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rne fwroreen <br />CITY QF <br />everett <br />BUILDING DEPARTMENT <br />259•8870 <br />APPLICk�f10N FOR CONSTRO►CTION <br />PERMIT <br />TO BE COMPLETED IN INK— PLEASE PRINT <br />�dCr�T �Y�z�3 <br />zir � <br />/JICMITECTOR�ESIONER MAIL�DDRE55 ptY 2iP PHONE <br />co m�cro <br />D a ,�h�� Co.�7-i• ix>—L .r- .�r. �'� �� �� ��,� <br />�S 2— �/nli i" <br />PNONE LICENSE � � <br />!r5—G/i� �cdu3UL� � <br />FIIONE LICENSE • �i <br />PLUM&NOCONTH�GTOA M�ILAOOHE55 ' GIIY ZIP PIIDNE LICENSE• <br />❑ NEW V❑ AODITION ❑ ALiERATION I� REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL INSER7 CI BUILDING RELOCATION <br />TENIINT IMVRW EMENi OR INiEBIO,�R" REMOOEL ONLY I CON I�GI PEfiGON �NO PIIONE NO <br />OOHTRACTPRICEOFWOPK // II3s�•OU I y---- <br />1 <br />LOT BLOCK Oi <br />PLUMBINO <br />WATER <br />/.✓�DD/�1F,�/✓ <br />DRAIN <br />SUCI�I lL-7 <br />TOTAL FEE E <br />FRONTSET&�GN RE�RSETB�CN 90ESETBFCI( <br />U9E20NE LOTAFE� VAGRNTSITE <br />❑ YES ❑ NO <br />ttPEOFCONST. OCGUP�NCVOROUP NDAFOWELLII <br />QLOW�BLE/�CTUAL <br />61ZEOFBL00. NO.OFSiONIES BSMt. OCCLO�O <br />❑Y <br />❑N <br />HEI6NI IIMIT�i <br />flRE 9GNINNLERS REOUIpEO ❑ YES O NO _ <br />I HEFE6Y GEFTIFT 1 HHI 1 HHV t IItPU nrvu cnnmu�ev �� no... �..v .............. <br />KNOW'HE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS AND <br />ORDINANCES GOVERNING THIS NPE OF WORK WILL BE COMPLETED WIiH <br />W HETHER SPECIFIEO HEREIN OR NOT. THE GRANTING OF F PERMIT DOES NOT <br />PRESUME TO GIVE AUTHORITV TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANV O7HEfi STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PER� <br />FORMANCE OF CONSTl7UCTION. THAT t AM AUTHORRED BY THE OWNER OF <br />THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE <br />AND I COMPLV WI7H THE STATE CONTRACTORS LAW 1827 RCW AND <br />296.200 WAC. <br />SION�iUREOfCONiRAL10t10f.A111110R2EURGENf O�TE �-7� <br />����l//�/ " _ 1iD�//�L(�'�N✓ <br />�PPUWMS G1Y B1151NE55 LIGEHSE NO. �ND BUSiNESS N�ME <br />MECNIINICAL <br />TVPE OF E�UIPI <br />A/C — AlHNDLG UNITS — H.F <br />FORCED AIR SYSTEMS — B.T <br />UNITHEATERS—BT.U. M <br />CLOTHESDRYERS <br />WOODSTOVE <br />METAL FINEPIACE 8 <br />FIREPLACEINSERT <br />HEATPUMP <br />GAS PIPING <br />PERMIT <br />TOTAL FEE <br />BUILDING <br />PLUMBING <br />MECHANICAL <br />OTHER <br />STATE BUILDING SURCHARGE <br />STATE ENERGY SURCHARGE <br />PUBLIC WORKS <br />TOTAL <br />M EA <br />S <br />S <br />S <br />rx'.�•�...._ . - �-.r. �::. . . � .. �.. .. _ . . . .. . . . . . .. <br />� <br />L <br />