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APPLI�AT10►_ FOR CONSTRUCTI..N P'ERM17' °��•'�'" <br /> � , TO BE COMPLETED IN INK—PLEASE PRINT � <br /> cirv or <br /> everett f HEATING SYSTEM ',GAS J ELECTRIC U___ --- —� <br /> BUILDING DEPARTMENT — <br /> 259�8810 <br /> DEMOLITION COMBINATION �BUILDING MECHANICAL PLUMBING SIGN <br /> OWNER n^ /lAFILADORE55 ❑lY TiP P��U4E (1 <br /> 7oN✓I �' V�nr1 ni� �c I�O L3r ,r S _�5? i=rPiirf- C�1� - <br /> ��typ��j J'— MAiIApDNESS CiIV 21P Pf�ONE 7 l /� <br /> 7 7� ��S TC� <br /> nViGInIEGTORDESiGNER MPIlR00RE55 CIiV ZIP PMONE <br /> UEt nLCONiRPCIOR MAILADDRE55 CITV DP PNONE LtCENSE• <br /> �riaH�•u�rin CaK,��., h�,�..���� ��y23-3ST''/-I�n )�_ <=���itz���' 'a�� <br /> IaEGr�AWCALWNi(iPGiOii 1ANLA iiE55 CITV ZIP PNONE UCENSE� <br /> h+ 3 -�� -i�.a�a <br /> p �� vlUNpiNGGONiRACiJF MNIA��RESS LrtV ZiP P��ONE LIC[NSE• <br /> l+l y <br /> �1 y <br /> QAS50°WORK <br /> ,�y y!�! � NEW ADDITION '�ALTERATION REPAIR UEMOLITION WOODSTOVE/FRPL INSERT BUILDIkG RELOCATION <br /> �„� C� LONiACi PERSON AND P��ONE NO <br /> HzF� Z � <br /> FQ (7 CONiRAGT PRiCE OF 1VOfaK <br /> 'o y 'ro D[$CRI����IG DSOUa�A� RNFW�U�INVOLVED <br /> V� F�� i i r PYi c <br /> � Z � vaorose useorem�o�r+c I HEREBV CERTIFV THAT I HAVE READ AND EXAMINED THIS <br /> p S � � T���. (/ � i L 'C APPLIC^TION AND KNOW THE SAME TO BE TFU[AND CORRECL ALL <br /> y rJ imni oescniarioH �aaorenrv is��ow�u ofLo+oa nrincNvouncoriesi PROVISIJNS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> O H —�'1 7,/(� �v{ VJORK WILL BE COMPIETED VlITH WHETHER SPECIFIFU HEREIN OR , <br /> N�g ,�, Ll u�ocK �x� oF � �✓L IJOT. THE GRANTING OF A PERMIT OOES NOT PRESUME TO GIVE <br /> �� � AUTHORITV TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> �..� q OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> 7, M 3 PERFOR�dANCE Of CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> .�,� y Z OWNER OF THIS PROPERTV TO PERFORM THE WORK FOR WHICH <br /> �� y APPLICATION IS MADE AND I COMPIY WITH THE STATE <br /> l7 f/� CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br /> C,O,'�� SIGNAil1RLOFCONin�C10�iOR�UilIONI)EORGENT DAl[ <br /> �� � ����� /�,.Zv �/ <br /> �Q y cnaecr nocncss ��� <br /> I 'C / nPFUCANiS i1vFiU5iN[SSUC[NS[NO RNDOUSNESSNPM[ <br /> �' PLUMBING MECHANICAL <br /> NO. TYPE QF FIXTURE OR ITEM FEE N0. TVPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) !+�'C—A�HNDLG UNITS—H.P <br /> 1 BATHTUB FORC[D AIR S`'STEMS—B.TU M E A. i <br /> �� _ LAVATORY I�'�'�SH BASIN) _ — UNIT HEATERS--B.TU. M <br /> ' —� <br /> _ SHOWER CLOTHES DRYERS <br /> KITCHEN SINK 8 DISP VENTILATION FAN <br /> DISNVJASHER RANGE HOOD <br /> � � LAUNDRY TRA'f WATER HEATER <br /> � �� ' _ CLOTHESWASHER WOODSTOVE <br /> � METAL FIREPLACE 8 CHIMNEV <br /> URINAL — <br /> DRINKING FOUNTAIN FIHEPL�CE INSERT ; <br /> —T-- <br /> FLOOR DR�IN HEAT PUMP <br /> BACKfLOW PREVENTERS GAS PIPING <br /> � ROOF DRAINS—RAINLEADERS � EXHAUST FAN <br /> SWK(SERVICE—BAR ETC.) � <br /> � T <br /> �I�� <br /> SUB TOTAL 4 SUB iOTAL 5 <br /> ' PERMIT $ —T— _ PERId1T 5 <br /> �t�'� TOTAL FEE S TOTAL FEE 5 <br /> FOR OFFICE USE ONLY: <br /> l��ONiSETpACK REPRS[ipnCK Si�EoETBPCN PInYC��LGrcNUMOEP FEE RECEiPiNO <br /> us[za�[ ioraaea VACANTSITE FEES VALUATION FEE <br /> B111L01NG <br /> �vPE 0!LGIIiS ALIOWABIE ivPE Of LON51 AGIVAL ocwv�ncr NO m oxni�.r.�•�'s -- — <br /> �9oj° pLUM81NG <br /> SiZ[OF 9LDG NOAF STOHIES DASEMENT MECHANICAL <br /> O�CUP�NGVLOAD FIRESPRNNLF:RSR[OD HEIGNtUMITATiDN �DDITIONALPLANCHECK <br /> OTH[R <br /> �vEnSpN FOR SPRlhhl[RS —�— <br /> STATE DUIIDING SUNCNARGE <br /> n�uKcer aurvsnvrnovcom CITYOFEVERETT ruoucwoaKs <br /> LOCALSALES <br /> �(a�� TAX CO�E IS 3105 TOTA� <br />