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F <br />� <br />APPLICat10N FOR CONSTRt�CT10N <br />PERMIT <br />fhe Everpnsn <br />GTY OF everetl <br />everett e <br />BUILDING DEPARTMENT <br />259•8810 TO BE COMPLETED IN INK— PLEASE PRINT <br />OWNEfl M�IL�DOPE55 GIY 21P PMONE <br />j�U.. E10LtiE.�1-�� 11x� w, MARa�VItl4J D2 [:�i 98Zv1 <br />TENNIT MML�ODRE55 QIY ZIP PHONE <br />rnscslortl.S �k]^�c�¢+AF3- 12��A w. ^.^nR.,►�Mvrtwa� �� �8m� ZSYi-2yy� <br />ARGYITEGTORIIESIONER MMLA�ORF.53 GTV ZIP PHONE <br />rii ��_N ��IJ�J�I �� �� <br />OENEMLCONTPI1CiOR M�IL�OURE55 CITY 21P VNONE LICENSE• <br />�1 <br />MECH�NICALCONTMCTOR M�IL��DRE55 CITY 21P PIIONE LICENSE• <br />PLUMBINaGONTR�CTOR M�IL��ORE55 CITY ZiP PRONE LIGENSE• <br />❑ NEW ❑ ADDITION �AL7EiiAiION ❑ REFAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPLINSERT ❑ BUIL��NGRELOCATION <br />YENANTIM <br />� CONTMGi <br />�s�PO <br />: � <br />RIOP08EL <br />' LOT_ BIOCK Of <br />PLUMBINO <br />WATER <br />ROOF <br />� <br />� <br />po0 i ►ti <br />TOTAL FEE S <br />R�SETB�AC(N� SIDE51 <br />JV/ I _ <br />A�/HE� VACANI <br />�1p OI a � � O YES <br />UP� CVOROUP NOAF <br />� Z <br />JF9TORIES BSMT. OCGLI <br />3 oY <br />NEIOHI <br />_ pN0 � <br />!9 �PPR BY <br />�W <br />FEE <br />I HEPEBV CERTIFY THAT 1 HAVE READ AND E%AMINED THIS APPLICATION AND <br />KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS AND <br />ORDINANCES GOVERNING THIS TVPE OF WORK WILL BE COMPLEfED WITM <br />WHETHER SPECIFIED HEREIN OR NOT. THEGRANT�NOOFAPERMITDOES NOT <br />PRESUME TO OIVE AUTHORIN TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANV OiHER STATE OR IOCAL LAW REGULATINO CONSTRUCTION OR THE PER- <br />FOFMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BV THE OWNER OF <br />THIS PROPERNTO PERFORM THE WORK FOR WHICH APPLICATION IS MADE <br />AND I GOMPLY WITH THE STATE CONTRACTORS LAW 1827 RCW AND <br />296200 WA�. <br />SION�TUREOp1:Gy1R�C10f1011AUI110RRE0�GENi ��iE <br />NO. TYPE OF EOUIPME <br />/VC — Al HNDLG UNITS — H.P. <br />FORCED AIR SYSTEMS— 9T.U. <br />UNIT HEATERS— &T.U. M <br />FEES <br />BUILDING <br />PLUMBING <br />MECHANICAL <br />OTHER <br />STATE BUILDING SURCHARGE <br />STATE ENERGV SURCHARGE <br />PUBLIC WORKS <br />TOTAL <br />M EA <br />Ed <br />FEE <br />