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.:,, <br /> ;t <br /> APIpLICQ►TION FOR CONSTRUCYfL�N PER�il11T <br /> Ihe Frerqrcrn everett <br /> ���Y�� e <br /> eve�•ett J <br /> EiUILDING DEPARTMENT <br /> 259-8810 TO BE COMPLETED IN INK—PLEASE PRINT <br /> I i DEMOLITION ry3 COMBINATION i I BUILDiNG I I MECHANICAL I 7 PLUMBING 1 7 SIGN <br /> ov�ur.n Mnanooness cirr zm a�io�ie <br /> ,j � F,� Prn p�i-, 0'������= 331 t. c �,�-,�39r�� E�;w_=i7, t�». �-5`7 -Y�Y3 <br /> LEII�Ni MAILADDRESS CITY ZIP PHINlE <br /> MCHIIFC70ROESIGNER IAAILAUDRESS CITV IiP PIIOtlE <br /> �:1 . f➢i �. OP M�ILAOOf1E55 CIIY ZIP PIIONF UC[NSE� <br /> �S'f1Y�F�A�.f� <br /> �✓n41�Nr Lo�-ST. 2/�L /t�(-/�Ln�ii .9��_ Ev�:�tk5ll' /../1. 2.SL-'7YSc> Nqv3ik.-yz3uoh <br /> IAFG114RP�LCONif1ACTOq l.IAII.ADURE55 CITV ZIP CfIONE LICENSEt <br /> Plfll.![iltlGCON7R6GiOR IA4IL�ODRE55 CI7Y ZIP PIIONf: LICENSEI <br /> CI ASS OP Wt]I1N <br /> '�' ' NEW I I �DDITION I 7 ALTERATION .�cl REPAIR I. I DEMOLITION I I WOODSTOVE/PRPL INSERT i I BUILDING RELOCATION <br /> iFllANi IMPqOVEh7ENT OR INTGI110R REIAODEL ONLY CONTACT PERSOH�ND PI1011E NO. <br /> couinnctrniceoFwonK: U,OC� �" L,7(iv/l�.�T �� 2.St- <br /> /t. N �s��.. �ys'o <br /> DESCR�OE WOfiK AND SOU�RE FOO AGE RJVOIVED <br /> h i 1���'�(Rfn�r,or��; Gvf711c�S!•tlrnq.r �U:hn�• /'rr��.t <br /> rnoroseouseoFowioir+c . I HEREBV CERTIFY THAT I HAVE READ ANO EXAMINED THIS <br /> APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> iecni oescmrtior+oF rnorenrr�sr+ow��eE�owon n.rnci+Foun cories� PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> i�n J�) ��J,�"r~�r ALOCK 7�J Y or (�Vl T UT- E �"�1/.'TT WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTIIJG OF A PERMIT DOES NOT PRESUME TO GiVE <br /> l.•1/�n �.�� � �5%�Oo 'T� <�`1��2j�1- _ OTHER STr TE OR LOCAL l W REGULATWG CONS RU�ION OR THE <br /> PERFORMANCE OF CONSTRUCTION. THAT I AM AUTFIORIZED 6Y THE <br /> OWNER OF TfilS Pf10PERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS M�DE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br /> SIGNATUREOFCONTII�CTOfiO{IAUTHOqIZEDAGEqi OATE 7^ 251�� <br /> rw.ircr nooness <br /> X '�� b� N��/1�.� co,�s i� <br /> 3 3 sL LnF�/j,3itp APPLICANi5LI7Y0lISl1lf55lICE1lSENO AHUBl15MES5NAlAE �p� <br /> PLUMBING � <br /> MECHANICAL <br /> 170. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT PEE <br /> WATER CIOSET(TOILE�) � NC-NHNDLG UNITS-H.P. � <br /> _ BATIiTUB ; FORCED AIR SYSTEMS-B.T.U. M E.A. � <br /> LAVATORY(WASFI BASIN) —T— UNIT HEATERS-B.T.U. M ; <br /> SbiOWER ' CLOTHES DRYERS —�- <br /> KI fCHEN SINK 8 DISP � VENTILATION FAN � <br /> DISHWASHER —�— � <br /> RANGEHOOD , <br /> LAUNGRY TRAY ; WA7"ER FIEATEft � <br /> CLOTHES WASHER --T— WOOD STOV[ ; <br /> URINAL ; METAL FIREPLACE&CFIIMNEY —� <br /> DRINKING FOUIJTAIN � FIREPL�CE INSERT ; <br /> FLOOR DRAlN —~— HEAT PUMP --� <br /> BACKFLOW Pf1EVENTEFlS ; GAS PIPING � <br /> -— � <br /> (i00F DRAINS�-RAINLEADERS � EXH�UST FAN <br /> _ SINK(SERVICE--BAR,ETC.) � I <br /> r—— - , <br /> --�—— � <br /> i � <br /> -- � � <br /> -- ' � <br /> � T— <br /> SUB TOTAL $ ; SUB TOTAL $ /�j� <br /> ___ PERMIT $ � PEFiMIT $ <br /> TOTALFEE $ ' TOTALFEE $ 7�Q <br /> ff10NISEi��CK qEARSETBAGK SIOESEIAACK PLANCIIECHNUMBEfl FEE RELEIPTNO. <br /> usezone �ornnen vncnNtsrte FEES VALUATION FEE <br /> 1=1 YES L 1 NO �— <br /> BUILDING // 7 � <br /> 11PE Of CONSi AILCwABIE 1YfE Of CON51�f.IURL OciurAncr uo nr oxnUNcurvns <br /> rnam i <br /> PLUMBING � <br /> i <br /> 517F.Of OIDG. NOAf SiORIES O4SEME1l1 �— <br /> MECHANICAL � �� <br /> I-I YES I_l NO � <br /> � <br /> xcurnNcvlono nnEsrmIRLERsnEo'o r�[�crttnr.urnnoN OTHER ; <br /> I 1 YES I.I NO STATE DUILDING SURCIIARGE v� <br /> PFASOtI fOp SPRINNLEIIS <br /> STATE ENERGY SURCII�fiGE � <br /> nrrur,nuonnCC.or rin��snrrnoveoor CITYOFEVEflETT puBucwontcs � <br /> LOCALSALES ' — <br /> _ _ TAX COUE IS 3105 rorn� �.3��1% <br />