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APPLICATIOPL FOR CONSTR�JCTI4N PEF�MIT <br /> fhe[vergroen everett <br /> CITV Of } � <br /> � �� ever D" RTMENT <br /> p x . 259-8810 TO BE COMPLETED IN INK—PLEAS[ PRINT � <br /> y y y " I I DEMOLITION I 1 COMBINATION I I BUILDING I 1 MECHANICAL I ��'PLUMBING ❑ SIGN <br /> y � OW1lER M�IL�DORE55 � CITY ZIP PIIOIIE <br /> k o I,VE'teN �����Le�2s� 5312 23 �1,t,% E'//G-'ti26T// �48- 75�2 <br /> IENPNt MRI�ADDf1i55 � CIiV <br /> H :U nr r��orie <br /> � H � 7'Ax# C6�o SGo 4�6 <br /> y � MCIIRECiOfi0C51GHER MAIL4�ORESS CIIY ZIP p1101lE <br /> � S�yi <br /> S GENERALGONTp�CTOR MqILAD!IDE55 CITV ZIP PHONE LICENSE� <br /> n <br /> OH <br /> ��g IAECIIANIG�LCONTP�CiOq M4ILADORELS CIIY ZIP PHONE LIC[NSE/ <br /> Qyy,;� � L�F-IS������L� <br /> �i y �LUM6INCCONiMCIDf1 MAIL�pOHE55 CIiY ZIP p��pNE LICENSEI <br /> � C=�Y:i-rs% /Y,.,,.y�r, r_ FIrY�%i,.� , +ti <br /> �' I ,�� 8�— si 5��,�fl.�»„sr�! £in. Sdb'-55'77 <br /> �"� c�nsSOFwoeK ' <br /> y M Iv�NEW L I ADDITION I.] ALTERATION I 1 REPAIR ❑ DEMOLITION I-J WOODSTOVE/FRPLINSERT ❑ BUILDINGRELOCATION <br /> ��y ^ <br /> TENr1Ni IMPROVEMENT OR INTEFIOIi REMODEI ONL° CONTr1CT PERS@!ANO PHONE NO. <br /> � CON711qCT PRICE OF WORK: <br /> H� OESCRIBEWORNAN�90UApEFOOTAGEINVOWEO <br /> ___O._ .. ��l. n-IiJI� .L' <br /> PHOPOSEDUSEOFBUII�ING I HEREBV CERTIFV THAT I HAVE flEAD AND EXAMINED THIS <br /> . N����� (S .S�F �� APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> �EcaoescAiprioruoFpAorenrr�s��owNee�owonnrTncurouncar::=� PROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTYPEOF <br /> . WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> �or etocK oF NOT. THE GRANTING OF A PEPMIT DOES NOT PRESUME TO GIVE <br /> AUTHORITY TO VIOIATE OR CANCEL THE PROVISIONS OF ANY <br /> O�HER£TATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERI'ORMANCE OF CONSTRUCTION.THAT 1 AM AUTHORIZED BY TtiE <br /> OWNER OF THIS PROPERTV TO PEflFORM TNE WORK FOR WHICH <br /> APPIICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br /> SIGNNUfEOFCONIf1�C10p0lI�UTHORREO�GENL OATE y/Z/9U <br /> � 0215�1 <br /> rno�ecr noortess X? � i-. <br /> '�1 ` RJ1 I� arvucn����Tsa�veusi�+ H�' S7 ��L.,...-✓Si.•c.ro� F�GVE7i•-i- <br /> SyQs �'J� "f�C� � /� -S;LICENSENO.AN�BUSINESSNAME <br /> ' PLUMBING v MECMANICAL <br /> ' NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> L WATER CLOSET(TOILET) 7 i <br /> ��' - O A/�A/HNDLG UNITS—H.P. � <br /> 2 BATHTUB o ; FORCEDAIRSVSTEMS—B.LU. M E.A. � <br /> $� LAVATORY(WASH BASIN) i UNIT HEATERF�B.LU. M � <br /> I�' ( SHOWER 5�� CLOTHESDRYERS i <br /> / KITCHEN SINK 6 DISP VENTILATION FAN � <br /> 1 / DISHWASHEF � RANGE HOOD <br /> ' / LAUNDRYTRAY � <br /> , i WATER HEATER <br /> CLOTHES WASHER � � WOOD STOVE <br /> URINAL ' METAL FIREPLACE 8 CHIMNEY i <br /> '_' DRINKING FOUNTAIN i FIREPLACE INSERT � <br /> FLOOR DRAIN � HEAT F'UMP � <br /> '+' BACKFLOW PREVENTERS i GAS PIPING <br /> �' ROOF DRHINS—RAINLE��ERS � ExfIAUST FAN —T— <br /> SINK(SEPVICE—BAR,ETC.) � � <br /> ' —T i <br /> _1 — �_ <br /> � � <br /> I SUB TOTAL $ �j'�j � � SUB TOTAL $ <br /> '� _ PERMIT $ � PERMIT $ � <br /> - -- - TOTALFEE $ ,�O-' TOTALFEE $ —~— <br /> FBONiSEiBACK RERRSETOACK SIOESEID�CN P��NCHECKNUM�EII PEF. flEGEIPiNO. <br /> usEzor+E LOtAftEA vncnrirsirE FEES VALUATION FEE <br /> I_I YES I] NO �UILDING ' <br /> IYPEOfCOHSi.AILOWAOL[ TYI'EO(COlISLACiWL acu�excr ri0nr��pxGaxnS � <br /> LPpLP <br /> PLUMBING i <br /> — � <br /> srz[or gioG. no.oF Sroni[5 O�SEMENI MECHANICAL ' <br /> f_I YES I I NO <br /> pCCU�RICY LOAD FIRE SPqNRlEBS REOD ��[IGVIT LIMIIAt10N OTHEP � <br /> CI YES IJ NO <br /> STATE BUILDING SUfiCIlAf7GE � <br /> RE�SON FOO SPRINKLEBS i <br /> STATE ENLRGY SUf1CHARGE � <br /> nrrucnnoNncc.nr r�nnsnrrnoveonv CITYOfEVERETT puBUCWO�Ks i <br /> �ocn�sa�es „ � <br /> TAX CODE IS 3105 707AL ; <br />