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� .�.;i. <br />i, <br />i <br />tAs Ewrpreen <br />1 CITY OF <br />= everett <br />�� BUILDINGDEPARTMENT <br />259-8870 <br />,.... <br />APPLIC ����ION FOR CONSTRI�,:T10N <br />PERMIT <br />TO BE COMPLETED IN INK— PLEASE PRINT <br />everett <br />e <br />OWNEN M�LL�O�HE55 GtY 21P PNONE <br />/ n ,�L ' <br />1,0� � d Los�o 2.''ta7- 60��' �vt2�r� 9��03 339'3s87 <br />TEN/�NT MAI��pDNE53 CITY ZIP PHONE <br />� �i /JiGNRECTORDE510NER 1MR��ORE55 CIIY ZIP PNONE � <br />.� <br />i <br />:� <br />OENEMLCON7MCiON MAILAODPE55 CIiY ZIP PHONE LIGENSE• <br />!�� �WNe� <br />.� <br />. MECH�NIGKCONTFACTOR M�I��DORESS GtY 21P PNONE LICENSE• <br />PLUMlINpGONTMLT011 M�ILAOONE55 CIIY 211+ PNONE IICENBE• <br />❑ NEW ❑ �ODITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPLINSEfiT ❑ BUIL�INOPELOCATION <br />NNlTIMPPOVEMEN�OR INIERIOR REMODELONLV I CONI�CI PERSON �NU PIIONE ND. <br />COkiR�CT PiiICE OF NVqK <br />C�� <br />� c� <br />LOT BIOCR OF <br />3ory <br />rwrsiNo <br />KITCHEN 91NK6 DIBP. <br />DISHWASHER <br />FIHE <br />,t U�fe/S'� <br />I HEREBY CERTIFY THAT 1 HAVE READ AND FXAMINED THIS APPLICATION AND <br />KNOW THE SAME TO BE TRUE ANO CORRECT. ALL PROVISIONS OF LAWS AND <br />ORDINANCES GOVERNING THIS TVPE OF WORK WILL BE COMPLETED WIiH <br />W HETHER SPECIFIED HEREIN OR NOT.THE GRANTINOOFAPERMITDOES NOT <br />PfiESUME TO GIVE AUiHORIiV TO VIOLATE OR CANCEL THE PROVISIONS OF <br />AfJV OTHER STATE OR LOCAL LAW REQULATIN6 CONSTRUCTION OR THE PER� <br />FORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE OWNER OF <br />THIS PROPERiY t0 PERFOPM THE WORK FOR WHICH APPL!CATION IS MADE <br />AND I COMPLY WITH THE STA'fE CONTRACTORS LAW 1827 RCW AND <br />298.200 WAG <br />SIONATUREOFCONiP�CiOROR�UTHOPI2EDA0ENT D�TE <br />X �L7e�P� //—.� 3- €?$' <br />•PPLIC�Nt9CIT NESSUCENSENO.ANOBUSINE93N�ME <br />MECHANICAL <br />RANCaE HOOU <br />WATER HEATER <br />WOODSTOVE • <br />METAI FIREPLACEB CHIMNEY <br />FIREPLACEINSERT <br />HEAT PUMP <br />GAS PIPING <br />E%HAUSTFAN <br />❑ YES O NO <br />� NO.OFDWELUNOUNIIS BUILDING <br />PLUMBING <br />BSMT. OCGLOAD <br />o v MECHANICAL <br />ON <br />� <br />� \�.•::. �. <br />(�THER <br />STATE BUILDING SUFCMARGE <br />STATEENERGYSUFCHARGE <br />PUBLiC WORKS <br />TOTAL <br />SUBTOTAL S <br />PERMIT S <br />TOTAL FEE S <br />l7_\�17_`il.I�l <br />� <br />