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�PPLICATION � FO1�-� ����„ <br /> p`�'"" CONSTRUCTION e <br /> everett PERMIT <br /> BUILDING DEPARTMENT <br /> 259•8745 TO BE COMPLETED IN INK• PLEASE PRINT <br /> O DEMOLITION O COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBtNG ❑SION <br /> OWHER FIql�00RfS9 GI1Y IIP PNONE <br /> Wayne Derrick 17t0 W Silverlake Rd E�erett 98206 337-2636 <br /> •RCNITELTORDE910NF.P MM��OOFESS CIIY lIP P110NE <br /> OEHER�ICOHIR�CION M�ILa00�f55 Clrv IIP P11ONC JGENSE• <br /> EWerett Bldrs Inc 5606 EWerRreen Wav ��erett 98203 353-7161 EVF.BEB*3 11L3 <br /> MECN�NIULCONTR�CiOq Me1L�0011E49 QIY 11 ONE LIGEN9E <br /> PLUMSIMOCONiR�CIOR M�II�DDRE55 Ci1V ZIP 1'110NE UCENSE• <br /> C1�530�WORN <br /> ❑ ryFW ❑ �DDITION � ALTERA710N ❑ FEPAIR ❑ DEMOLITION ❑ WOOUSTOVE/FRPL.INSERT ❑ BUILDiN6 RELOCATION <br /> v11L WT�oN or WORM Icosr o��/�t[aul5 olus t�eou� <br /> 3,196.00 <br /> OElCRilE WORe <br /> Tear oEf and reroof existing residence w/ 22 sq. comp) <br /> une or ew�o� • �p I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP• <br /> �.— �./�aaQe.. F—°�- PLICATIONANDKNOWTHESAMETOBETRUEANDCORRECT.ALL <br /> LE4ALDE8CRiPTiONO O�EHfY�SMOWNBEIOW A�»�������RCOPIESI PROVISIONSOELAWSANDORDIN4NCESOOVERNIN6THISTYPE <br /> OF WORK WILL BE COMPLETED WITH N'HETHER SPECIFIED MEFE- <br /> �or_e�oc�or IN OR NOT.THE 6RANTING OF A PERMIT DOES NOT PRESUME TO <br /> GIVE AUTHORITY TO VIOLATE OR CANCEI THE PROVISIONS OK <br /> 4943-005-009-0002 ANY Ol r1E R STATE OR LOCAL LAW REGULATING CONSTRUCTION <br /> — OR THE PERFORM0.NCE OF CONSTRUCTION. <br /> SION�IURE O�CONiP�GTOR Op AUiHORIZEU�OENT O�TE <br /> X �,ti� y-a�-3� <br /> MqJECT 110�NE49 �PPL�C�NiS CrtY BUSINESS UCENSE NO <br /> 1710 W Silverlake Rd �erett 98208 <br /> /LUM�INO MECHIINICIIL <br /> NO. T1��F OF FI%TURE FEE NO. TYPE OP EOUIPMENT FEE <br /> WATER CLOSET TOILE AIR COND.UNITS—H.P.EA. <br /> BATHTUB REFRIQERATION UNITS—H.P.E�. <br /> IAV�T011Y W�SM B�91N� BOILERS—H.P.EA. <br /> SNOWEN ��S F'RED AQ UNITS—TONNAOE EA <br /> KITCMEN SINK{OISP. FORCED�Ifl SYSTEMS—B.T.U. M EA. <br /> DISMW�SNER WAILMEATENS—B.T.U. M <br /> LAUNDNV TRAV UNIT NEATERS—B.T.U. M <br /> CLOTHES WASNEA EVAPCMTIVE COOLERS <br /> WATER HEATER _ CLOTNEB DRVEFS <br /> URIN�L VENTILATION FAN <br /> DN�NKINO FOUNT�IN RANOE HOOD <br /> FLOOR DR�IN AIR HANDLING UNIi— QP.M. <br /> VACUUM BFE�KERS 9TOVE <br /> ROOF DRAINB—R�INLEA�ERS METAI FIREPLACE 6 CHIMNEY <br /> SINK SERVICE—BAP,ETC. WOODSTOVE/FIREPLAGE INSE(iT <br /> 8UB TOTAL SUB TOTAL 1 <br /> PERMIT t PERMIT s <br /> TOTALFEE { TOTALFEE � <br /> THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br /> iRONTSETB�LM REAqSE1B�CN SIAESETB�CN PLANGHECKNUMBER PLANGNECMfEE <br /> FEE RELEIPt N0. <br /> USE ZONE �OT ARE� y�C�Ni SiiE FEE6 V�LIIATION FEE <br /> ores ar+o <br /> TYOEOFGONSI OCGUV�NCVGPOUP MOOFpWELLINOUHIiS <br /> BUILDINO f <br /> BRE OF BlD6. NO.Of S10PIE5 M�%AGG.LOAD <br /> PLUMBIN6 <br /> MECHANIC�L <br /> FIRE SPRINKLERS REOUIRED ❑ YES O NO Or11ER <br /> PENRLTY <br /> �PPLIL�TON�GC Bv PlAN9Q�ECrcEDBY APPN.fORI55U�NGEBV <br /> TOTAI <br /> .i• <br />