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i <br /> APPLICATI�.�� FOR CONSTRUC7�.JN PERMIT <br /> �,.���« <br /> 1hr F�rrpronn � <br /> GIIv O� <br /> � �� evereit <br /> y BUILDING DEPARTMENT <br /> �> H 259-BB10 TO BE COMPLETED IN INK—PLE�A E PRINT <br /> H �� � DEMOLITION f I COMBINATION I BUILDING >/fuIECHANICAL i I PLUMBING ! ' SIGN <br /> y H oww:n <br /> M41��DDRL55 CItY 'IP PIIONE��2o3 �3 •3�15`� <br /> " y �, �oP1o,�' Dwl.u�ol 2501 �arYx�✓l.e.v.3' (�Ivd F�.�,o�- <br /> Q�N � TE�qryT MRRGODR[SS CITY 2iP PHONE <br /> VJ H <br /> x ARCNIiLCTO00E51GNEN MAIL�DDRE55 GTY 21P PIIONE <br /> �O � CIiV ZIP PHONE LICEHSE� <br /> D�y GEN[11ALCONTMGiOR M41L�ODRE55 <br /> �� g <br /> 4]� O uec�mrncn�coriinnr.ion mm�noosess cnr, zm v��or+e ucer+s�. <br /> .z H � �um I..o K I Iq 15 . t 2y R� N�- Y,ut-kla�md q`b0.3H g2l •W54 soN�owriy��) <br /> �i'� y z V�LIIl10itlOGONiRAC10R MAtL�DORE55 f,I1V ZIP PHONE LICENS � <br /> r <br /> Ny <br /> y cinssonvonK <br /> H <br /> O GC7(/) � - NEW I 1 ADDITION �x ALTERATION I �. REPAIR I I OEMOLITION I I WOODSTOVE/FHPL INSERT BUILDING RBLOCATI <br /> [s] 1FIi���liIAPROVEVEN�ORINIERIORpREMOOEIfWNLY^''� CONIACTPERSONANDPHONENO. <br /> y� ccumnct rmcEorwone: � 1 I D 'w <br /> H O tn b�sccm�n�e�wonK�nr+os�o'un�n�crF�oor�ncne�invaveo <br /> C��i �AW�>Nl:, IS""N ^"`^-' <br /> roseouseoFoui oinc � I HEREDY CERTIFY THAT I HAVE READ AND E%AMINED THIS <br /> ��.�(�'n��„� APPLICATIUN AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> L[G4LOESCRiPiIONOFPR - LY�SH�IOELOWORR � c��rouncoriesl PROVISIOK30FLAWSANDOROINANCESGOVERNINGTHISTVPEOF <br /> WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OFi <br /> �or mocK or NOT. 7HE GRANTING OF A PERMIT OOES NOT PRESUME TO GIVE <br /> AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANV <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR Tl1� <br /> — PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY TIiE <br /> OWNER OF TFiIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MAOE AND I COMPLY WITH THE STATE <br /> CONTHACTORS LAW 18.27 FiCW AND 296200 WAC. <br /> sicNarune or cor�mnc�on on nuu�2ionizeo nr,er+r Or11E <br /> �G� �Z-0 ✓�� <br /> rnacctnooness ` �� � n �M 'n <br /> X S�tfYl{��<. 9'nC • `�e-�.h `(�s.�'�'n <br /> '�1 J C,�..�vCJVC� PfC�ICaqISCILY0U51NE5SlIf,fNSENORN00U5R1E5SNAME <br /> PLUMBING MECHANICAL <br /> 1�I NO. TYPE OF FIXTURE OR ITEM FEE HO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) NC—NHN�LG UNITS—H.P. �._ <br /> ' 1 _ BATHTUB � FORCED AIR SYSiEMS—B.T.U. M E.A. � <br /> UIVATOFY(WASH BASIN) 1 UNIT HEATERS—B.T.U. M �_ <br /> '�I SHOWER � CLOTHES DRYERS ' <br /> KITCHEN SINK 8 DISP i VENTILl�TION FAN __� <br /> ' ' DISViWASHER � _ RANGE HOOD ' <br /> LAUNDRV TRAV ' WATER HEATER � <br /> '�' CLOTHES WASHER —� WOOD S10VE ' <br /> URINAL ' METAL FIREPLACE 8 CHIMNEY ' <br /> �' , — <br /> DRINKING FOUNTAIN i FIREPL�CE INSERT <br /> FLOOR DRAIN ; NEAT PUh1P ' <br /> 7� GAS PIPING � <br /> � BACKFLOW PREVENTERS �_ �L —i— <br /> '�� ROOF DFAINS—RAINLEAOERS i _ EXHAUST FAN ` <br /> SINK(SERVICE—BAR,ETC.) _�_ ; <br /> ' ' __ _ —�— <br /> � � <br /> — � <br /> ' ' _ SUBTOTAL $ _ SUBTOTAI S O'�Q <br /> PERMIT $ PERMIT $ I _� <br /> - TOTALFEE S TOTALFEE S Jr' <br /> ft10Ni5ETB�CK REMSEtOACK SIOESEtO�CN �UNCRECNIIU�.10[R FEE BECEIPTNO. <br /> usE zor+e LOTAREA VACaNt SrtE FEES VALUATION FEE � <br /> !�I VES f I NO BUILDING ' <br /> IvfCOfLONS1.�llOWA9lE lYPEOft@ISL.ACIU�I �unucr wdontunTwn2 � <br /> L9�r p1.UM81NG � <br /> _ <br /> �� <br /> SV[oFBlDO NOAFSTOIIIES DASEMENI MECHANICAL j__ <br /> I 1 YES I I NO � <br /> OCCUPANCYlO�� FIRESP11tINlEPSREOD HEIGIITLiMItRl10N <br /> OiHER ' <br /> � <br /> I1 YES I I NO StATEBU1L01HG5UNCHARGE � <br /> �� <br /> ❑EA50���0(iSPfIWNLEFlS � ' � <br /> STAiE ENE(iGV SUfiCHAR(iE <br /> AfPlif.�IIONAf.COV PL�NSAPPROYEDBY ��7y0FEVERETT PUBLICWORKS <br /> LOCALSALES � <br /> TAX COUEIS 3105 To�A� <br />