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��..\ <br />APPLICA714r�1 FOR CONSTRUC?��ON PERMIT <br />rna e��y,�,� <br />CITV OF <br />everett <br />BUILDING DEPARTMENT <br />everett <br />e <br />259-8810 TO BE COMPLETED IN INK—PLEASE PRINT <br />I! DEMOLITION � i COMBINATION i i BUILDING �� MECHANICAL i i pLUMBING I I SIGN <br />OWNER 1ANlAUD11f55 (:IIv IIP P110NE <br />�RKNA�tD W. ouN�fi 'l50 � b8TH A� N� M��SVIl.1.G� WA 9 g27o 654 -533 1 <br />TEN�NT M7.�L4DOPE55 I(:IIv 7i1` PIIONF <br />�RCHIIECipROESICNER M41L�OURE55 CIIY ZIP PIIONE <br />GENERALCONiRnC70R MML�DCRE55 GIV ZIP PIIOHE UCENSEI <br />R�cNMti� W. YouN� (s��c �> /��3o✓e ) <br />MlCNRNICAICONTR�CTOq MAIL�UDRG55 CIIY IIP PHONC UCENSE� <br />PWMBINGCONIRACiOR M�IL <br />p!Y ZII` <br />LICENSE � <br />I I NEW I � ADDITION I I AUL-RAiION !! REPAIR I � DEMOLITION �� WOODSTOVE�FRPL INSERT I I BUILOING FELOCATION <br />TEN�NI IMPROV[MCNf OR IMEIIIOII fiF.610L[l ONLY I CONI�G PF.ItSON �NU PIIONC NU q � �/ <br />ca+tnncrrniceorwonw: ---(_Y_iS�l.i`l�D�----� _��[�j.�1D�.y(`ktlf�----.�SO_(L>�� <br />OESC(IiOE WOIIK ANI� SWAiI[ 1 WIAGF INV(%V[U <br />_ n l� 1 � <br />VROPOSJEDUSEOFBWLDMG ' ' ' <br />f`.�Px <br />LEMLDESCRI iIONCFPRO�ERiV�5110WNOf O\VO��ILACH�IXInCOPIESI <br />�ors R C � xl. e�ocK psy D'b� �y�eTi �►Y M P�aT <br />F4�oTie%1 �•GO <br />t5 e �.b f3Le�oo8 .c <br />iyEllE TT <br />i4 RocKEFRL4E�1 AV,�I <br />TAOORESS <br />UMBING <br />T IPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILE7) <br />BATHTUB <br />LAVATORV (WA6H BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISP <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FIOOR DRAIN <br />BACKFLOW PREVENTERS <br />ROOF DRAINS—RAINLEADE <br />SINK ISERVICE—BAR, ETC.) <br />FRON75E1P�CK <br />�r <br />USE20NE <br />1Y('f Of CON51. ALtOW�OL[ <br />�-N <br />S12[ Of 01 fH: <br />_I�31 5 E, <br />OGCUPANC�LOdU <br />REASON fOp SPIIINNI F.I15 <br />qPPIICAIIUN Af.0 Av <br />SUB TOTAL $ <br />TOIAL FEE <br />RE�RSF.IAACK I <br />20' i <br />LO' OfiF.A_ . � <br />im[ ur coxsi nr. <br />�—� <br />r�o. or stomr.5 <br />FIfiE SPI1NKLf:fi$ OfOV <br />I � YES X NO <br />r�nNs nr^noveo nv <br />/� <br />I HEREBY CERTIf-V THAT I HAVE READ AND EXAMINED THIS <br />�PPLIGATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF IAWS AND OADINANCES GOVERNING THIS TYPE OF <br />WORK WILL BF COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THF GRANTING OF A PERMIT DOES NOT PREuUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR 7HE <br />PERFONMANCE OF CONSTRUCTION. THAT 1 AM AUTHOHI2ED BV THE <br />OWNER OF TfiIS PROPERTV TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br />9f NAiIIR[ 0� CON I ItnC10R 08 �UiMORIZED AOENI ORl E <br />9201 � X. i�% i <br />FEE <br />nrri �cnms cnv <br />, <br />c.� � '�,<«C• c 7 - %�C <br />INOAND� S�NESSNAME; • ' <br />TYPE OF EOUIPMENT <br />NDLG UNRS—HP. <br />AIfiSYS1EM5--B.iU. �7 E.A, <br />UNIT lIEI1�ERS-8. <br />CLOI�HES DRYERS <br />VENiILAiION PAN <br />RANGEHGOD <br />W�fER HEATEfi <br />MEIAL FIREPLACE 8 <br />FIREPLACE INSERI <br />I�IEAT PUMP <br />GAS PIPING <br />EXHAUSiFAN <br />Slp[SCI�ACK Pl�t�t'j1f:CHH .�F❑ �EF <br />5 ` c- <br />vncnr+t sne EES <br />� � YES I I NO <br />nuu.uiNc <br />MCOfAY�v �nMpNlllMfillHlli - � - � <br />�,,,�,� 2 <br />Pl.UM131NC <br />�_�_. . —_.— _ _ —_"_.. _.__"_— <br />Im,1 �,n�r�i Mf CIIAIJICAI <br />I I Y[S ��.j! NO . . _. .. -- --�------� <br />I IF.16111 I IM I14I I O I I IG fl <br />___' � �� � _ SIAIf I1111LUMG SUIICIIAfIGG <br />SIAiE [NFR6Y tiUf7CIlARGE I <br />CITY OF EVERETT <br />LOCALSALES <br />TAX COUE IS 3105 <br />PU9LIC WOfiKS <br />70TAL <br />SUB TOTAL 5 ; <br />PERMIT $ � <br />TOTALf-EE $ ' <br />necEirr ko <br />✓ I <br />VALUATION FEE <br />� 1'' S°`' ' l�z <br />� <br />__ _ i <br />— <br />i <br />�Ii <br />i <br />_ 1 <br />i <br />� <br />