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APPLICATI�.N FOR CONSTRUCI rON PERMIT <br /> (he Eve�preen everett <br /> ��T�oF e <br /> everett <br /> BUILDING DEPARTMENT <br /> 259-8810 TO BE COMPLETED IN INK—PLEASE PRINT <br /> f I DEMOLITIOIV f 1 COMBINATION f I BUILDING I I MECHANICAL i 1 PLUMBING C 1 SIGN <br /> ow'�r+en/ L ( i1.ADDRE55 A n cnv nr��t-� PIIONF �/ } <br /> _�jJ` � lI�O�!"S �/1'� �S� T—�/Y�.9cl.�(Clfl4 �1>trC��/�LQ � �S�_7-�J / <br /> ien�+nHr Mnanuoness cirv' zm rr+cr+r — <br /> /CU�,�� 3514� -1;v.,�Pu�,� L������ 9�zv/ 339 —/��O <br /> �11CMiTECTORDE5IGNF MARADDRE55 ITV zIP PIIONE <br /> GENEp�LCONIIUCTOB M�ILAD�RE55 GTY ]IP PIION[ LICEIISEI <br /> MyGVIRNIC�L�R M�IL ADUR����� GITV 21P PI/ONE LICENSE� <br /> �� i� �� • <br /> �y.,�y -�a:�o�---'v R�A.,_��x�,- _ =_=9��-2_5s�--� .3.�/- OLeJlZ11�� <br /> PWMOIIIGCONfP4CTOB MAILRO�RE£. CITY 21P PIIONE LICENSEI <br /> CL�SSOf WORK <br /> I I NEW I I AUDITION � I ALTEf7AilON I I R[PAIR I I DEMOLITION �WOOdS1�OVE/FRPL INSERT I I BUILDING RELOCATION <br /> TEN�NT IMPpOVEMENt OR INiEqIDfl REV.OpELONtV f.ONiACT PERSON pND PNONE NO. <br /> CONiR�GT PRICE OF WOP1t: <br /> OESCRIBE WORN A40 SOU/NE FCOTr1GE INVOLVED <br /> J�i:vsµ� GJ� s�� <br /> PROi'OSE�USEOFBU�IDINb o �L I HEREBY CERTIFY TIiAT I HAVE READ AND EXAMINED TIiIS <br /> x�PSiG�.� 4 (-- /�riv/�+-C APPLICATION AND KNOW THE SnME 70 BE TRUE AND CORRECT.AlL <br /> LCO�LDESCAIPTIONOFPROPEATY�SI:OWNBEIOWORATI/.CNFWRCOPIES� PRUVISIONSOFLAWSANUORDINANCESGOVERNINGTHISNPEOF <br /> WORK WILL BE CONPLETED WITH W1IETHEFi SPECIFIED HEFEIN OR <br /> lOi_ BLOCK oc NOT. THE GRANTING OF A PEPMIT DOES NbT PRESUME TO GIVE <br /> AUTHORITY TO VIOLATE OF7 CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAI LAW REGULATING CONSTRUCTION OR THE <br /> PERfORMANCf OF CONSTRUCI ION.THAT I AM AUTIIORIZED BV THE <br /> OWNER OF Tfi15 PROP[RTY TO PERFORM THE WORK FOR WHICVi <br /> APPLICATION IS MADE AND I COMPLY WITH TfiE STATE <br /> C�NTRACTORS LA'N 1827 RCW AND 296200 WAC. <br /> SIGNATURE/JFCONiRACTOROFAUI110R12ED�GENT DAi[ <br /> X 1 � L L, <br /> rna�c*nuun�e/S5 p /J y ���_�yv� �l <br /> 'k �J 7�� ' l.�/'OAd��[.7 `_�/['fe��. Arr!.icHiSLIlY0U9NF.55LICENS[NO.nNDCU51NE55NA1AE <br /> PLUMBIN3 McCNANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE Of-EOUIPMENT FEE <br /> WATER CLOSET(TOILET) NC—NHNDLG l.�Nf�S—N.P. <br /> BATHTUB ; FORCED AIR SYSTEMS—B.T.U. M E.A. ~— <br /> LAVATORV(WASH BASIN) �_ UNIT HEAT[RS—B.LU. M ; I <br /> SHOWEA � CLOTHES DRYERS rr--�—��— j <br /> _ KITCHEN SINK 8 DISP � ; VENTILATION FAN 1 : <br /> DISHWASHEH � RANGEI100D 1-�— <br /> LAUN�RY TRAV � WATER HEATEN <br /> CLOTHES WASHER —i— <br /> � W�D =TOVL- <br /> URINAL ' METAL FIREPLACE 8 CHIMNEV � F ) <br /> ORINKING FOUN�AIN —�— FIREPLACF INS[RT <br /> FLOOR DRAIN � HEAT PUMP �— <br /> OACKFLOW PHEVENTERS � GAS PI!'�NG � <br /> — � <br /> ROOF DRAINS—RAINLEADERS � E%HAUST FAN -T— I <br /> SINK(SEiiVICE—BAR,ETC.) � � � <br /> � <br /> � i <br /> i i <br /> — T <br /> 1 <br /> ^ � SUO TOTAL $ ; SU6 iOTAL $ ' r'— <br /> PERMIT $ � PERMIT $ —I— <br /> TOTAL FEE $ ' TOTAL FEE $ <br /> fRONTSETBAGK IlEAR5EIBAGN SIDESETB4CK PLANCHECKNUMOER FEE RECEIPTNO. <br /> usezone �ornnen VACANTSITE FEES YALUATION FEE <br /> ❑ YES ❑ NO BUILDINO . i <br /> 1Y�"OfCONST.AIIOWABIE iYl'EOfCON57.1C1UAL �'�'<Y No.avMnuNCUmis <br /> Gn01m � <br /> PLUMBING <br /> SRE OF OLO(3 NO.OF STOPIES BASEMENT MECHANICAL . � � <br /> ❑ YES ❑ NO <br /> OCCUPANGYLOnO Fll1ESP,lNKLERSPEO'D NEIGNTIIMIIAiION OTHER � <br /> ❑ YES I.l NO STATE BUILDING SURCHARGE � <br /> REASON FOP SPfiINK�ERS -- � <br /> T <br /> STATEENERGVSURCHARGE � <br /> APPII TION� COV "�ANSAPPROVEDBY CITYOFEVERETT PUBLICWORKS � <br /> � LOCAL SALES ' <br /> TAX CODE iS 3105 roTn� � ' � <br />