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APPLICATIO�.+ FOR CONSTRUCT► .IN PERNi1T `'``'"'" <br /> ,.., .„ . , TO BE COMPLETED IN INK—PLEASE PRINT � <br /> ,. ., ..,.,,�.. <br /> cnv oi <br /> everett — - - - ——---- � <br /> HEATING SYSTEM� J GAS J ELECTRIC J _ _ __ - � <br /> BUILDING DEPARTM1IENT �-- --- — " — <br /> 259-8810 <br /> DEMOLITION COMBINATION BUILDING _ YMECHANICAL PLUMBING SIGN <br /> ��� y;y6� ADD(VfSti / f,liv / :�.�' P��O':E �! / G <br /> �iG' �i�/iGi J�Y/� ���L.��V�/ /f��"Y���j�'�—J / :�� � ��3� �/ <br /> �rryqNi MAiLADDRESS OIV I.IV PNONE <br /> nqC��li[CTORDES�GN[R 6miL400RES5 Crtv 2iP PnONE <br /> i'.VIEBALCONiPAGIDP AIAILA�DFESS piY ZIP PNONE UCENSC• <br /> �'.CCIIANiCALCONiPACtOR MAILA�ORE55 CRY ZiP PHONE LICENSE� <br /> y�� PlUqO�NGCONT� M4ILADOPE55 Cliv ZIP VMONE LICENSE� <br /> [�] <br /> � y <br /> LIASSOF WORN <br /> � y y NEW ADDITION pC��TERATION REPAIR DEMOLITION . WOODSTOVE�FRPL INSERT BUILDING RELOCATION <br /> � ')/J CONiACi PERSON AND PNONE NO <br /> H� � CONLPACiPRICEOFIVORK '�v`� � <br /> � y � OCSGRIOEWO�iNAN�SOOAREf iAGF/l1lY"OLVE�O �//_ <br /> 'i1 H �4 __n�s�i,.+�i��i�!.-l/7"�'>'�'�� <br /> . .�•j_,... <br /> y H rn voseWseoFowinir�c I HEREBV CERTIFV THAT I HAVE READ AND EXAMINED THIS <br /> � x� �� � APPLICATION AND KNOW THE SAME TO BE iRUE AND CORREC7.ALL <br /> � ieG�ioEscAi ior+ocva Earr�sNowr+ee�rnvoanrucNvomicari�si PROVISIONSOFLAWSANDOFDINANCESGOVERNINGTHISTVPEOF <br /> y d WORK WILL BE COt.1PI.ETED WITH WHETHER SPECIFIED HEREIN OR <br /> �pi e�ocK or NOT. THE GRANTING OF A PERh11T DOES NOT PRESUME TO GIVE <br /> � � g AUTHOFITY TO VIOLATE OR CANCEL THE PROVISIONS Of ANV <br /> C,]� (] OTHER STATE OR LOC�L LAW REGULATING CONSTRUCTION OR THE <br /> H � PERFORh9ANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> Zy <br /> 9 OWNER OF THIS PROPERTV TO PERFORM THE WORK FOFi WHICH <br /> [� x APPLICATION IS MADE AND I COh1PLY WITH THE STATE <br /> �"� y CONTRACTORS LAW 1827 RCW ANG 296.200 W�C. <br /> �-y ti <br /> y H $IG4AiUR[O�CONLfiAQO110FAlIfMOqIZEOAGENT DALE / � <br /> �d � � �/ <br /> 5 -- �� � , <br /> � L" � l��,.i�-/� ��i ���0—C <br /> Pno�ecrnooaess / 1�r� d �' �—;- <br /> y O y — 6 �dPVIIGANTS GIf V OVt�9E'_`.i L�CkNS[NO AN�OUSME55 NAIdL <br /> �Z�e-- <br /> PLUMBING � MECHANICAL <br /> � NO. TYPE OF FIX7URE OR ITEM FEE NO. 7VPE OF EOUIPMENT FEE <br /> . WATER CLOSET�TOILET) 0.�C—AMNDLG UNITS—H.P <br /> � BATNTUB FORCED AIR SYSTEM1IS—B.T.U. M11 E.A. <br /> � _ LAVATORY(WASH BASW) UNIT HEATERS—B.T.U. M <br /> ' � SHOWLR CLOTNES DRYERS <br /> ��' KITCHEN SINK 8 DISP VcNTILAT10N FAN <br /> DISHWASHER PAi IGE HOOD <br /> LAUNDRY TFiAV WATI R HEATEfi _ <br /> '�� CLOTHES WASHER WOOL'STOVE <br /> I ��' URINAL METAL 9REPLACE 8 CHIMNEY _ <br /> DRINKING FOUNTAIN FIREPLACE INSERT <br /> FLOOR DRAIN HEAT PUMP <br /> � BACKFLOW PREVENTERS GAS PIPING <br /> � �1r ROOPDRAWS—RAINLEAOERS E%HAUS7FAN <br /> SINK�SERVICE—BAR.E7Q� <br /> � — <br /> SUB TOTAL 5 SUB TOTAL 5 /.� ; <br /> ` PERMI7 5 PERMIT 5 �r � <br /> �-. TOTAL FEE $ TOTAL FEE S >�' ' — <br /> FOR OFFICE USE ONLY: <br /> fBONiSEIBACe IIEARSEiIIACN 510[SETBACN PIANCHELkNUM9ER FEE f1CCF.iPIGO <br /> u;�aa�r. �otnaEn vncnrutsitE FEES VALUATION FEE <br /> BUILDING <br /> 11P[OfCONRAIIOWRBI[ nPfOfCONSfACiU�I amr�yp MOdoAYu�xLimnS -- <br /> °"�`° pLUM61NG <br /> SREOFBLD�. NOOFSTOPiES BRSEMENi A7ECHANICAL — <br /> 3d <br /> Of.CopNCVLOAD FIRESPRNNLERSREOD N[IGNTIIMITAilO!! ADDITIDNAIPLANCHECN <br /> _ _ OTHER <br /> REPSON FOR SPNNNLENS r— <br /> STATE�UILDING SURCNARGE <br /> r�}nrt.nr r'tnr+snrrnomnnv CITYOFEUERETT PUBLiCwORKS <br /> LOCALSALES , <br /> TAX COOE IS 3105 mT�•i <br />