br />KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISION90F LAWS AND <br />ORDINANCES GOVERNING THIS T'PE OF WORK WILL B[ CAMPLE7ED W�TIi <br />WHETHER SPECIFIED HEREIN OR NOT.THE 6HANTIN60FAPERMIT DOE9 NOT <br />PRESUME TO GIVE AUiHORITV TO VIOLRTE OR CANCEL THE PROVI&ONS OF <br />ANY OTHER STATE OR LOCAL LAW FE6ULRTIN4 CONSTRUCTION ORTHE PER- <br />FOHMANCE OF CANSiRUCTICN. THAT I AM AUTHORIZED BY THE OWNER OF <br />THIS PROPERN TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE <br />AND I COAIPLY WITH THE STATE CUNTRACTOFS LAW 1827 ';,W ANO <br />298.200 WAC. <br />SIOX�TUAEOFGONTN�CIORON�UTIl0f1RED�0ENT ��h <br />X/ /fi�"�-S'a .s, � c� // / � r <br />AFPLIGANTS GITY BUSINESS IIGENSE NO. �ND BUS�NE%N�ME <br />MECN�NICAL <br />NO. TYPE OF EOUIPMENT <br />AIC — NHNDLO UNITS — H.P. <br />FORCED AIR SYSTEMS —&T.U. M EA <br />11NI7HEATERS—&T.U. M <br />FAN <br />MEATER <br />BUILDING <br />oweuiNa uwits <br />� PLUMBING <br />��.�l MECHANICAL <br />rLMii�N OTNER <br />2� STATE BUILDING SURCHARGE <br />STATE ENERGV SUFCHARGE <br />PUBLIC WOtiKS <br />TOTAL <br />FEE <br />� <br />... ...... ....._.... : .. _.,�� <br />. � . . .. .. . . <br />