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Qi ~ <br />�V <br />VO <br />p M <br />� � � <br />��� <br />y M <br />� M � <br />� � OQ <br />M , � <br />� H <br />N <br />N <br />O N <br />� �M N <br />O N <br />J��i c c� <br />APPLICATIG.d FOR COR�STRUCT JN PERMIT '•`'°'�''t <br />TO BE COMPLETED IN INK—PLEASE PRINT � <br />e�r o� <br />verett I_ ViEATINGSYSTEM: '�GAS ,�ELECTHIC J _ ____ � <br />BUILDWG DEPFRT61ENT <br />259-8810 <br />DEMOLITION COMBINATION �( BUILDING MECHANICAL ��LUMBING SIGN <br />�,-....��� MNl DU�!55 fI1T ll� VHON[ <br />���ca✓� �von', �� af 23 NarY;son�l�e k.�e.re7� i S�o/ _ <br />.ii.�,.y! MARADDRESS CITY I�P P���NE <br />e�r.HiiECTORDES�GNER �An�LADOPE55 GTY ZIP PNONE <br />�::!'��ALC(1Nif Ct� �` IIAD�RE55 CITY ZIP PNONE lIC[NSE� <br />ui�. l%V.1�� i�� �y� i3��l,.Av 5E Sv��%or��s�1 �$�90 S�8-a�a3 Dut�l�hcl�01 <br />!^PIANICRLCONiR�C10F NPiLPODRE55 G�TV ZIP PHONE L�LENSE� <br />1'�t'.IAPiNGCONTRAGIOR MMIRDDPE55 dTY ZIP PHONE LICCNSEt ... <br />GL ASS Oi WOPN <br />NEW ADDITION ALTERATION FEPAIR DEMOLITION WOODSTOVEiFRPLINSERT BUILDINGRELOCATION <br />�/S� J!�'G�' /�` ty��e�� CO TAGTPER NANOP ENO <br />' // o00 , oo s, ds� �g�� � IP�� s� R-�aa � <br />CONI RAGT PRIL[ OF V/OFN <br />D[$CPIQEWURNnND$OU/RC;OQT �EINVOLVfO � �� <br />IEGPL DESC�'PiION OF PROPCRTv ISMOW�! �ELOW OA /•LiALM FOL <br />�or a�oce _ oF� <br />�J �-a,-., a,-.fi �Idd t�� ��x <br />R�� ySr� - n� o� �� <br />t3�� �-1 S� <br />aaami nooaess <br />� � <br />l <br />�' KITCHEN SINK B DISP <br />OISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHEF <br />uaiNn� <br />DRINKING FOUNTAIN <br />FLOOF DRAIN <br />BACKPLOW PREVENT <br />ROOF DRAINS—RAINI <br />�rr+ <br />aE OR ITEM <br />PERMIT <br />TOTALFE[ <br />FQR OFFICE USE ONLY: <br />faONTSEiPRCK R[RPSET9ACrc <br />ZU' w� <br />use zor+ ior nnen � <br />5 <br />SiDG <br />FEE <br />I HEPEBV CERTIFV THAT 1 NAVE READ ANO EXAMINED THIS <br />APFLICATION AND KNOW THE SAIdE TO BE TRUE AND CORRECL ALL <br />PROVISIONS OF IAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOrS 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 />PERFJRMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BV TF� . <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTOR3 LAW 18.27 RC�V AND 296200 WAG. <br />SIGNATUREOFCONiRACTOROBRUtM EDRGENt 0/TE <br />X �, �� <br />RVPLICANTS V BOSME 5 LiC NSE NO RNp 9USiNE a GAME -- <br />�.� <br />UNII HEAiERS—�.TU. M <br />CLOTHES DRYERS <br />VENTILATION fAN <br />R�NGEHOOD <br />WATER HEATER <br />WOODSTCVE <br />METAL FIREPLICE 8 GHIM <br />FIREPLACEINSERT <br />HEATPUMP <br />GAS PIPING <br />ExHAUSTFAN <br />� <br />SUB TOTAI $ <br />�ERMIT S <br />TOTALFEE 5 --�� <br />� <br />CNNUMDEIi F[F RECEIPTNO <br />,�rG�� i3��rs' yi7a <br />—Z b 6UG n�J pUILDING �'�� gz (1'.i'�] <br />tYPE 0� CONiS AIIOWRBI[ iYFE Of CONSt RCiUAI ocGunt„:v xo a�mmcu4i�5 <br />pB010 pLUMBING <br />� �— � <br />5¢EOFBID). �+o.oFSioaiE� ons[MEr+T MECHANICAI <br />44L S�• nOxl � � — <br />occU�ANC" lonD Fme SaRnKI[r+s nEoO i�F icirt uMnanor� �DDITIONAL PLAN CHECN <br />N p I <br />� � O' OTHLR <br />� <br />R[ ASON f C R SPPINNlERS <br />STATE BUIIDING SURCHARGE �' S(�I <br />—i <br />inrnKe ev rinr�s nrrnovrn �3r CITY OF EVERETf PU�LIC WORKS <br />`� LOCALSALES <br />� 1`� TAX COOE IS 3105 TOTAL <br />s <br />