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� ��J <br /> . � <br /> � <br /> � APPLiCAT10N FOR CONSTRUCTION PERMIT <br /> � iME��.� everet <br /> ., ���� e <br /> � everett <br /> � BUILDINO DEPARTMENT TO BE COMPIETED IN INK—PLEASE PRINT <br /> 259•9810 <br /> � O DEMOLITION ❑ COMBINATION ❑ BUILDING OMECHANICAL UPLUMBINa ❑�SI(il <br /> � q � M�IL110d1E5! C�TY 21P P110NE <br /> � � ET �/�(��7✓leN{` Ic�S i65� Lynhw+en we. 7c�C�-g� <br /> , <br /> � TENNIt MML�ODIIESS CIIY 2N 1'IqNE <br /> .i <br /> I1i1CMiEGTpiDEBqNER MMlM0f1E89 CIIY 21P MqNE <br /> V <br /> a <br /> � OEMEMI.CWtp�CTOq MI1IL�ODIIE89 CIfY 21P PIIpNE .LqENSE� <br /> � h � .t��f �oHoo �or.crl� / V3l /oB��Tsa� Htara� 9aro� AdM�vtE..ILia��F <br /> y 1AEdIN/1f,ALCdITAIICTq1 MML�DUIIEH! CITY 21P P11pNE IICEN8E1 <br /> i <br /> '� <br /> � I2�GlI�pOp/1pA0TpR MI111AU011E88 CIIY ZIP PIqNE IICENBEI ' <br /> a •�CU18 K Wd1K <br /> EW ❑ ADDITION ❑ ALTERIITION L REPAIR LI DEMOLITION O WOODSTOVFJFRPL INSERT ❑ BUILD�NO RELOCATIOI <br /> TlIMNTMVIWVE�AfNTOf1MTERI0N11EMODEL� CONTAj:tl'ERBpN NDP tl lq. �� ' � � <br /> �^ONiR►CTVRICEOFY/ONf: IGC � � <br /> d�MpIR 11N0lOUMR FOOTMIE MVOI�- <br /> ho►��. i 3s� sq . �-. <br /> � vnovoecouaeoreuspra ' � I HEREBV CEA7IFY THA7 I HAVE READ AND EXAMINED THI <br /> � � 5i p<���.y L, APPLICATION AND KNOW THE 3AME TO 8[7RUE AND COiipECL AL <br /> � llWL OEM)M►TION OF PROPEFTt�BMOWNlEtOW d1117I11CN FOUfl CIX'IEB� PROVISION3 OF LAW9 AND ORDINANCE3 OOVERNINO THI9 TYPE O <br /> '� �ot I�1,b �� ;.�— or f�t�V rti'�' WORK WILL BE COMPLETED WIiN WFIEiNER BPECIFIED HEREIN O�� <br /> NOT. TH[ OfiANTINO OF A PERMIT DOE9 NOT PREBUME TO OIV <br /> ;j r AUTNORIrY TO VIOLATE OR CANCEI THE PHOVI910NS OF AN <br /> � ZS p�r � :�1 z-� f'�Cl'�C/'UC� 1 / OTHFN BtATE OR LOCAL LAW REOULATINO CONSTRUCTION OR TH <br /> /� PERFOfiMANCE OF CONSTRUCTION.THAT I AM AUTNORIZED BV TNI <br /> � UO�• `tS C�t` rJ�J'�� DP�y� OWNER OF THIS PROPERTY TO PERFOPM THE WORK FOFi WNICI <br /> APPLICATION IS AfADE AND I COMPLV WITH TNE STIITI <br /> � �— CONTRACTOR3 LAW 1827 RCW AND 298.200 WAC. <br /> � ���r„�� ��- �-�v�41,ni�� BqN�TU1IEOFCONTMCTOROR�UtNOPREDAOENT D�TE <br /> I <br /> �jjj �dU+�'F� �—�_��.� <br /> I P:bJECT 1100RE6B <br /> i • APPLICMlTB CITYlURINEBK LICENBE NO.�NO BUBME88 NNAE <br /> 190 6 �i'7rx�.•_,...� <br /> � PLUMlINO MECH�NICAL <br /> � NO. TYPE OF FIXTURE OA ITEM FEE NO. TYPE OF EOUIPMENi F_ E�_ <br /> e WATER CLOSET TOILET) �— AIC—NHNDLO UNITS—H.P. � <br /> �; �_ 3ATHiUB 0 '— _ FORCEO AIR SYSTEMS—O.LU. M E.A. —~ <br /> 7 LAVATORV WASH BASIN) /d�i— UNIT HEAiEpS—B.T.U. M � <br /> ( , �' BHOWER f— / CLOTHES DRYERS �— <br /> ,-� KITCHEN BINK 6 DISP � ; — ( VEN7ILATION FAN ' <br /> ��� _ OISHWASHER �:-� � RANQE HOOD i <br /> LAUNORV TRAY � WATER HEATER � <br /> 17 CLOTHES WASHEfl �=— WOOD STOVE � <br /> a UAINAL ' ' I METAL FIREPLACE 8 CHIMNEY ��- <br /> ? DRINKINa FOUNTAIN � FIREPLACE INSER7 � <br /> � FLOOR ORAIN � HEAT PUMP i <br /> � � BACKFLOW PREVENiERS � � OAS PIPINO ' <br /> :� ROOF DHAINS—HAINLEADERS _ ! EXHAUST F�N � <br /> � SINK(SERVICE—BAH,F*C.) ' ' <br /> '] � i <br /> ,L i � <br /> 7 � � <br /> � � <br /> � � <br /> ..� SUB TOTAL S ;� _ SUB TOTAL S _ S '� <br /> PERMIT S � PERMIT S � <br /> � TOTAL FEE S '� TOTAL FEE S �� <br /> FNONT 6fiB�CN REAq BETBACIf S�DE 6ETBACN PV�N CIIECN NUMBEII FEE RECENT NO. <br /> � Z � 2.v S �i 1-C, o/9 <br /> ,i useJ� if rnnen V�C�Ni511E FEES YALU�TION FEE <br /> +a I�� (p�XJU � . �YES l] NO . �J� Y73 ��Q <br /> OUILOINO <br /> � iTPEOiCONbi.AIIONARE lYl'EOiCONST./�C1UAL �Nu�r .xpaoxtLLnroumt - <br /> � . PLUMBINO � <br /> U- �' v- /p ' <br /> �— <br /> B12EOFBLDO. NO.OFBTORIEB BASEMENT MECIiANICAI. � � <br /> � .�F.�-�5.� / o.ves l�i No . --�— <br /> OCCUPANCYIWD FIfiEBPRNNLEf15AE00 NEIONtl�MI7NI0N OTIIEfl � <br /> _J u Yes o r+o ' �— <br /> STATEBUILDINOSURCHARUE � i� <br /> RE�BON FdIBPPMI(LEi16 r <br /> SiATE ENEf7OY SUPCHAAOE � <br /> � <br /> y APPLIC�TqNf�.BY PUNSMPPOVEDBY CITYOFEYERETT PUBUCWORNS � �" <br /> ) LOCAL SALES <br /> � TAR CODE IS 3105 To*�� G 3.2 � SL <br />