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APPLICp►T10N FOR CONSTRt�CTION <br />PERMIT <br />fM Enryn�n <br />GTY OF <br />everett everett <br />BUILDING DEPARTMENT � <br />269�8810 TO BE COMPLETED IN INK— PLEASE PRINT <br />OWNEF M�IL�O�RESS �IIY 21P PHONE <br />�[+nr� l—�tr o���tj iCo,v,ir,- ��1f1 .�-ib;.�/�{ 9Sc��lu1 ai,Z-.Sl,.rcJ , <br />MCHITECTORDESIONER MML�DUPE55 �IiY ZIP PNONE <br />OENEMLCANiRACTOR MRIL�DOHE55 CItY ZIP PHONE LILENSE• <br />Se/-� <br />PLUM&NOCANTMCiOR M�I�ApDRE59 C�IY 21P PNpNE UGEN9E• <br />❑ NEW ❑ ADDITION ❑ ALTEFATION � REPAIR ❑ OEMOLITION ❑ WOODSTOVE/FRPLINSERT ❑ BUILOIN6RELOCATION <br />CONTRAC'PRICE <br />D� <br />LOTSL:[Lf(1 BLOCK�J�� OF � �" <br />7 <br />91{AIC41 IW VNEi{$ <br />ao a g�'x Rn �.t,e. Ade ,, E✓..s>-/, 4/R 4 6.0/ <br />RUM�INO <br />/�LIOwABIFJ�cTU�t <br />ii�'1 <br />8 UISP. <br />WASHEH <br />PERMIT <br />TOTAL FEE <br />ur <br />oN <br />YES ❑ NO <br />S <br />o res ❑ No <br />I HEREBY CERTIFY TMAT I HAVE READ AND EKAMINED THIS APPLICATION AND <br />KNOW THE SAME TU BE TRUE AND CORRECT. ALL PROVISIONS OF UWS AND <br />ORDINANCES GJVERNINCa THIS TYPE OF WORK WILL BE COMPLETED WI7H <br />WHETHER SPFi.IFIED HEREIN OP NOT. THE GRANTINOOFA PERMITDOE i NOT <br />PRESUME TO GIVE AUTHORIN TO NOLATE OR CANCEL THE PROVISIO,.S OF <br />ANV OTMER STATE OR LOCAL LAW R'cOULATINO CONSTRUCTION OR THE PElF <br />FORMANCE OF CONSTRUCTION. THAT 1 AM AUTHORIZED BV THE OWNER OF <br />THIS PROPEHTY TO PERFORM THE WORK FOR W F'ICH APPLICATION IS MADE <br />AND I COMPLV WITH THE STA7E CONTRACTORS LAW 1827 RCW AND <br />296200 WAG <br />SipN�TUNEOF�ONTR�C10qOp�lITNORIEE0A0ENT DAiE <br />X ��-� L�.' 4'� �-�C, a - � - � `� <br />APP��C�NTS CITY BUSINESS IICENSE NO. AND BUSINE59 N�M <br />MECHANICAL <br />NO. <br />—T�=, <br />3 UNI75— H.P. <br />/SiEMS— 6T.U. <br />— 9T.U. M <br />8 CHIMNEY <br />BUILOING <br />PLUMBING <br />MECHANICAL <br />OTHER <br />STATE BUILDING SURCHARGE <br />STATE ENERGY SUqCHARGE <br />PUBLIC WORKS <br />TOTAL <br />\!_1S�IS7I�Fl <br />� <br />S <br />S <br />RECEIPf <br />.. . .. _ _. _. -. .. _. .�-_�.._'.•'." <br />, � . . - . . .�_. _ . . . . . _ ._.. <br />_ _.,..,,..1..� .. ., �. ', .. ......— . <br />r <br />e <br />