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N �everett <br />APPLICATI�ON FOR CONSTRUCI'ION PERMIT <br />TO BE COMPLETED IN INK—PLEASE PRINT � <br />fM c'wro�n ' <br />CITY OF } <br />eVere�l HEATINGSYSTEM: C]GAS ELECTRIC ❑ <br />BUILOING DEPARTMENT <br />259•8810 / <br />O DEMOLITION ❑ COMBINATION f<fi BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />ONTIEP MAILAODRE55 GITV ZIP PHONE <br />(sw�Ct w�Y Gao�P t�� golG s H6e.�o4,�-r tve2brr wv4 9g2o3 '�S'S�i-B49% ' <br />7ENNlT MA0.AUGHESS CIiV 21P PMONE <br />- S'h.�aa �i �49uuu <br />11PCHITECTORDESIGNER M�ILADORESS CIiY 21P P/qNE, <br />�j'A.«.� �5 AAe�r <br />6ENERALCONiRACTOR MAIL ADDRESS CITY ZIP 7MONE UCENSE /(� <br />fl' ..__ �'_' '_' .. _. �lA..0 c«.,_. G Ln.44uv l..A 997lr1 2i� 717`� fJ�V�J/ tn9T1 <br />GOHiP�CTOR MARADDRESS CITY ZIP PI10NE LIGENSE• <br />RUMBMGCONTRACTOR MAILADDRESS GITV ZIP PHONE LICENSE� <br />CLA650F WORK <br />❑ NEW I�DDITION I 1 ALTERATION I I REPAIR <br />�f"'�`�Iw`_ _ • o <br />OEBCNIAE <br />S� <br />IJ: �i:.�.i�] <br />LEML DESCRIPTION Of PPOVERTV (SI�N� BELOW OR <br />LOi�_ 9LOCK D�D OF �C <br />i ��0.� 0 hl� <br />BIN <br />TYPE OF FI%TURE OR <br />WATER CLOSET (TOILEn <br />BATHTUB <br />UVATORV (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />LAUNORYTRAY <br />ROOF <br />SINK ( <br />FOR OFFICE USE ONLY: <br />FIqNT6ET8�CK RERR! <br />�, <br />VSEZON LOTAF <br />� - 1 �. I <br />SIZE OF BLDG, <br />I �� � <br />OCCUPANCVLORD <br />NO.OF <br />I I DEMOUTION I I WOODSTOVE/FRPI.INSERT ❑ BUIL�ING FELOCATION <br />COlIT�CT PENSOH �ND PHONE N0. <br />Tne C�rRr i,.�. a 221-71 7�I <br />I HEHEBY C[RTIFV THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND I(NOW THE SAME TO BE TRUE AND CORRECT. ALL <br />coriEs� PROVISIONS OF IAWS AND ORDINANCES GOVERNING THIS TVPE OF <br />�n S p� WORK WILL BE COMPLETED WITH WHETHEFi SPECIFIED HEREIN OH <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE �, <br />AUTHOfiiTY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY � <br />�� p� 2-oa� OTHER STATE OR LOCAL LAW REGUV+TING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHOHIZED BY THE <br />OWNER OF THIS i'ROPERTY TO PERFORM THE WORK FOR WHICH � <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />SIGNATU(iEOFCONiqRCTORONAUTHORIZED�GENT DRTE i <br />X (� 9/B�4U �AyUi�w CocglL�tti � <br />6 <br />IIPPLIC�NTS CITY BUSINESS IICENSE NO. AND BUSINESS NAME <br />SUB TOTAL S ; <br />PERMIT $ �— <br />TOTAL FEE $ ' <br />�K SIDESETB/CN <br />5 <br />VACANT,SITE <br />� /�/b <br />.�CiUAL a�cgur�xc 'oaVMIUNGuxns <br />�! � nWP�2 �� <br />N v <br />FIFE SPRNRLERS REOD HEI IIT LIMIjAT10N <br />�V m r <br />WOOD STOVE <br />METAI FIREPL/10E 8 CHIMNEY <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />D /i 1'3 �J <br />BUILDINO <br />PLUMBINO <br />MECHANICAI <br />ADDITIONAL PLAN CHECK <br />OTHER <br />STATE BUILDING SURCHAflOE <br />SUB TOTAL E ' <br />PERMIT $ i <br />TOTALFEE $ ' <br />fEE RECEIPTNO. <br />7G. o�— 3 P'� 7 <br />VALUATION FEE <br />GO�) � /-�� <br />INTAKE9V PUNSAPPROVEDBY CITYOFEVERETT PUBLICWORKS <br />_/J LOCAL SALES <br />,� TAX CODE IS 3i05 TOTAL <br />. .. _ _.. .. . .._ ___...._.__..�..._ _.._ .._ ... . .__,.....,._. _ . .. <br />w <br />