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�i ty�1 � <br />�1 y <br />9H[~i� <br />4 <br />H �'. <br />y H <br />K C] <br />H X1 <br />'�TI. H '� <br />V1 H <br />�O�H <br />N �LT�1 O <br />(�] V �q] <br />9 H t�1 <br />y <br />HH <br />O�� <br />� � iTi <br />HO� <br />_.�: <br />APPLIC/STiQr�l FOR C0�1STRl9C7 MQN PE�iIVIIT <br />�������« <br />�,.,��,�..�.,�„ � <br />��,��� <br />everett <br />i3UILDING DEPARTMENT <br />259-8810 TO BE COMPLETED IN INK—PLEASE PRINT <br />DEMOLITION COMBINATION BUILDING MECHANICAL /"PLUMBING SIGN <br />owrvEr� r.�m�nonness cirv --�— �..��� �'��'..� <br />/j�_��� � � � L_/� �< . � i,� � �Ill � ♦r�� � 'CG�i lk'. �`�. ?. L� � <br />iLNAHI � MAiLADDR[SS LIiY PP �HONE <br />, /':I���L \ <br />nnc��C[CTOROF.SIuNF.fl MRRADDRE55 CITV 2�v PHONE <br />G�.NEP�LCONiFAGTOH MAtL��DRE55 CITV 21P PHONE UCENS[/ <br />�'�� i' , i- i �r) i�' c' ���71- <br />/� r i(f ! i 1'7 S i L L ✓'�PiX �S" •� � -- <br />!'fCMnrviGALCONTRAGTOR MAiLA0DRE55 GiY 2iP PHONE IICENSEY <br />vlUA�oiNG CONTRALtOR MRII AD�RE55 CrtY ZIP PNONE LICENSE �� t' / y1_ �� ' <br />ti��, n�2 5�+�1 J�i�,�/J�;_�ic,��� % 5"i /i7r�i2s��� /Z.� /.7e�L�i1c.,��I �( �,9 :'.✓ , � � <br />❑ A55 OF 1YOFK <br />NEW . ADDITION . ALTERATION .� PEPAIR . DE�dOLITION WOODSTOVE/FRPL INSERT . BUILOING RELOCATION <br />iENnNT IMPROVEAI[NT OF W iERIOR BEMODEL ORLY I CONiACT PERSON FNO Pi�ON[ N0. <br />� <br />CONTflRCi PRICEOF WCRK: � <br />� OESCPipF�Yf)RNANOSOUAREFOOT�GEINVOWED <br />/ enovc <br />T � <br />�mn� <br />LCT <br />, <br />6LOCK <br />7 (, <br />oF <br />%J _'C <br />TYPE OF FIXTURE <br />WATER CLOS[T ITOILET� <br />BATHTUB <br />IAVATORY�WASH BASINI <br />SHOWER <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />FLOOR DRAIN <br />BACKFLOW PI <br />ROOF DRAIN� <br />FnONi5ET0ACK <br />tISE .ONE <br />h �[ Of LOHSI AILOWABIE <br />SZC: OF OL W <br />OCGUP�NCYLOAD <br />NEA30NfOR5PRiNHLEPS <br />n��rucnuoHncc nv <br />� I HEREBY CERTIFV THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />uHFouacoPiesl PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL 8E COMPLETED WITH WH[THER SPECIFIED HEFEIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PIiOVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OH TH: <br />PERFORMANCE OF CONSTRUCTION. TH�T I AA1 AUTHORIZED BV THE <br />OWNER OF THIS PROPEATY TO PERFOflM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I CJ�Jf'LY WITH THE STATE <br />CONTRACTORS LAW 1B 27 RCW AND 296200 WAC. <br />9GNAtUR[OFCO'diHACtORORM1iN0"TCUFf.CM1T DATE <br />X � �. <br />� '� ; <br />,.�,�;'�rs�=1� -� <br />. . 1_V% CC (( n���, u�i;�ci�.t� 5�iie r..,_ �,��f�ouus�+Essn��+e <br />� C// i �A %L.�i <br />FEE NO. TVPE OF EOUIPMENT <br />��.--__ A�C—A�HNDLGUNITS—H.P. <br />FORCED NR SYSTEMS—B.T.U. M EA. <br />UNIT HEATERS—B.T.t!. M <br />CLOTHES DRY[RS <br />�j;� � VENTItAT10N FAN <br />— RANGEHOOD <br />WATEP.HEATER <br />� WOODSTOVE <br />� I I METHL FIREPLACE 8 <br />HEAT PUh9P <br />GAS PIPING <br />EXHAUSTFAN <br />SUB TOTAL S """ """" <br />PERMIT 5 � T PERMIT <br />TOTALFEE $ TOTALFEE <br />RF�RvEiDACK SIOESF.iF1AGK �'IAn1.i�I.r.ntiul,�.O[q fF.0 <br />�oTnRen vncaN�sne FEES VALUATIOt <br />� YES NO p�ii�piriG <br />7VPE �f CONSf ACIIIA� ottu��bcv xo ni exui�ti;'-`,�. "-- �--- — — —— <br />cNouv pLUM�ING <br />NO.OFSTOfiiES BASEMEN7 MECHANICAL <br />VES NO — — <br />FlRESPRNxlERSR[00 ��FIGIIIIRAilAtiON OTHEfi <br />YES NO S1ATE BUILDING Sl1RCHARG[ <br />STATE ENERGV SMCNANGE <br />�'�^'+` ^�'"����'���'' CIT'f OF EVERETT PUDLIC WOflKS <br />� LOCAL SALES <br />rnx cooeis 3ias TOTAL <br />__�_===S��J� I <br />5 1 <br />5 � <br />RECEiPiNO �i <br />FEE <br />�� <br />/,i/l;_�_ �. <br />