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�� k APPLICATI� FOR CONSTRUC �'v��ON PERMIY <br /> �,.� <br /> fM Errryrwn <br /> everett <br /> cm oF � <br /> :, everett <br /> ; BUILDING DEPARTMENT <br /> ' 259-8810 TO BE COMPLETED IN INK—PLEASE PRINT <br /> :i <br /> � ❑ DEMOLITION ❑ COMBINATION ❑ BUILDINO ❑MECHANICAL ❑PLUMBING ❑ SIGN <br /> A q MAR�DORE CITY 21v PIIpNE <br /> � ��s,lG�' �g ��C�c. ��/ C!�'E�.,�•%o e?s�--�3 y� <br /> ; <br /> � TEIUM 1UR ADDREBS GITY 21P P E <br /> � � �"$ Lal ' <br /> ; ARCNRECTORDESIONER MMlA0DRE88 CITY ZIP PIIONE <br /> i .Ul�C�LRC/,�l r� <br /> � /�E EML MAIL DNESS CITY 21P PNONE LICENSE� <br /> ico�/.�l�h�'v .�o.d,7`,�,«�7ew ��s-� n•,•rr•�+Ce�c. B�.� ��s-4�s� �icPchc�u�N <br /> � <br /> "`�'""'���er'°7�IGOIV��DRESB °�TM 21 aRk Na,l� Fd�a»� <br /> ( PLUMlINOCpITRACTOR MAIL�DORE58 CITY 21P PHpJE LICEN9E1 <br /> .' <br /> � � <br /> i <br /> CU!!OF V/ORN <br /> ' ❑ NEW ❑ ADDITION ❑ ALTERATION Iy0 REPAIR I i DEMOLITION I I WOODSTOVE/FRPL VJSERT U BUILDINp RELOCATION <br /> 11 TE/LINTIIAPIIOVEMENTOqMTER�ypp NEMODELONLY CONT�CTPER9p/�NDPIqNENO ,; <br /> � CONTMCTPRICEOFWORM: X � LO�O <br /> pElCRIlE WORIf M!DlOU�HE FOOTAOE INVOIVED • <br /> ! C�✓.✓e�"S�M�cI�ItGc �ih1�'N�'� C1W^��.�»/S <br /> � raoroeeouseoreu� I HEREBV CERTIFV THAT I HA'.E READ AND EXAMINED THIS <br /> � S APPLICATION AND KNOW THE 9AME TO BE TRUE AND CORRECT.ALL <br /> IEML OEBCRIP OF PPOVERTY �ow A N FOUR COPIEB� PROVISIONS OF LAWS AND ORDINANCES OOVERNINQ THIB TYPE OF <br /> �7. WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> 'i LOT ,B1O0" °F �'� NOT. THE ORANTINO OF A PERMIT DOES NOT PRESUME TO OIVE <br /> ' NNyldTy AUTHORItY TO VIOLATE OR CANCEL THE PRO`/1SIONS OF ANY <br /> � I�►A4 �O , �ST' OTHER STATE OR LOCAL lAW REOULATINO CONSTRUCTION OR THE ;;y <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE (� <br /> � ROOr��71� � Q/bu.d OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> � APPLICATION IS MADE AND I COMPLV WITH THE BTATE `�,� <br /> Y� � .� � � CONTRACTOflS LAW iB27 RCW AND 288200 WAC. <br /> BqN�NRE Of COIkMC T1kMiRED 11'JENT DAtE <br /> A /�� <br /> � �no.�ct�ooaesa <br /> ' �5.�' /���/`��a APPIILANT6CITYBU!NE98L NBENO�NOBUBINEBBNMIE <br /> i L <br /> . ry.UMSMp MECMANICAL � <br /> �� NO. TYPE OF FDfTURE OR ITF.M FEE NO. TYPE OF EOUIPMENT FEE <br /> '+ / WATER CLOSET OILET � A/�NHNDLO UNITS—H.P. __�_ <br /> � / BATHTUB ' FORCEO AIR SVSTEMS--H.T.U. M E.A. � � <br /> IAVATORV(WASH BASIN) � UNIT HEATERS—B.T.U. M � <br /> � SHOWER � CLOTHESDRYERS � ���, <br /> r 3 KITCHEN SINK�-019r � VENTIIATION FAN ' ���� <br /> �j DIBHWASHER HANOEHOOD � ��� <br /> ;� LAUNDRVTRAY � WATER HEATEF ' <br /> CLOTHES WABHER � W000 STOVE � <br /> �� URINAL ' METAL FIHEPLACE 6 CHIMNEY � <br /> �: DRINKINO FOUNTAIN FIREPLACE INSERT � <br /> '.I FLOOR DRAIN � HEAT PUMP � <br /> �1 BACKFLOW PREVENTERB i OAS PIPINO � <br /> �I ROOF DRAINS—RAINLEADERS � EXHAUST FAN � <br /> SINK(SERVICE—BAR,ETC.) ' ' <br /> � � i <br /> ? L/ � /�4TQ/�` � <br /> � i <br /> 1 i i <br /> � i <br /> � . SUB TOTAL S ; — SUB TOTAL S �_ <br /> PERMIT S � PERMIT f � <br /> i TOTAL FEE S ' � TOTAI.f'EE S ' <br /> � FiqNTBETBACK PE�R6ETBACN BIOEBETBACN PIANCHECkNUMBER FEE RECEIPTNO. <br /> ueetone IOTAREA v�c�wteire FEE9 VALUATION FEE <br /> f] VES ❑ NO BUIL�INO � <br /> trrFacoxecuiow�eic meaco�sc�cruu aY�..,cr raw�u.ou.n <br /> enour PLUMBINO � ' <br /> � <br /> BREOFBLDO. NO.OFBTORffB BA6EMENT MECH�NICAL i <br /> ❑ YES O NO <br /> OCCUMNCYLWO FIREBPRNNLEH9RE09 HEY?NTLIM�TATION OTHER � � <br /> ❑ YES O NO � <br /> BTATE BUILDINO SUflCHAROE � ��j I <br /> REAtON FOR BPRM114ER8 .. <br /> � 9TATEENEROYSURCN�ROE i <br /> �P►LICATWNACC.BY PUNBAPPROVEDBY CITYOFEVERETT PUBUCWORKS � � <br /> LOCALSALES � I <br /> TA)(CODE IS 3105 �T�� �� I <br /> �Y���/?A51.i.��r:^i . . ... :1 . '7�^ , .. . - ..�. i . '._ . . � .. . . . . . , . ... . . .,- <br />