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BUILDING DEPARTMENT <br />259-8810 <br />DEMOLITION <br />TO BE COMPLETED IN BLA�:h: INK—PLEASE PRINT � <br />HEATING SYSTEM: �i'iAS J ELECTRIC J <br />COMBINATION � BUILDING �MECHANICAL �_iPLUMBING <br />f�DORE55 CitY ZiP PHONE <br />� _ Jl/� r7 _ . . /) . �. � .. C: T ��%/1 . "7? / 1 <br />TEHANi � AUIL�ODRE55 ���� <br />�11nn= <br />�RCMITECTORDESIGNE MRILApDRE55 CITV <br />GIE/NEN0.CONiP�CTOR MRIUpDRESS ��T� <br />/Yu,� ln�i9T�.�'%��ATiC' .-�460 ��%� <br />CI� M�NIC�LCONiP�CiOR M�ILADD�VE55 ��t� <br />PWIABINGCONTRAGTOR M�ILADDFE55 ��T� <br />CONiF�LT PFiCE OF WpR� ^ <br />��7C-' <br />OESCRIBE WORK AND SOURBE fOOTRGE INVOLVED <br />PROPOSED USE OF BWIDING <br />IEOQ DESCRIPiION OF PHOPERIY �SMOWN BEIOW OR ATt�CM TWO COPIES� <br />LOT BIOCR OF <br />PRRCEIT�%1� NUMBER <br />CONSTRUCTION IORN LEI <br />WATER CLOSET(TOIL <br />BATHTUB <br />LAVATORV (WASH BA', <br />SHOWER <br />HITCHEN SINK 8 DISP <br />DISHWASHER <br />LAUNDRVTRAV <br />FOR OFFICE USE ONLY: <br />FRONTSEiB�CN REARSEiBACK <br />USE ZONE lOT PREA <br />LYPE Of CON51 <br />NUMBEF <br />FIRE SPRiNNLENS REO'0 <br />FlPE AI�RM PEOD <br />INTRXE6Y PUNS�PPAOVE�BV <br />o�re <br />FEE <br />f b <br />FEE S <br />21P <br />$iP <br />ZIP <br />CON7�CT PEFSON RND PHONE NO <br />PMONE <br />PHONE <br />PMONE <br />i <br />PMO� <br />PNONE <br />STRTE 110EN5E � <br />i <br />ST�TE l� <br />STATE IICENSE • <br />SIGN <br />L.2c-r i C` i�k,10 l��r�'/r� <br />E� Y�s <br />I HEREBV CERTIFV THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TVPE (1F <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. TNE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNEti Of THIS PROPERTV TO PERFORM THE WORK FOH WHICH <br />APPLICATION IS MADE A D I OMPLV WITH THE STATE <br />CONTRACTORSLAWI CW 96aBQ'C1�4C. <br />FORCED AIR SVSTEMS—B.T.U(p� M E.A. <br />UNIT HEATERS—B.T.U. M <br />CLOTHESDRVERS <br />VENTILATION FAN <br />RANGE HOOD <br />WATER HEATER <br />WOOD STOVE <br />METAL FIREPLACE (WOOD BURNING) <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN <br />SIpESETB�CM PUNCNF.CkNUM9ER <br />VRCANT 511E FF.ES <br />� � VES � NO BUILDING <br />(1[� nlyf♦ 59 01 �M1l1�yt�i.N'� -- <br />'' ` PWhIAING <br />BnSE�ENT MECIIANICAL <br />VES NO -- <br />MEiGHTUMrt�iloN ADDI110NALPLANCHECN <br />OTHER <br />STATE PWLDING SURCHARGE <br />CITY OFEVERETT aueuc woaKs <br />LOCAL SALES <br />TAX CODE IS 3105 TOTAL <br />SUB TOTAL <br />PERMIT <br />FEE <br />PECEiPTNO <br />T <br />.� <br />