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APPLICATII.� FOR CONSTRUC7 ��ON "=RMIT <br /> rno e,rere,�,� e�-erett <br /> ���oF e <br /> everett <br /> BUILDING DEPARTMENT <br /> 259-8810 TO BE COMPLETED IN INK—PLEASE PR�NT <br /> DEMOLITION COMBINATION X BUILDING MECHANICAL XPLUMBING SIGN <br /> OWNER MAI�AD�RE55 LILY piP PHONE <br /> 7'o�i�,ur�RftAsr-y i�oe l�cr,�,e�= �J�'w-r? -�J�ZG/ 0?��- 7a�P <br /> T[NANi MARAppRE55 GITV 2iP PNONE <br /> PRCMRECTOROESIGNER IA�IL�pORE55 LITY Im FNONE <br /> H(]H �.y <br /> �['��{f �G[pFNRLLONiq�LTOR Mnyi �DORE55 qiV ZiP Pi�ONE liCErvSE• <br /> G��y Ol//CD� ��//A�d Co�rs7R• /<t s� irl,n,r•�r�C 6�.�i�i,Lsc2 t✓�l- 9ra» ti�s-G/�3 <br /> M 1AECIIANiULCOHiRACiOR I.IAIL ADDP[55 piV ZiP PMONE LI�ENSE� <br /> �YHtn <br /> F„� �.f PWM�iNGCON1qACTOR MRILAOORE55 �ITY ZiP PNDNE UCENSEI <br /> H H <br /> �C c] <br /> y;q anssorwor+K <br /> y N� . NEW ADDITION . ALTERATION �EPAIR DEMOLITION WOODSTOVEiFRPL INSERT . BUILDING RELOCATION <br /> TENANi�4PROVEMENIONINLCR1pRREMO ELONLV CONi<CiPERSONANOPMONENO <br /> � O� CONiRALT PHICE OF WORK: �� �,. O D <br /> DESCPiBEWORRRNOS�'�RREPOOiRGEiHVOLVE C �y�� <br /> OM� C7rI//0 E� IL �� qN/ /NG. 4�•�;vsAJY <br /> /f /fY /C�- �QoM' T CA�i.J TS <br /> z c�g Eccc sr�1,,.c <br /> p.� (q vnovo5`�q'usEOF i ort+c I HEREBV CERTIFV THAT I HAVE READ AND EXAMWED THIS <br /> z H S �' APPLICATIOIJ AND KNOW THE SAME TO BE TRU[AND CORRECi ALL <br /> � yZ IEGRLD[SLRIPTIDNOFPROP[RiV�SNOWNOEIOWORRTTAGNFOIIRCOPI[5) PROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTVPEOF <br /> WORN WILL BE COMPLETED WITH WHETNER SPECIFIED HEREIN OR <br /> H y ior aiocK oF NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> g y AUTHORITV TO VIOLATE OR CANCEL THE PROVISIONS OF ANV <br /> ~ OTHER STATE OR LOCAL LAW REGULATMG CONSTRUCTION OR THE <br /> �� �j�'y PERFOFMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BV THE <br /> `"� OWNER OF TFilS PROPERTY TQ PEFF('�RM iHE WORK FOR WHICH <br /> y •.3y APPUCA?ION IS MADE AND I COMPLV WITH THE STATE <br /> H O V1 CONTRACiORS LAW iB27 RCW AND 296200 WAC. <br /> S�GNATUREGfCONLR i0fl TNOBiZEOAGENi DAIE <br /> PRp,�ECTPO/D7RE55 /J� �/ <br /> // D� ��T/%QK�� ��CIICATSGiVBU9tlE554CENSENO�N�BUSINESSNPME <br /> PLUMBING MECHANICAL � <br /> N0. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> I -' WATER CLOSET(TOILET) _ NC—A�HNDLG UNITS—H.P. <br /> DP.THTUB PORCED AIR SVSTEIdS—B.T.II M E.A. <br /> IAVATORV(WASH BASIN) UNIT HEAT.RS—B.T.U. M . <br /> I'�" � SHOWER CLOTHES DRYERS <br /> •_ � KITCHEN SINK 8 DISP VENTILATION FAN <br /> DISHWASHER qANGE HOOD � <br /> LAUNDRVTRAV WATER HEATER � <br /> � CLOTHES WASHER WOOD STOVE <br /> � URINAL METAL FIREI'LACE 8 CHIMNEV <br /> DRINKING FOUNTAIN FIREPLACE INSERT <br /> ��'� ' FLOOR URAIN HEAT PUMP <br /> -.� BACKFLOW PREVENTERS GAS PIPING <br /> ROOF DRAINS—RAINLEADERS EXHAUSTFAN <br /> SINK(SERVICE—BAR,ETQ) <br /> (...I� <br /> '�'�� SUB TOTAL 5 SUB TOTAL S <br /> PERMIT 5 PERMIT $ <br /> TOTAL FEE 5 TOTAL FEE $ <br /> • " FRONTSETBACN RGqSEiDALN SIDESET9RCk PLANCIIECeNUMBER FEE RECEIPTNO. <br /> usezorve �oraau vnenHrsrte FEES VALUATION FEl�E <br /> ttF(OiLONSi.�LLOW�BIf iVPEOiCONSi�CNAL IXc�e�x[ESN�arp�,v��NO��y.i5 BUILDING �"7 �h�7��/ l ,`�� � � <br /> _�__�_ v <br /> cro�e 1 <br /> PLUMBING �O ; I � <br /> SREOFBLDO. NOOGSTORIES BASEMENT MF.CHANICAL <br /> i VES NO _ <br /> WCLIPANGYIOAD FlRESPRIIXlER5RE00 NEIGHiLIMIiAiION OTHER <br /> VES � NO STATE B111L01NG SURCMARGE /� ir' '. <br /> IiEASpN iOR SPRINHLER$ 1 9/' <br /> T'� <br /> STATE ENERGY:iUFCIIARG[ <br /> nrrucnrior�ncc �r rinnsarrnov�.uur CITYOFEVERETT ruoucwonns �i <br /> LOCALSALES <br /> TAX CODE IS 3105 TOTAL � <br /> d- i 3 �; ' <br />