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. <br /> APPd.ICATIC,�N �dR CONSTRliC7 RON �ERIWIT <br /> ���-��«,n <br /> �. �.�� , e <br /> ���,��� <br /> e�verett , <br /> BUILDING DEPA�TMENT TO BE COMPLETED IN INK—PLEASE PRINT <br /> 259-8810 <br /> DEMOLITION COMBINATION �( BUILDING MECHANICAL PLUMBING _ SIGN <br /> o�vr�er+_� n+ni�noor+tss cirv 1u� v��ome <br /> _��ar Ga,-� ia PoBoY a�� v �'Ye�tt, wQ. �So'to3 �59-so8� <br /> ;pqpqi MM�ADDRESS Giv DP P��ONC <br /> ��� <br /> nn���rtEC10ADE5iGrvER i����LADDRE55 CITY 2iP PNONE <br /> r�y <br /> �'a S ��ry 2iP PHONE �ICENSE� <br /> 6[1lIIMLGONTRACIOR �AA�I���R[SS <br /> Ha� _ Owvler <br /> y zH Ieft.�mNiCRLCONTRACTOR MAllA00PE55 GITV 11P PNONE LICENSE� <br /> � y� CITY LP VNONE LIGENSE� <br /> � H� i'i W:f1iNG CONiPACTJR MAtL ApOFE55 — <br /> fp H <br /> �x-3 z� n nss ov won« <br /> C7 p[i7 IJE1N ADDITION yC ALTERA'i iON REPAIR DEh10LITION WOODSTOVEiFRPL INSERT BUIL�ING RELOCATION . <br /> y� t1 l�nNt iMPPOVEAIENT OR IYTEBIOH R@dODEt ONIV 1� w� P(�,�,� �.�� �ON1ALt P[RS@1 AND TPIIO1rv[NO <br /> CO'JiRPfT PRIfEOF WORN' (�^ �3�f�_ 5�'G� Iq 1 N OV�D� R S9- so 8� <br /> H �,g _ i <br /> (�]� ('] DES.:R'9E\YOPK AND SOV��E FOOIAGE INyGLVED � <br /> z r�� Rca L� acz o f�{S9�'-e►f w ;�-k vie.w one _ -- -- <br /> 9 H rpoacseouseornu.�ort+c I HERE9Y CEATIFY THAT I HAVE P,EAD AND EXAMWED THIS <br /> r H y Dy� �X� 5}�y��u^t�G SI4Io� AFFLICATION AWD KNOW 7HE SAME TO 3E TRUE AND f,ORRECT.AlL . <br /> N �m��ocscniar�ur�oFrnore, r�swwrie[towoWnr.nu+Fouacorrt;, PROVISIONSOF�AWSANDORDINANCESGOVERNINGTHISTYPEOF <br /> H I WORK WILL BE C061PLETED WITH WHETHER SPECIFIED HEPEI:J OF <br /> O Cti ��r��- �t ei�K ��_ o� _ I I'}D �SF�A��l , NOL THE GR�NTWG OF A PERMIT DOES NOT PRESUME TO GIVE � <br /> AUTHORITV TO VIOLATE OR CANCEL THE PROVISIONS OP ANY <br /> �j �Crc7 OTHCF STATE OR LOCAL LAW REGULATING CUNSTRUCTION OH THE <br /> y O y PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFOFiM THE WORK FOR WHIC� <br /> APPLICATION IS M�DE AND I COIdPLY WITH THE STATE <br /> — CONTRACTORS LAW 1827 PCW AND 29G200 WAC. � <br /> ;icaniunCOFconrnnnoAoanurroe�zeon�e+r nrit <br /> _ -- � ' <br /> .-- \ ��A�i�-� <br /> �no�wrnooaess� nPr��cnr: scnveusiuessu-_� e�ionwoousir�essr+nni[ <br /> '�� PLUMBING �✓ MECHANICAL <br /> ! NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE � <br /> :JATER CLOS[T ITOIL[T) _ __ n�C—AHNDLG UNITS—H.P. <br /> BATHTU� _ FORC[D AIR SVSTEMS—B.T.LL t.1 EA. _ ' <br /> �� I LAVdTORY�WASH BASIN) _ UNIT HEATERS—B.T.U. M �_ � <br /> � SHOWER CLOTHES DFYERS <br /> KITCNEN SINK 8 DISP _ VENTILATION fAN �. <br /> ` � DISHWASNER RANGE HOOD <br /> ! �"! LAUNDR�TRAY __ �N�TER HEATER <br /> CI OTH[S WASHER _ WOOD STOVE <br /> URWAL METAL FIREPLACE 8 CHIMNEY <br /> �,.� I DRWKWGFOUNTAIN _ FIREPLACEINSERT <br /> FLOOR�RAIN HEAT PUMP <br /> BACKFIOW PREVENTERS _ GAS PIPING . <br /> O^ , ROOF DRAINS—RAINLEADERS EXH�UST FAN - <br /> � SINK�SERVICE—BAR,ETC.) _—__ <br /> —� <br /> �I � _— <br /> SUB TOTAL 5 SU�TOT�\L S <br /> �— PEFMIT 5 —� ___ PERMIT S <br /> -- TOT�L FEE 5 TOTAL FEE S _ <br /> {nONiSROPCK RERfi5Eit3ACN SIUESEip�f�c PLANGHFChNUfAPIN f[[ ���� �CCEIPi 0 � <br /> 2�� ZU� S �� � '� <br /> ��,;�:joN� ictn��en vncnr+tsrte EES VALUATION FEE <br /> Z_ Q 3OO YES � NO puiLoiNc a��y U --_. ��_;_�_U <br /> iAfl Of C�NSI A1101NABL( I�PI 0�'0951 �CiIIPI O�nioFl�p tiJ e�Cail�M:nnJs —" --- <br /> ,�_ `/ ry�°:°; p y�G PLUML3WG <br /> �Y �'I <br /> 5,21 OF BlP6 NO OF 5109iE5 DASE�d[NL MECHANICAL <br /> �3� $'�(j'KDQ� � YES 1� NO -- 'I - <br /> UCCOPANGVlOAO FIRFSPRNNLEIiSREOV IIFICIRLIAIII N OTHER _ , l <br /> � YES X N� STATF 0111LDMG SJRCHARGE `"����,� <br /> _ � <br /> isnsor�Fon saair�K�[��s <br /> STATE ENERGY SURCHAf1GB _ <br /> �rvucanor+acc.ar r�n� pJryg ven CITYOFEVERETT puoucwoaKs <br /> //,{� �'� LOCAL SIILES � �� <br /> � '� J TP.X CODE IS 3105 rora� <br />