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�� <br />^ !ne 1 �%AWC I�AKIOH <br />APPLICATION FOR CONSTRUCTI4N <br />PERMIT <br />Ihe Evslprsan <br />CITY OF <br />everett everet� <br />BUILDING DEPARTMEN'� e <br />259•ed10 TO BE COMPLETED IN INK— PLEASE PRINT <br />��Ep FUIL�OC]ES9 <br />�1 QiY .•IP P��ONE <br />QAICN CaNS�Pu���n� T.., - 4ain-wot� cT a�_.��w.. � 1 ..' __ <br />:�3cj Om� ��. sr � 6 <br />�ui� �oone <br />�t2�o- 149t� S? ��_rt <br />1MIl �DDRE59 <br />M�II�DDRE55 —' <br />- Qll�/� _h�'� eT <br />C�I NEW ❑ ADOITION ❑ ALTERATION ❑ REFnIR ❑ DEMOLITION ❑ WOODSTOVE/FqP� INSERT ❑ BUIIDING RELOC�TION <br />ff N�NT IMPNOVEMEM OR IHTERIOq qEMODEL ONIY --- <br />' �y GONI�CT pER50N �NO Pb(lNE NO <br />CIX/iRACTPRICEOFWpIR ��- 1 �"`'�I U� / ! t —_—' <br />DESGRIBEW0/1�1K�ND80UMEfO0TA0EINVOlVEO _fr_\•. �n 1�D ;� <br />� U�^�,� J ��f�l�� <br />MurnNo <br />�� <br />BLOCK OF <br />�� <br />iu ' . <br />��Oa� � <br />,Q_ 3 <br />STORIES BSN <br />/ OY <br />� <br />---d' � -.J <br />S <br />S <br />O NO <br />IT LIM11A <br />� NEREBY CERTIFY TMAT I HAVE HEAD AND EXAMINED THIS APP�ICATION AND <br />KNOW TME SAME TO BE TAUE AND CORRECT. ALL PROVISIONS OF UWS AND <br />OR�INANCES GOVERNING THIS iVPE OF WORK WILI BE COMPLETED WITN <br />WHFTNFBSOCPmmnu�nu.�r�......� �"� __' _ __ <br />ni a.� vr vvrvs� HUGIIVN. TMAT I AM AUTHORI2ED BY THE OWNER OF <br />THIS PFOPERTY TO PERFORM THE WORK FOR WMICH APPLICATION IS MADE <br />AND I COMPLV WITH THE STATE CONTRACTORS LAW 18.P7 RCW AND <br />296200 WAC. <br />S�ON�fUREOFCONiMC1000f.qU1NOR1(ED�6ENT O�TE <br />�—��yI/- /��J•�(y'/��]I'Il{/5^�/ •—(p�I� <br />XP����N�S����'BU51HC•�f.E .LNO�NOBUSiN[SSNM+E "—"' <br />MECHAMICAL <br />RANGE <br />FAN <br />OF EOUIP, <br />NITS—:1.F <br />EMS— flT <br />3T.U. M <br />,�� .' � _� �,C> "� <br />FEES <br />BUILDING <br />PLUM�ING <br />MECHANICAL <br />OTHER <br />STATE BUIIDING SURCHARGE <br />STATE ENERGY SURCHARGE <br />PUBLIL' WORKS <br />TOTa� <br />�� <br />)TAL s <br />T s <br />FEE F <br />RECEIPT N0. <br />��'�l <br />4LUATION FEE <br />�.�Y � :3� `S <br />i �j�iT � <br />c_ <br />r" � `�/' <br />_ '` l�. <br />