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` <br />m. E�ror..� <br />CRY OF <br />everett <br />BUILDINO DEPARTMENT <br />269•BB10 <br />°. � <br />APPLI�T'ION FOR CONSTR� CTION <br />PERMIT <br />TO BE COMPLETEn IN INK— PLEASE PRINT <br />everett <br />e <br />QMNEfl MAIL�DORE55 CITY ZIP PMON� <br />�iU/U RUdo � /0325 /JAU/�S �Pel L4Kt S7Fr�n5 9d.�s8 � � <br />NMIT M11L�0 RES� 5 - CITY ZIP PHONE I <br />MCMITECTONDESIONER M�IL�DORESS CITY ZIP PHONE <br />OENEMLCON7AACTOR M�ILIIUDRE55 CITY ZIP PHONE LICENSE• <br />MECN�NICALCANTIUCTOR ' MAIL�OORESS GIiY 21P PNONE 4CEN9E• <br />liFe NEAT/A/Q �90/-SmiTN /i!/E �UER�Tl" 9�aoi asa-oiyyA,��HEir�Rw <br />PLUM&NpCONTRACTOR � M�IL�DDRE53 GITY ZIP PMONE �ICENSE• <br />❑ NEW ❑ ADDITION ❑ AITERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL INSERT ❑ BUILDINO RELOCATION <br />.S/p/Le lit�.d ✓ �PECidMG C <br />LE DEOCNIPTION qBOPERIY�BHOWNBELOWORATUCHFOUFCOR;S) <br />LOT BLOGK OF <br />PLUMBINO <br />— <br />d DISP. <br />- RAINLEADEHS <br />—aea Frr.� <br />❑ YE9 ❑ NO <br />fii�.',I <br />OY <br />❑N <br />❑ YES o No <br />1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND <br />KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAW9 AND <br />ORDINANCES GOVERNINO THIS TVPE OF WORK WILL BE COMPLETED WITH <br />WHETHER SPECIFIED HEFEIN OR NOT.THEORANTINOOFAPERMIT DOE9 NOT <br />PRESUME TO GIVE AUTHOHI7Y TO VIOUTE OR CANCEL THE PROVISIONS OF <br />ANYOTHEF STATE OR LOCAL LAW RE6ULATINa CONSTRUCTION OR THE PER <br />FORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE OWNER OF <br />THIS PROPEFTYTO PERFORM THE WORK FOR WHICH APPLICATION 13 MADE <br />AND I COMPLY WITH THE STATE CONTRACTORS LAW 1827 RCW AND <br />298200 WAG <br />&ON�TUREOFCONTR�CTORONAUTHORRED�OENT D�TE ^l���_ �9 <br />X � . � n <br />MECMANICAL <br />BUILDING <br />PLUMBING <br />MECHANICAL <br />OTHER <br />STATE BUILDING SURCHAFGE <br />STATEENEROYSURCHARGE <br />PUBLIC WORKS <br />TOTAL <br />� <br />H,P. <br />BT.U. M EA <br />TOTAL FEE <br />6 <br />FEE <br />■ <br />� <br />