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APPLICATIC"1 FOR CONBS'TRUCT''1N P�Rl491'!' �✓� <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />r-- ---- —,_— -----t <br />BUILDING DEPARTMENT �-- -- - --- —_— <br />259-8810 <br />C i DEMOLI110N I COMBINATION ! i BUILDING ❑ MECHANICAL ❑ PLUMBING ✓ SIGN <br />OWNER M�II ADDRE55 LITV ZIP PMONE <br />�/1- r�¢ � Gblr Ba,��� Bk�r7 f✓va-,ef.r 98�oj 1=�5>js3-336'if -- <br />TE N1 n MMI�C:AE55 LRv DP PNONE <br />U.P�^ f.��7 j <br />� CNITEf.TOR IGN H M�ILADDRESS LITV ZIP PW.NE <br />G'NER�L f,ONTNACTOR MML ADDRESS LITY IIP PHONE S7�TE IICENSE � <br />fLl(%/i2�' G619 R¢ut�i.FU 6�v� F✓l.��.f %b'�3 lro�� 3J-3 -338�/ —_-- <br />MECNANILALCONIFPCIGP MAII�^^^.555 CItV 21P PMONE SiRELICENSE� <br />VLUMBINGCW'T:UGTOH MML�UDR°5 CITY 2iP PHOIIE STATELICENSE� <br />CONTR�CT PRiCE OF WORK <br />� /95. �3 �y�—.� � (Nc CNS-P1Ndj r�H —__- <br />DESCRIBE WOPK �ND SOUARE FOOT�GE INVULVED t^�"" •-7^� CON7ACT PERSON �N� PHONE NO <br />i\ o:__ ._a_..�_../� ✓_ r/o �:__s:....1�X6�X lD �.�rA hnd 1 31 �� 93,P/L <br />)�� sg�a �woand 6�'r <br />PPOVOSED IISE [F BUILOINO <br />LOT — BLOCN <br />BELOW OR RTTRCH TWO GOPIES) <br />— OF <br />P�RCEL T�K I D NUMBER O� �OS ��� O 1�• O� J <br />CCNSTPUCTIONIOANLENDER.ADDRESS,TEIEPHONENUMBER <br />OF <br />LAVATORV�WASH BA'. <br />SI10WEfl <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />FOUNTAIN <br />ROOF <br />FOR OFFICE USE ONLY: <br />FRONTSEiB�CK NE�rB! <br />L <br />USE .'0� � tOT �F <br />y� � �� <br />rrvc �K coxsi "o � <br />:IZE Of <br />TOTAL $ <br />MIT 5 <br />�L FEE S <br />FIRE SPRINKLERS NEO'0 <br />FIRE Q�RM RW C� <br />INT�kEBv I P��NSAPPROVEDBY <br />D�TE <br />FEE <br />0 <br />i HEREBV CEHTIFY THAT I HAVE READ hNG EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORPEC i. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TVPE OF <br />WOfiK WILL BE COMPLETED WITH WHETHER SPECIFIED HERP"' OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PFESUME TG WVE <br />AUTHORITV TO VIOLpTE OR CANCEL THE PROVISIOIJS OF ANV <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUC716� OR THE <br />PERFORMANCE OF CONSTRUCTICN. THAT I AM AUTHORIZED BV THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WOFiK FOR WHI(,Fi <br />APPLICAlION IS MA�� ANO I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.21 RCW AND 296.200 WAC. <br />,� C� •_ p,�^�y ,y�L �-z-9,� -- <br />scru.run[ wt[ <br />OFEOUIPMENT � FEE <br />UNIT HEATERS—B.T.U. M <br />CLOTHESDRVERS <br />VENTILATION FAN <br />RANGEHOOD <br />METAL FIRE <br />FIREPLACE <br />HEAT PUMP <br />GAS PIPING <br />5!OE SETB�CN PUN LNECK NU tltn <br />—�� <br />V�C�NfSRE FEES <br />" VES � � NO BUILDING <br />OC[v>�N[r N�qRMRUHGUN.�S —� <br />°R"'j0 PIUMBING <br />B�SEMENT MECHANICAL <br />"-� YES �� NO <br />NEIGNT LIMIIATION ADDITION�L PUN CHECN <br />OTHER <br />STATE BWLOING SURCHARGE <br />CITY OF EVERETT PUBLIC WORKS <br />LOCAL SALES <br />TAX CODE IS 3105 rorn� <br />M E.A. <br />� <br />_� _ <br />SUB TOTAL $ � <br />PFRMIT $ <br />TOIALFEE E , <br />�s" � /OssG,� .. <br />i <br />D <br />