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':a�1. ��.F � ..•..�.... '. _.' � . ' . . _... ._... [ _.-. .� ... _. � _ ._ _._ ... . .._..� �.. J .�....._.......SI1....� , <br />. .. . ..M1... .� ._.. .... <br />ths Er�rpresn <br />ciTv oF <br />everett <br />BUILDING DEPARTMENT <br />259-8810 <br />APPLIr:AT10N FOR CONSTkUCT10N <br />PERMIT <br />TO BE COMPI.ETED IN INK— PLEASE PRINT <br />OWNER M�II�ODRE55 CITY Z�P �Sl�—'��Z� <br />MA�2Y ��CeL�� 541 N�TH�>Ytn)t.. .��3��� i i � <br />TENMlT M�IL�ODRE55 CITY 21P PMONE <br />�pLHRECTORDESIGNER MML�DDflE55 CITY 21P VHONE <br />everett <br />e <br />OENEMLCONTIACTOR MAILAODRE55 CITY 21P PHOHE IILENSE• <br />���p� `(.��,f,f,ln�[. 3023 uW�S�''S� S�+rTi� 9E311'! 7d3c�Yl7 Tuuepcl��e�� <br />._ _ _ �.... �m PHONF LICENSE• <br />PLUMlINOLMITR�GTOR M�IL�DORE55 CITY ZIP �HONE IILENSE• <br />❑ NEW V❑ AODITION ❑ ALTERATION 111 REPAIH ❑ DEMOLITION ❑ WOODSTOVE/FRPLINSERT ❑ BUILDINGRELOC�TION <br />uc�o+ <br />�,.,.,a...,..�...... _.._..._. __...__....-- -- <br />et-vnNc f-��� �wMcn. o� M� 4� � N ��; <br />►du M�� <br />�pt BLOGN OF <br />Pf10JEGi wuncsa <br />541 HM^�1��/�� <br />PLUMSINO <br />ROOF <br />ALLOW�BLEMGTUAL <br />Fl11E <br />SINK 8 DISP. <br />FOUNTAIN <br />SUB TOTAL <br />YE9 ❑ NO <br />❑Y <br />❑N <br />ONTAGT PEPSON �Np PNONE NO. <br />���� -C�� 2n` � �3- �4� 7 <br />I HEFEBV CERTIFY TMAT I HRVE READ AND EXAMINEO THIS APPLICAiION AND <br />KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVI910N8 Of LAWB AND <br />ORDINANCES GOVERNING THIS 7VPE OF WORK WILL BE COMPLETED WITH <br />WHETHEN SPECIFIED HEREIN OR NOT. THE GRANTINOOFA PERMRDOE8 NOT <br />PRESUMk TO GIVE AUTHORI7Y TO VIOLATE OP CANCEL THE PRONSION80F <br />ANY OTHER STATE OR LOCAL LAW REGUTATING CONSTRUCTION OR THE PER� <br />FORMANCE OF CANSTRUCTION. THAT I AM AUTMORIZED BY TME OWNER OF <br />THIS PROPERiY TO PERFORM TME WORK FOR WMICH APPLICATION IS MADE <br />AND 1 COMPLV WITH THE STATE CONTRRCTORS LAW 1827 RCW AND <br />298200 WAC. <br />516NATUREOfCONiNI�CTOpOR�UTMORRED�OENT DAIE <br />/p��� � (�/ <br />X �'Tl l/�1l �l �A /J y ���` S/ bY <br />U� v�V�., ���.-ci <br />APPLIG�NTS CITY BUSINE55 LICENSa�NO. �ND BlI51NE55 N�ME <br />MECHANICAL <br />FEE NO. TYPEOFEOUIPMENT <br />!VC — Al HNDLG UNITS — H.P. <br />FORCED AIR SVSTEMS — 87.U. M EA <br />IINITHEATERS—B.T.U. M <br />❑ YES ❑ NO <br />VENI'ILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />WOOD STOVE <br />METAL FIREPLACE 8 <br />FlREPLACEINSERT <br />6AS PIPI� <br />E%HAUST <br />SUB TOTAL <br />PERMIT <br />TOTALFEE <br />BUILDINCa <br />PLUMBING <br />MECHANICAL <br />OTHER <br />STATE BUILDIN6 SURCHARGE <br />STATE ENERGY SURCHARGE <br />PUBLIC WORKS <br />TOTAL <br />Fi <br />FEE <br />