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m.ev�ry.«n <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />259•8745 <br />;-,�PPLICATION FOi.r <br />CONSTRUCTION <br />PERMIT <br />TO BE COMPLETED IN INK - PLEASE PRINT <br />���rcn <br />e <br />, ❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />OWNER RIRILPDDFESS CITY Zil' PHONE <br />� William A. Tjerne 2009 21st St. �l+erett 98201 259-6414 <br />� ARLMIiECTOR0E510NER MnRAO��F55 Liiv )IP Po�ONE <br />GENEP�LLONTFACiOR M�ILAODRE55 C�tV IIP PuONE IICENSE• <br />�erett Bldrs. Inc. 5606 Ebergreen way �erett 98203 353-7161 EVEREB`301PH <br />MECH4NICAL CONTRACTOq MRIL AODRESS CpY ZiP PHONF LICENSE • <br />� PLUM6INOCONiRACIOR MAllA00RE55 GIIY 21P PIIU�IE LICENSE• <br />GLASS OF WO(iN <br />' ❑ NEW ❑ ADDITION �'I ALTERATION ❑ REPAIR ❑ DEMOIITION ❑ WOODSTOVE/FRPL.INSE(iT ❑ BUILDING RELOCATION <br />! V�LU�TIONOFWORH�COSIOFMrIi[RIALSPLUSLABORI <br />6400.00 <br />� D[SGPIBEwORN <br />USE OF <br />LOi—BLOLIt_OF <br />4379-420-015-0206 <br />PpOJECT�DORE55 <br />2009 21st St <br />FRONiSEiBRCK <br />ttPEOFCONST. <br />on residencEa (20 sa. <br />Everett� Wa. 98201 <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATION AND KNOW THE SAMETO BE TRUEAND CORRECT. ALL <br />PROVISIONS OF LAWSAND ORDINANCES GOVERNINGTHIS TYPE <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE- <br />IN OR NOT. THE t;RANTING OF A PERMIT DOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVIS�ONS OF <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. � <br />SIGNATURE OF CON1f1AC70R OF ALITIIORIZEO AGENf OATE <br />(n� I - <br />X 1�Ai n r. , �M � i��,_ r' O_-� /_Q �l <br />UNIi! <br />nre oF <br />N0 <br />H.P. <br />THIS PORTION TO BE COMPLETED BY �3UILDING DEPT. PERSONNEL <br />' APPLIC�iION ACC. BY <br />REAR SETBRCK <br />OCCIIP�NCY <br />$I�E SEiBACK PLNN (:HEGN NI <br />VRC�NL 517E <br />❑YES �NO <br />NO.OF OWELLINO U111LS <br />BUILUINC <br />MA% OGC LOAp — <br />PWAIO�NG <br />MECH�NICAL <br />OTIIEfi <br />PENALTY <br />APPR. GOR ISSUANGE BV <br />TOTAL <br />IMBER PLAN CNECN FEE <br />iEE �ECEIPT NO. <br />iEES VALU4TION FEE <br />5 <br />p <br />� <br />