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APPLICATIV�� FOR CONSTRUC7 .ON PERM14 �' � <br /> everett <br /> ine Cve�gr�n � _ <br /> QTv OF <br /> everett <br /> BUILDING DEPARTMENT TO BE COMPLETED IN INK—PLEASE PRINT <br /> 259 8810 <br /> DEMOLITION COMBINATION ✓BUILDING MECHANICAL PLUMBING S <br /> [ GiY 21P �'NJ�i[ <br /> OYRIER Mml ADDR655 q` �I�5`' <br /> P �] T <br /> ALaC.-fl'( �A'14�L lo?.� U� 17-35i �e,�'Tc u-. t..iP `�$�25 PHo�+e <br /> TENANI M411.�DDR[SS <br /> ♦qCNrtEGTDR0E5iGN[R MMLnODRE55 <br /> CItV IIP PIId�E <br /> O�a.>JGiL R�oJ(p cror�e uce��se. <br /> GE�lLRAICONiRACTOR <br /> IAPII AD�RE55 GITV 21P <br /> ��y GTY ZiP PNONE IIGENSE• <br /> MECNANIGAL LONTRPCiON MI.II ADDRE55 <br /> p�HCITY ZIP PNONE IIGENSE• <br /> ayS� (�J PIViABINGCONiNALTOR MAILAO�RES$ <br /> M T3 <br /> � Z� CUSSOF WORN . <br /> y.� NEW . � ADDITION ✓ALT[RATICN - REPAIR DEMOUTION WOODSTOV6FRPL INSERT BUILDING RELOCA I <br /> � y� iENANTIAIPROVEMEFLORINiERIORN[MOOFANIV I, <br /> ca+rnc*rEnsor+�r+orwov[r+� 5C+'�T,.r•L� <br /> CONTRAGi>RICEOFWORN: �L'OD �L �/��4�- 363 ����Y' <br /> y <br /> Z DESCRiBEWORNPNDSOUAREFOOUGEINVOIYED 5�+�'CA�-� Z uC��• <br /> � Qyd G.oJrt' 1na��S�uaIP�Atf;i�s �p➢ 6�. _ <br /> ��KoU6- <br /> p� � PRUCOS[DUSEOFBUIIpIN;N �M Ip ��WQ�'y �-P(l',K 1 HERE6Y CERTIFY THAT I F'.AVE READ �ND ExAMINED THIS <br /> �y C�{Ad4F AMN ` APPLICATION AND KNOW?HE SAME TO BE TRUE AND CORRECT.ALl <br /> H Cs7 O Sflf�eT Re�K � Q���^t�� pROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> �� nCCC �[en�oescnipnorvoFPaoPenrv�s+owmeeiowonnnncNFouncoviesi y�ORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEFEIN OR <br /> z y� i�T 19- 19 piaK (0 15 oF _P�'Ki oF E��M1� � NOT. THE GRANTING OF A PERMIi DOES NOT PRESUME TO GIVE <br /> AUTHORITY TO VIOLATE OR CANCFL THE PFOVISIONS OF ANY <br /> � ��r OTHER STpTE OR LOCAL LAW REGULA?ING CONSTRUCTION OR THE <br /> � ~y � �.1�T—Z� �� A� PEHFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BV THE <br /> N <br /> C-XtCPT T�+ <br /> �"� OWNER Or'THIS PROPERTY TO PERFORM TNE WORK FOR WHICH <br /> n dCy APPLICATION IS MADE AND 1 COMPLV WITH THE STATE <br /> � [�[i — CONTRACTORS LAW 1827 RCW AND 296200 N1AC. <br /> M SIGN0.LUAFJ�GONTRPLiGRORAUiHOR12E0AGENi OATE <br /> H O tyir — X G%�/�r!—�R'"" <br /> �i� <br /> PROJECTAO�RE55 /� qppLICANTSCrtYBU5ME55liCFNSE OANOBUSiNE55NR1AE <br /> Z(�Z6 R�4Cl�C'(L 1An11T 2 . <br /> PLUMBING � MECHANICAL <br /> NO. TYPE Of FIXTURE OH ITEM FEE N�' a,�_�,HNDLCE NFT OUH M ENT <br /> FEE <br /> WATER CLOSET(TOILET) <br /> '.,.�' FORCED AIR SVSTEMS—B.T.U. M E.A. <br /> BATHTUB <br /> �'� LAVATORVIWASHBASIN) UNITHEAfERS—B.T.U. M <br /> SHOWER GLOTHESDRVERS <br /> � <br /> KITCHEN SINK 8 DISP VENTI'ATION FAN <br /> � � DISHWASHER ' RANGEHOCD <br /> — WATER HEPTER <br /> LAUNDRVTRAY yypODSTOVE <br /> CLOTHES WASHEFi ' <br /> 'w� METAL FIREPLACE&CHIMNEY � <br /> ' URINAL <br /> �� ORINKING FOUNTAIN FIREPLACEINSERT <br /> FLOOR DRAIN <br /> HEAT PU1.1P � <br /> BACKFLOW PREVENTERS GAS PIPING . <br /> � ROOFDRAINS—RAINLEADERS E%HAUSTPAN � <br /> � w <br /> SINH(SERVICE—BAR,ETC.) <br /> ���� _ --i— <br /> SUBTOTAL $ _ SUBTOTAL 5 _ <br /> PERMIT S <br /> I ( � PERMIT 5 TOTAI FEE 5 <br /> TOTALFEE 5 <br /> FLANCHE eHUM0E4i (EE R[CEI4TN0 <br /> FRONTSEiBPCN RERNSETBACN SAESETBACK (� ^ p (. 7S 2 <br /> • " I Q 10 j .l O � J <br /> FEES VALUATION FEE <br /> USE ION! LOT ARER \'ACGNT SITE � � ��"� <br /> 23' SOeo .! YES � NO ew�oiNc '-� . _—�-t' <br /> IYPIOfLON51MlOWABIE rvPEOifON5iFL1U�l amr�x[r xcpuvnuYco+'s <br /> ceuiv ^_ p�UMBMG <br /> �/ N V� � T <br /> 512[OF01�('i. NOAFStONiES BASEI.IENi MELNANICAL <br /> �— —� � � YES NO <br /> OTHEF � <br /> P:CUPANCYLOAD fIPESPRNNlERSl:E00 MEIGNTUMrtAt10N _ r,� <br /> _ , I YES \�NO _ STA7EBUILDIRGSURCNAflGE _���- <br /> / <br /> RU:ON FOR SPRINelEBS <br /> STATEGNERGVSUHCHARGE , <br /> nrruce*ior+rccov Pur+snrra�vrouv CITYOFEVERETT PuouCwoaKs � � <br /> /` i LOCALSALES �� F=�' <br /> �� ,,C�'� TAR CODE IS 3105 rou� ' <br />