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APPLICATIA�N FOR CONSTRIjC?rON PERMIT <br /> ����«�« <br /> „�E,�.,a,,.,.� � <br /> ceverett ; <br /> BUILD�NG DEPARTMENT � <br /> 259-8810 TO BE COMPLETED IN INK—PLEASE PRINT <br /> DEMOUTION COMBINATION X BUILDING MECHANICAL PLUMBING SIGN � <br /> owNen r.ui�nooness cdrr -m ruou� <br /> C��t;i' ��c.!��.i�'j F'.��4'>�c �1�,�/ �VLr'e7f Wct `I��O� ��,'�i'S��' � ; <br /> lErypryi MAtL�DDRE55 f.IiV ]iP PHONE <br /> N�'� <br /> ��� ARGn1ECLORO[SiGNEF MAILAD�PESS CiTY ZiP PMONE <br /> ��� G[��IFALCONTRACTOF IdAILA0�RE5S CIiV 21P PHONE UCENSE� ' <br /> [ H <br /> ayv� — <br /> �d6OUNICRICONTRACTOR MAIIRDDRE55 CITY 2iP PHONE LiCENSE/ <br /> K �� fluGi�iNGCONTPFGtOR MAiLGDDP[55 CITV ZiP P��ONE I�CENSE� <br /> I <br /> "�i1H"� anssoFwor+K � OU:7' l!- i0Y1 O�7 <.X�S- -i/N' Ye.:Ic�2nC'1. <br /> CA H <br /> Hryp� z C NEW ADDITION � ALTE.'lAT10N . REPAIR DE � LITION � WOODSTOVF/FRPL INSERT . BUILDING RELOCATION <br /> l•1 y� IfNAIlTIMVROV[IA[NTORINTEBIOPREMOO[LONLV LOMqCTP[RSONANOPHON[NO <br /> 0H�y CONLR/GTPFIC[OFWORN: S�'-1 <br /> � ��LQ.I �Cl T�LorfiL 5%S�e'Y) �27`I ' �75�, �, <br /> � �y DESLRI]EWOR✓,ANOS�URFEFOOiAGEINVOLYEO I � � <br /> �� n C.7mpl�tir.� F�;:reeLaY.nn on N>l s � r.�.� <br /> z HS �oaoseousEOFouiioiNc I HEREBV CERT�FY THAT I HAVE READ AND EXAMINED THIS <br /> � N z '7Y`1 V[i I-P_ �WE,I�1 Y�q APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> H H ir.cni.r.eswmTiouo�aaorenrv israv+r�oei W OR ATTACH FOURCOPIE51 PFOVISIONS OF LAWS AND OFDINANCES GOVERNING THIS TYPE OF <br /> �y �J� ��JI�� ��f / / � J� WORK WILL BE COMPLETED WITH WHETHER SPECIFlED HEREIN OR <br /> Q �1..1 H �c,r :T /i�J�./.J��noce _�L oF 1 r/YSt NOT. THE GRANTMG OF A PERMIT DOES NOT PRESUTAE TO GWE <br /> n V� a.�y aiY i <br /> C"� �" �) / / 1 � �J AUTHOhTT'I TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> 3. C+1 C �(J�7 j'] (d y1 `O �-1��+�1 L� �CCOI��)2G��d OTHER STATE OR LOCAL LAW REGULATWG CONS?RUCTION OR THE <br /> C:� �7 J PERFORMANCE OF CONSTRUCTION. THAT I Alvt AUTHORI2E0 BY THE <br /> / ) i / OWNER OF iHIS PROPERTV TO P[RFORM THE WORK FOR WHICH <br /> y �� �j )"Q-J- )"e�ill'!J[..'�/ ) �OL � APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> � .�f n / � , I CONTRACTORS LAW 1827 RCW AND 296.200 WAC. <br /> ��(t(L5 �a� �i /rACDrUS J� Jl'NJ!' �L�2��4 �r�C sicuntuaEOFcor�ra�.crononnun�oarz[onc[ui nnt[ � <br /> ' Gr;Ji �s � ���'1'.C.:. <br /> / n <br /> �J � /�.�C�['/�['��_l��i^G '�lt ._,..c�L� `��'%,� <br /> rnaea nooaess <br /> C��I�� � � APPLIC�NiSCIiVBU51NF55LICF.N5HN0 i O�USM[SSN��dE <br /> PLUMB�NG MECHANICAL <br /> �� <br /> NO. TYPE OF FI%TURE OR ITEM FEE NO. TYPE OF EOUIPMENT <br /> �'^ ! WATER CLOSET�TOILET� A�C—A�HNDLG VNITS—H.P. <br /> BATHTUB FORCED�IH SYSTEMS—B.T.U. M E.A. <br /> �.� ;,s LAVATORV�WASH BASIN� UNIT HEATERS—B.T.U. M <br /> �4 � SHOWER CLOTHESDRYERS <br /> � •~ KITCHEN SINK 8 DISP VENTILATION FAN � <br /> --�— <br /> DISH WASHER RANGE HOOD <br /> �= w WATER HEATER <br /> LAUNDRYTRAV <br /> ! '! CL'JTHES WASHER WOOD STOVE <br /> URIIJAL METAL FIREPLACE 8 CHIMNEY <br /> � r„� DRINKIN6 FOUNTAIN _ FIREPLACE INSERT � <br /> .....�1 � FLOOR DRAIN HEAT PUMP --� <br /> BACKFLOW PREVENTERS G�S PIPING <br /> ROOF DHAINS—RAINLEAOERS EXHAUST FAN <br /> ��� � ' SINK(SERVICE—BAR,ETQ) <br /> :� — <br /> ' ts' ---r � <br /> w <br /> SU�TOTAL 5 —� SUB TOTAL 5 _ I <br /> PERMIT 5 �— PERMIT 5 �I <br /> TOTALFEE $ TOTALFEE 5 <br /> FI'.p4i$ETpACN R[ARS[T�ACN S�DESET�ACK VLr1NLMCCKNW.111[B FC!'. �ECEIPiNO. <br /> usttzone LOTAREA VACANTSIt[ FEES VALUATION FEE <br /> ��J� � <br /> � YES � NO ouaoiNc __��VV i <br /> +�P[OiLONS1.RLLOWABLE tYPEOiLON51AtiWL �cuenxcr nvacm�nrt„i:',is -- <br /> tnocr / pLU61�ING � <br /> --�— <br /> ;¢EOPOLOG NO.OFSTORIES BASEMENi MECNANICAL � <br /> VES NO -- <br /> OGCl1PANCYL04� FIRESPRNkIERSREO'0 NEiG11TUAlIi�iiON OTHER ' <br /> — —� � <br /> . � VES X N� STATEOWLDINGSURCHAPGE <br /> RI:ASON fOP SPRINNlERS <br /> _. — —� <br /> STATE ENEfiGY SURCHARG[ , <br /> nrriicnnoHnecnv ninr�sneriwvroirv CITYOFEVERETT PU�LICWORKS ' <br /> LOCAL SALES � <br /> �� 1ty�� TAX COOE IS 3105 TaTAi <br />