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i0 A7 G <br />7 H y <br />K � n <br />H A <br />O C O <br />'L y I'V-� <br />� O � <br />O H � <br />N N O <br />G1 . n <br />ri C <br />Zy y � <br />r N H <br />N <br />O N <br />��0ro <br />n O �y'. <br />� �� <br />APPLICAiI�.�d FOR CONSTRUCT�ON PERMIT <br />�,���«��� <br />,���.�,� :��, e <br />��rY �� <br />everett <br />BUILDING DEPARTMENT TO BE COMPLETED IN INK—PLEASE PRINT <br />259 8810 <br />DEMOLITION COMBINATION �: BUILDING MECHANICAL PLUMBING SIGN <br />cwr�ea nmi�nnor+Ess cnv zir ri�cu� 3�-t7_ 43 7'3 <br />�u l;r' r r b 7cz- r ��c <br />1<"�cu w- L, tir`r T}� P� r �iC%" �vc��Zf \"in 9?9L'i. <br />iLilnNi <br />MAILRODRESS CiTY ZiP PHOtIE <br />'�f.v,�6 <br />ANCIaIEGTORDE5IGNER MRItA�DRE55 GITY ZiP PNONE <br />I:.W. i3.--..ee: <. As�uc:.�.;�lo! �ITH�Y�. ���%MT(� Lu�. `181�1 K41 -77��c;cxT. 16Y <br />c3[t1[RALCONTRACTOR MAiL�0�RE55 CITV Z�P PHONE IiCENSE� <br />C.FC��ANiCALCONtRRGTOR MAILAD�RE55 CrtY Z1P PMONE IICENSE� <br />i�.iwnwntnNTRACTOR IAAILA�DR[55 CILY ZIP PHONE LIC@JSEt <br />CLn550F 1YORN <br />� NEW -. � ADDITION �. ALTERATION � REPAIR <br />LGNANTIMPFOVEId[NtORiNTfRIORREMODEIONLV J�/r� �O� <br />CONiRACTPRIGEOFWOFK' � / <br />DESGRiBE WOFH RNp SOU�RE FOOTAGE INV GVED�A �' <br />c:4�VGF.L`TE RET( IN1NZ '3 ' — <br />�. y�GA .25� 7 <br />�'ROPOSED USE OF BUiI�ING <br />Lrf.AL <br />LOt <br />� ico <br />OF PROPE <br />BIOCN <br />KITCHEN SINK 8 DISP <br />OISHWASHER <br />LAUNORYTRAY <br />FLOOR DRAIN <br />OF <br />FEE <br />DEMOLITION � WOODSTOVEiFRFL INSERT � BUILDING RELOCATION <br />I WNTP^T^ERSON AND PNONE NO. <br />v c.'.nrr :� �. i. Rcr.h i J\•.��:�--. <br />�I Y i -/ 7 U� ,� i u c <br />I HEREBY GERTIFY THAT I HAVF READ AND EX�AIINED THIS <br />APPUCATION AND KNOW THE SAME �O BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND OFDINA�'ES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WiiETHEFi SPECIFIED HEREIN OR <br />NOT. THE GRANTWG OF A PERMIT DOES NOT PRESUtdE TO GNE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANV <br />OTHER STATE OR LOCAL LAW f�EGULATING CONSTRUCTION OR THE <br />FcRFORMANCE OF CONSTRUGTION. THAT I AM AUTHORIZED BY THE <br />OWNER O� THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE SiA7E <br />CONI RAGTORS LAW 1027 RCW AND 29G200 WAC. 2 <br />SiGN R[OFCONTRnCTOFORPUtNORiZEDAGENt OFTE J y_���� <br />'�,� Ia 1 or Si�Honl,s�-� �Cw�.:� / <br />X � "1„ , 1 \ <br />TYPE OF EOUIPMEN i <br />A�C—A�HNDLG UNITS—H.P. <br />FOFiCED AIR SYSTEMS—B.T.U. M <br />UNIT HEATERS—B.T.U. M <br />CLOTHES DRYERS <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />WOOD STOVE <br />METAL FIREPLACE & GHIMNEY <br />FIREPL�CEINSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN _ <br />SUB TOT�L $ _ <br />PERMIT S <br />TOTALFEE S <br />FflONiSET�ACN R[AR6Ci0ACK SIOESETORCK �IPNC�IE INUII�R � <br />� � IJ <br />usEzor�E_ 2�E���� vncnrvtsirE FEES <br />YES NO OUit�iNG <br />� eccu��r�w rmoi�sw� .ve�is <br />tYPEOFLONSCALIOWABIE 7VPEOILOYSinCIUAI �qo,p <br />PLUM�ING <br />512[ OF OLOG. NOAr STORi[5 DAS[MENt MECHANICAL <br />' VES NO <br />OGCUPANCYLORD FIFESPRNKLERSR[O'D MCIGHiLRAIiAbON OTHBR <br />� � YES ��'. NO SiATE0UILDWGSURCHARGE <br />R[PSONFORSPRINNlERS <br />STATEENERGVSURCHAFGE <br />I.PPIICAIiC'lA�C Ov PLANS/PPPOVEDBY CITY OF EVERETT PUOLIC WO(iK5 <br />LOCAL SALES <br />S� �1 �y� TAX CODE IS 3105 TOTAL <br />�/3 <br />3 <br />FEE <br />