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�.; �, <br />M� Ewryn�n <br />CITY OF <br />everett <br />BUILDINO DEPARTMENT <br />r.: <br />APPLIC�ION FOR CONSTR �'� TION <br />PERMIT <br />269-8810 TO BE COMPLETED IN INK— PLEASE PRINT <br />OWNER MMLApORE55 pfY 21P PHDNE <br />I���li�� VAr1anLFN Jk gK��' I�M6�iSfi.1 ��l Ca�,.tA', �n S'r•zc� 3.C�}-.�1d�/ <br />TENANT \'�IL�ODRESS CIIY 21P PMONE <br />NICHRECTONDESIONER MeILAJDRF&5 GI1Y 21P PMONE <br />everett <br />e <br />OENEMLCANTPIICTOH MAILAOORF55 GTY ZIP PHONE LICENSE• <br />/n�/� �n ) i /� �� Q n i.. C.. -.i.�.�., /... � r:,..-..r%/ �.'ii.>nV le'£�77iri flfe.vunf/ <br />GLUM&NOCONTMCTOR MML�O�PE53 GrtV ZI� PNONE LICENSE• <br />'lS NEW ❑ ADDITION ❑ ALTERATION <br />�C a., �o /`/J- /J .11�f`, d7l. . � <br />lEp�1LyEBGqIPTIONOFPR PENIYISHOWNBELOWOR�i" YLC <br />�or��� e�ocK�_ oF /'��T �'F i. <br />aiv �� <br />rLUM�INO <br />TYPE OP <br />Yi:7c15 <br />DRINKIN� <br />- RAINLEADERS <br />_aaa Frr.� <br />SUBTOTAL <br />PERMIT <br />TOTAL FEE <br />FqpNTSEfBACK RE�RSET&1CK <br />� �� <br />UBEZONE lOTARFA <br />TYPEOFCAN T. ✓�Ir OGGVPA CYOORO� <br />AILOW�BLE/AGTU�� \ I _ 1' �� � <br />.� R <br />61ZEOFBLD(3. NO.OFSTORIES f <br />�285s¢ -r 1 z <br />¢� 5 S� G,A�4�LG E <br />FlREBPPINItLER9PEWIREO ❑YES xND <br />.1PPLICATI�� GBY PL�NSAP� <br />►�1 � <br />.. / vr�1'f.� L V �X.0 J <br />❑ DEMOLITION ❑ WOODSTOVE/FRPL INSERT ❑ BUILOINO RELOCATION <br />�•5.2 . <br />I HEREBY CERTIFV TNAT I HAVE READ AND EXAMINE� THIS APPLICATION AND <br />KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS AND <br />ORDINANCES GOVERNINO THIS 7YPE OF WO.:v WILL BE COMPLETED WITH <br />W HETHER SFECIFIED HEREIN OR NOT.THE ORANI:NOOFA PERMITDOES NOT <br />PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION9 OF <br />ANY OTHER STATE OR LOCAL LAW REGULAiING CONSTRUCTION OR THE PER- <br />FORMANCE OF CONSTRUCTION. THAT I AM AUTHOR12E0 BY THE OWNER OF <br />THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE <br />AND I COMPLY WITH THE STATE CONTRACTORS LAW 1827 RCW AND <br />296200 W.4C. c}7'Q <br />&ONAi EQ^GONTP�CLORORnU1NORRE0�0ENT DATE G �'?O "'( <br />7 <br />X / � <br />� � �l/� � �.�_...,� <br />•PPUCANIS GITY BUSINE95 LICENSE NO. �Np BUSINESS N�ME <br />MECM�\N:G1L <br />NO. � TYPE <br />- A/C•-A/HND�GI <br />� ��PJED AIR SYS� <br />� IINITHEATERS- <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATEF <br />WO00 SiUVE <br />METAL FIREPLACI <br />FIREPLACEINSEF <br />HEATPUMP <br />FAN <br />BUILDINO _ <br />PLUMBING <br />MECHANICAL <br />OTHEF <br />STATE BUILDING SURCHARGE <br />STATE ENERGV SURCHARGL <br />PUBLIC WORKS <br />TOTAL <br />- H.P. <br />- 9T.U. M EA <br />M <br />Z28�g <br />FEE <br />� <br />