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� � <br />H <br />lHVHi <br />H <br />Is� � C] <br />'�tl H � <br />Hy <br />z^S <br />O M d <br />� <br />c��� <br />t"y� <br />HH <br />8y <br />C��N <br />� O � <br />APPLICATiAi ' FdR CONSTRUCTC�"N IPERMIT � <br />TO BE COMPLETED IN BLACK INK-PLEASE PRINT <br />HEATING SYSTEM: GAS ❑ ELECTRIC ❑ _ <br />BUILDING DEPARTMENT <br />• 259-8810 <br />I I DEMOLITION I I COMBINATION �BUILDING I I MECHANICAL I I PLUMBING I I SIGN <br />OWNER MAILAODRE55 Cltt 21P PNONE <br />M�IL AO�FiESS <br />��P PHONE <br />�RCIIITEGT01iUE51GNEN MAILADORE55 CITY ZIP PNONE <br />��ra,✓ �,��ra� �� o��/��Tr �� �vE,e�� r- wA �'eaoi a o� a�s �� i <br />GF.NERRLGONTNRCTOR MAILA��RE55 CITV 21P PMONE STATEUCENSEt <br />yC 3 <br />h1EGNnNIC�ICONTFiRCTOR 1.IRILA�DRE55 CRY ZIP PHONE STRTELICENSE/ <br />AIAIL RO�IiE55 <br />cuss oF woaK <br />I' NEW I 1 ADDITION � i ALTERATION '�� REPAIR <br />DESCRIBE WORK AND SDUAriE FOO�ntit mvutvtt <br />PFOPoSEO USE OF BURDING <br />LEGAL DESCRIPTION OF PPOPERtt (SHOWN OELO� <br />LOT B�OCK OF <br />TRDDRE55 <br />324 <br />LFVATORY <br />SHOWER <br />OR 4iTACN FOUR COPIES� <br />ZIP PHONE STAiEIICENSE� <br />I. I DEMOLITION I I WOODSTOVE/FRPL INSERT I.I BUILDING RELOCATION <br />CONTRCTPEFSONAN I/ONENO. <br />... � %..... �c-�-il� /lY//L'uA.I /IO�✓�7'v/:� <br />i3>v�- �6- 1 S- 30 <br />3.:7 - 3 % .'�u/C /+2 <br />FOR OFFICE USE ONLY: <br />FRONTSETBACN PEANSETB�CK <br />LOT ARER <br />iYPE 0( <br />SUBTOTAL 5 <br />PERMIT 5 <br />TOT/1L FEE S <br />SIDESETBACN <br />VpGRNT SITE <br />;NAL OCNi'WLY xOMPMlIixcNa�s <br />cAav / <br />OCCUPANCYLORU FIRESPflNKLER5RE0'D HEIGNTLIMITATION <br />�r H� �-n�s 71M� <br />REPSON FOR SP/P/IN�NL�ER•S ����� <br />G' i✓` /Lr ✓WG <br />INT�NEBV PUNSAP�RO\'EOBY CITYOFEVERETT <br />�/�r,��z JM �OCALSALES <br />TAX CODE IS 3105 <br />a5�-3�4� <br />i HEREBY CERTIFY THAi I HAVE READ AND EXAbIINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PFOVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT OOES 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 />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF S P PERN TO PERFORM THE WORK FOR WHICH <br />APPLICA ON IS ADE AND I COMPLY WITH THE STATE <br />CONTR TORS LA 1027�6W AND 296200 WAC. <br />x � (�f/W J ,�v��� <br />srox�mne wt <br />UiY OVSMESS IICf �bE NO <br />MECHANICAL <br />10. TYPE OF EOUIPMENT FEE <br />NC�NHNDLG UNITS—H.P. <br />FORCEDAIRSYSTEAIS—B.T.U. M E.A. <br />UNIT HEATERS—B.T.U. M <br />CLOTHES DRYERS <br />VENTILATION FAN <br />RANGEH00� <br />WATER HEATER <br />WOOD STOVE <br />METAL FIREPLACE 8 CHIMNEY <br />FIREPLACEINSERT <br />HEAT PUA7P <br />GAS PIPING <br />NUMBER <br />�UIWING <br />PLUMBING <br />MECHANICAL <br />ADDITIONAL PLAN CHECK <br />SPRINKLER <br />STATE BUIL�ING SURCHARGE <br />PUBLIC WORKS <br />TOTAL <br />RECEIPT <br />FEE <br />�2 G 9 � n oa- <br />