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pP1�LICATION FOR CONS'i�RUG7'I�,N PER�VIIT �'�°"�" <br /> ,•e<<•m���� TO BE COMPLETED IN INK—PLEASE PRINT � <br /> c:irv or l <br /> everett HEATING SYSTEM: U GAS iJ ELECTRIC D — _ �f <br /> BUILDING DEPARTMENT <br /> 259-8810 <br /> DEMOLITION COMBINATION BUILDING MECHANICAL PLUMBING SIGN <br /> - GLV Dn PNO��E <br /> 61AIL A�OFE55 c� i <br /> J.Jcc �7a`t�ctY � `� Elnrcrc���_ ��efCi't ! `��1�3 PH3�J 3 ' �' b '� <br /> IENANi tAPIIADDRE55 <br /> ��T� Z�p PHONE <br /> pqCNITECi0F0E51GNEfl MPILAODRE55 <br /> y�r C17V ZIp PHONE LILENSE R <br /> ��� GENERRLCONTRACTOR MAILMDRF55 �(�` I , r'/( n�� �D ' D11 <br /> ��erctr I�I�.�- � 5(�06• �vcrQf« � in/y �Uc(`etC �B�D3 � �1�� �vF+� r +� <br /> ��y' IAECMFNICAtLONTR4CTOR IAAILADDRE55 T- CITV Z�P <br /> PHONE LiCENSE� <br /> 9 y� CITY 21P PMONE LICENSE l <br /> [� x PW�A�PiGGONTRACTOF MAILADORE55 <br /> H ".�,s <br /> y zH <br /> '� y� unss oF wonK � <br /> O x O NEW . ADDITION . ALTERATION � REPAIR . DEMOLITION �^100DSTOVE/fRPL INSERT _ BUILDING RELOCATION <br /> K] H�+] - CONTAGi P[RSON Ah0 PHONE NO. <br /> Cn H <br /> COI:iqTCTPRICEOF WORN <br /> C� O� .�_3c�i�E WOPK AND 50VARE i00iAGE 1NVOlVE� <br /> y o � �_� � ' <br /> �� ~ ���o�EousEOFeui�DiN� I HEREBY CERTIFY THAT I HAVE READ AKD E%AMWED THIS <br /> �� C� O APPLICATION AND KNOW THE SFME TO BE TPUE AND CORRECT.A�L <br /> �` n J /�� <br /> C, i�sa_oescaiPrioHorPeoaeatv�sHovmoe�owoenrineHvouacoaie5i PFOVISIONSO'rLAWSANDORDINANCESGOVERNINGTHISTV <br /> � y 3 WORK WILL BE COMPLETED WITH WHETHEFl SPECIFIED HEREIN OR <br /> t� <br /> i��; e�p�K oF NOT. THE GRANTING OF A PERIdIT COES NOT PRESUME T IV <br /> �..�y AUTHORITY TO VIOLATE OR CAMCEL THE FROVISIONS OF ANY <br /> ty C/� OTHEii STATE OR LOCAL LAW REGJLATIKG CONSTRUGTION OR THE <br /> � �y __ PERfORMANCE OP CONSTRUCTION.THAT i AM AUTHORIZED BY THE <br /> q OWNER OF THIS PROPERTY ":� PERFORM TH[ WORK FOR WHICH <br /> 3 [�i7� _ APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> z: <br /> y N CONTFlACTORSLAW1827RCW AND296200 <br /> yO� SIGNM1tUREOfWNiRAfiOFOFAOiHOR1ZE0AGENT �4TE <br /> X l�u,-�__l� 1 1� �' <br /> nnp�[',ITG[1(1E55 p '�,��';ENSENOANDBU511ESSNAM <br /> �'�I L'AtliS CiT��P'IS^�r•�; <br /> _ . � �; � ��rQ�-� <br /> PLUM0ING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF E�UIPMENT FEE <br /> Qs> .,,�, A�C—A�HNOLG UNITS—H.P. i <br /> i WATER CLOSET(TOILET) FORCED AIR SYSTEMr—B.T.U. M E A. <br /> BATHTUB _ � <br /> LAVATGRY(WASH BASIN) UNIT HEATERS—B.T.U. M _ <br /> �' :� <br /> SHOWER CLOTHESDRVERS _ <br /> t I HITCH[N SINK&DISP VENTILATION FAN <br /> � D�SHWASHER RANGE HOOD — <br /> LAUNDRV TRAV WAT[R NEATER _ <br /> � � "�' CLOTHES WASHER WOOD STOVE <br /> � � "� UFINAL h1E7AL FlfiEPLACE 8 CHIMNEY <br /> DRINKING FOUNTAIN FIREPLACE INSERT ,�_ <br /> FLOOR�RAIN HEA?PUMP <br /> � S BACKPLOWPREVENTERS GA::?IPING <br /> � ROOF DRAINS—RAINLEADERS El(HAUST FAN <br /> SINK(SERVICE—BAR.ETC.) — <br /> I ..� __—_ � — <br /> . ,�j � SU6TOTAL b _ SUBTOTAL 3 <br /> PLRMIT S /L' � _ PEFiM1T 5 <br /> � WTAL FEE 5 TOTAL FEE 5 <br /> ' FOR OFFICE USE ONLY: <br /> �I1:�iIRS[iO�GM, fIEARSEL9nGK SIOESEI6PGN <br /> rinr�r.��ecrcr+uMeea v�e necevrr+o <br /> ,.,�,}.;�,r�E iorp�cn VACANTSITE FEES VALUATION FEE <br /> BUILDING <br /> I.��iorcoxisauow�ea rvacorcaxsr.ecrou �c�F�o�+ ����'^'���'"��^"s — - <br /> PLUMBING /� � <br /> �f[ OF BIDG. NO OF STONiES OASEMENi MECHANICM _ <br /> CV..'�PAHGYLORD FIAESPflNNLEN5flE00 HEIGHTUMILATIOH ADDITIONALPLANCHFCK <br /> OTHER <br /> m.. y�o�snninu�tns � <br /> STATE BUILUING SUFCHARGE <br /> i „ i �LANSAVPNOVEOOY CITY OF EVEflETT PUBLIC WORK$ <br /> LOCALSALES TOTAL /s� � t <br /> TAX CO�E IS 3105 <br />