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[*1 H <br />a � y <br />HZH-+ <br />I< z o <br />Ox0 <br />4HIt <br />Tn H <br />Fx3 <br />D7 O <br />H C <br />OH <br />H08 <br />H C <br />L H 3 <br />H h7 <br />HH <br />g� H <br />qo e7 vJ <br />07 m <br />HOTOA <br />APPLICATIG"I FOR CONSTRUCT, <br />JUN 2 8 1991 <br />Inr Errryrrrn <br />veCITY OF EVERETT ..... ue <br />vei•eit <br />BUILDING DEPARTMENT Public Works Dept. <br />259 6810 TO BE COMPLETED IN INK -PLEASE PRINT <br />I I DEMOLITION I I COMBINATION I I BUILDING, IKMECHANICAL IPLUMBING I.-] SIGN <br />OWNCn NAIL ADOnESS CITY 11r PNONE �gYj -/gall CN <br />1- 1,e-AAoCP/h q&09 j/),,,stwe.u) D,. L— rOiL c18a03 aG6-G`l7bCw) <br />ABCNIIEC1 a1 tlESOrlEn MAII ADDTIESS CITY <br />zm <br />nnKMLtallnACigl LICENSE <br />MAIL ADDnESS CITY ZIP PHONE <br />ans3w vrtKrA wA .. I I neAA(I ITInN I I wnnnBTOVF/FRPL INSERT I 1 BUILDING RELOCATION <br />I I NhW I I nVUn vry �••u o......... . <br />. ......... <br />I fNMlt IIArRDVENr11t On INIrn00 nEMDDEI aRY <br />CONIACf <br />rED50N ANO PHIOOE NO. <br />CaToIlACT rg.� cE Or WOnK• \ r/p <br />uE:.cn'mr wonK nn0 sgrnnE rarTnaE PrvgvrO <br />L/Fl�imu CLiYutc°.t_ 7Z? CCIS <br />vnorosrnusrsra DurtDl lD <br />1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />/- <br />/ =Q/1�� <br />SJI1 jW <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />AND ORDINANCES GOVERNING THIS TYPE OF <br />IEnnL orS-nmllartxn 8En1Y 151KTYlingAILACN ram <br />ca9F.sI <br />PROVISIONS OF LAWS <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />or <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />LOT BLmK <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />r <br />/ a.-41# /_ 05-8_Q 00-003 _ cw9 <br />�rPP <br />01HEn STATE OR LOCAL LAW REGULATING CONSTRUCTION OH THE <br />PERFORMANCE OF CONSTRUCTION, THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />_ <br />APPLICATION IS MADE AND 1 COMPLY WITH THE STATE <br />CONTRACTORS LAW I8.27 RCW AND 296.200 WAC. <br />-- <br />sONMUDE or conunwon On AUTIIDnIIED AGENT DATE <br />X 3un(ou nc. <br />rTOJECT AWRESS <br />''n� (•(~' iX V <br />nrrT lf, IFCITY RUSMEss LICENSE NO AN00051NE55 NnNE <br />PLUMBING <br />MECHANICAL <br />FEE <br />NO. TYPE OF FIXTUnE On ITEM <br />FEE <br />UIPMEIJT <br />TYP;NI <br />IJO.;A/C-All <br />WAT ER CLOSE T (I OILET) <br />r_ <br />INDL-H.P.BATHTUBED <br />AIR S-B.T.U. M E.A.LAVATOnY <br />(WASH DRSIN)HEATER. <br />MSHOWER <br />' <br />IES DRKHCIIEN <br />SINK 6 DISP <br />LAI ION <br />--_ <br />DISHWASHER <br />I <br />HOOD <br />- <br />J- <br />_RANGE <br />WATER HEATER <br />' <br />LAUNDRY TRAY <br />_ <br />CLOTHES WASHER <br />WOOD STOVE <br />METAL FInEPLACE 8 CHIMNEY <br />URINAL <br />--r— <br />_ <br />DRINKING FOUNTAIIJ <br />_ <br />FIREPLACE INSERT <br />_ <br />DRAIN <br />HEAT PUMP <br />_ <br />_FLOOR <br />BACKFLOW PREVENIE_RS <br />—� <br />_L <br />GAS PIPING <br />�- <br />_ <br />DRAINS-RMNLEADERS <br />_ <br />EXHAUST FAN <br />- <br />_ <br />_ROOF <br />SINK(SERVICE-BAR,ETC.) <br />' <br />i <br />_- <br />' I <br />I <br />i <br />_ <br />SU_13101AL <br />E <br />�_ <br />_ <br />SUB TOTAL $ <br />$ <br />PERMIT <br />S <br />I <br />PERMIT <br />TOTALFEE <br />E <br />' <br />TOTAL FEE $ <br />motto smwx <br />nEAn SETBACK <br />SOE SETBACK <br />PLAN CHIECK NUNnEn <br />ftE <br />RECEIPT NO, <br />USE. ialE <br />LOT AnEA <br />VACANISITE <br />FEES <br />VALUATION <br />FEET_ <br />BUILDING <br />' <br />I I YES I I NO <br />IM M EINISI MLOWAKIE <br />Im gCONST ACTH-, <br />aNrlxcr <br />4101r <br />Oa nw.w'S <br />—_--- <br />PLUMBING <br />SlzE or DrW <br />No. a'slOmrg <br />OASENEUf <br />MECHANICAL <br />I I YES I I NO <br />- <br />OIIIEn <br />' - <br />MrUPANOVLMO rmr sprImEns Aran <br />IIEOIIIIOAl1A.ON <br />I I YES I I NO <br />STATE BUILDING SURCIIAROE <br />' <br />_--i— <br />STATE ENFRGY SUncuAnOE <br />' <br />' <br />_ <br />REASON run svilmiERS <br />nrnlcMlLx+ncc.Or <br />Twnnsnrrnnvrnnv <br />__ _ <br />CITY OF EVF.OEIT <br />PUBLICwonKs <br />LOCAL SALES <br />I <br />TAX CODE I <br />TOTAL <br />