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4 <br /> !"�'\ <br /> APPLICATION FOR CONSTRUCT�a)I� PERMIT ''�°"'" <br /> , TO BE COMPLETED IN INK—PLEASE PRINT � <br /> c.nvor �/ ���� C-- <br /> everett _ � / _____ - <br /> I NEATING SVSTEM '�GAS LYELECTRIC U _._ -� �- -- <br /> BUILDING DEPARTMENT ` --- -- --"-- - <br /> 259 8810 <br /> `�n �d _DEMOLITION COMBINATION _ _ BUILDING _ MECHANICAI PLUMBING SIGN <br /> OWNHi ,l ,I <br /> MAIL�ODPE55 L�1V PP PIIONE <br /> O A � 1� �✓y` nts � �l e '47�U U�L'(u 4UL? LaU Y7�G S ,3 y7-¢�7p _ <br /> a H� 1[N��lSwL—�].d�.�1Z1�__�LSI���SI �,IL� ZIP PIIONL <br /> M�il�I)�RESS <br /> H 7. � _�'''�'� _ <br /> cnr ziv rr�orve <br /> K' C7 �ncHiicc�oNo[::icNtn unn�noN�s; <br /> � <br /> � � CITY 21P PNINE IICENSEI . <br /> GFNLfi�L C(N11P�CI011 1AAIL AflDRE55 <br /> y ���/�/C/SG.Px G <br /> :j <br /> �� 4ECIIANIL�ICONTP�LLOR MML�ODPE55 (:IIY _ IIP PHONE LICENSEI <br /> 0 H � PWMO�NGCONINAC1011 M�IL�D�RE55 CIiV 2'�P PIIONE LICENSE� <br /> � �g <br /> (�]Y (] <br /> CLASS OF WOAM � <br /> �y� NEW VADDITION ALTERATION REPAIP. DEMOLITION WOODSTOVE�FRPL INSEFT BUILDING RELOCATION <br /> CON1ALi PLPSON ANO PIIONE NO <br /> HH <br /> �J�/J CONTRAGT VPICE OF WOPN <br /> � "y pE5GP�0E WORK NU SOWRE GOOtAGE iNVOLV[D <br /> v �q� �i r- �. .i�_J.nJ S� L o ' <br /> ra oseousecFaunou+c � I HEREBV CERtIFY 7HAT I HAVE READ AND E%AMINF.� THIS <br /> yO� ��'`� � � 1 ' y APPLiCATION AND KNOW THE SAME TO BE TFiUE AND CORRECT.ALL <br /> � PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TVPE OF <br /> i[r.��nescn�Ptwr+ovrnov nrvis�owrveeio��+onerT -Hwunccro s yyORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> ior_�'___ nicen _�_ ov __ NOT. THE GRANTING OF A PERMIT DOES NOT PPESUME TO GIVE <br /> • AUTHORITV TO VIOLATE OR CANCEL THE PROVISIONS OF ANV <br /> _m ,,��` 1���A� �^� OTHER STATE OR LOCAL LAW HEGULATING CONSTRUCTION OR THE <br /> ,�_r." —�-i 1 PERFOF.MANCE Of CONSTRUCTION.THAT 1 AM AUTHORIZED BV THE <br /> OWNER OF THIS PROPERTV TO PERFORM iHE WOFK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STP.TE <br /> — CONTRACTORS LAW iB.D RCW AND 296200 WAC. <br /> SIGNRiOBCOPCONIRACIORORAU1MOliIZED�GENi D��E �S/Y� <br /> X ",I�� <br /> PqWECfA[ll)RE55 � � . / �ypl.������pSiN[SSI�CENSENORIDfIU5WE55NAM[ <br /> �173 �'a a ilast. N <br /> /-� ��. PLUMBING _ _ MECHANICAL <br /> it Np, TYPE OF FIIfTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> C'i _ WATERCLOSET�TOILET) - AC-A�HNDLGUNITS-H.P. <br /> 1 __ BATHTUO _-- — ;_- - - FORCED AIR 5`'STEMS-BSU M E A. <br /> � LAVATORV�WASH�ASIN) 0 � UNIi HEATERS-B.T.U. M <br /> ._� _� SHOWC-R j i CLOTHES DRVERS <br /> � ��I KITCHEN SINK 8 DISP VENTILATION FAN <br /> � DISHWASHER RANGE HOOD _ <br /> LAUN�HV TRAV 'NATERIIEATER <br /> I - NIOOD STOVE <br /> i ,.,�� CLOTHES WASHER - <br /> ` � URINAL MET�L FIREPLACE 8 CHIMNEY <br /> � FIREPLAGE INSERT <br /> DRINKING FOUNTAIN �— <br /> �. FLOOR ORAIN H[AT PUMP _ <br /> BACHFLOW PREVENiERS GAS PIPING _ <br /> 1� - EXHAUSTFPN <br /> , _` ROOF DRA!NS-RAMLEADERS <br /> �� SINK�SLRVICE-BAR ETC.) ---- � <br /> � ��.��� _ --- — -- - — <br /> SUBTO7AL 5 _�ST _ __ __ SUBTOTAL S _ /S ____ <br /> .---- --- -r--- -- PERMIT $ <br /> PERMIT $ � <br /> r _—_."- _ _—_— _ __.____-- _- _ _ <br /> I I� "-- - �-��- � TOIAIFEE $ S ' TOTALFEE 5 /S <br /> L <br /> FOR OFFICE USE ONLY <br /> � rl nN O�t rn rNn�ltl rl rl t . / RCLL�ni Np <br /> fPONI5f10�(Y RI/II..I�IiRI N S f 1 .Rqni r <br /> ZS—� Zf' 7� / v� /a�v � � � � 7;+ , a c" S 3.� y 5 <br /> - -- - ' VALUATION FEE <br /> �•i turu - iui nni_n tn�nr�i �.0 � I � � FEES �� <br /> � <br /> �� N �w�oiNc 53�`/!J Y3.�_5�0 <br /> • - <br /> — __ __ -- <br /> �.N�11 L�I ION>Bll 1"N Ot CUN51 AC W! '�� -- — - � � �� q <br /> 4 'q . <br /> ..--� / IAECHANICAL I � vC' <br /> Pll1MBMG O � <br /> �L-n1_ ._ �'� _ � 3 ---- - — — — �-- <br /> ,�:i a a�oc r�oc sroaies - I „�,t�.,;r,�-- �- �o c _ <br /> ------- <br /> _ - <br /> .I_I�� F ���� � - '--- ""�—- ADOIIIONALPLANCH6CN )(c � � <br /> i��ciiV�NCYIOAp fNFSPRNNEfiS�E00 �' �r¢���I�IMiUtiUh _ __ ��� <br /> �J@ � i <br /> �ii I ..4�U-_'-___- O7NER � <br /> uf PSUN(OR SPRINNICRS <br /> ;in1Cf7UIlDINGSURCNARGE � _� �SC <br /> ��n�.enr P���+s^u���������� CITYOFEVERETT �ueuCwonKS �- <br /> �,". � /J.�} LOCAL SIl�ES <br /> —� �/ �?�q TAX COUE IS 3105 TOUL j I7� / <br /> --� -- J <br />