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l'J [�i � <br />C�J�H <br />ayxv� <br />y x ��-+ <br />K c� <br />H x1 <br />� H "��J <br />H�C <br />� �� <br />OHd <br />H/��S <br />y�Y C] <br />� H� <br />�yH <br />H <br />nd� <br />� � Cil <br />Z H t/r <br />H O V� <br />� <br />�� <br />� � <br />� ' <br />�� <br />�� <br />APPLICATIc�N FOR CONSTRiJt..'IO�f PERMIi' ����E'" <br />TO BE COMPLETED IN INK—PLEASE PRINT � <br />mcevmgmon <br />GTV OF i <br />everc�t � <br />BUILDItiG DEPARTMENT <br />259-8810 ' / <br />' DEMO!_ITION V COMBINATION <br />p�y��Eq I.IAILADOAE55 <br />�1" _ t I �/,. i i-?—.i i '. "�' � 4 <br />HEATING SYSTEM <br />BUILDING <br />CIiY <br />L�"=I' / i <br />C!tY <br />ARCHREGtOBDE5IGNEF N0.ILADDRE55 CrtY ZIP PHONE <br />G[IlERr1lGONTRFCTOR lAAILADDflESS QTY 21P PHO4E LiCENSE• <br />/7- ( L" l /I+ �� C � n2 "K;�'y' �?/�-//✓C� i'/ C% <br />i>r ; 4-..��� ! .(%liu7 �/ '�( (f�o /1 /P ri0 %%>`7 <br />Id[CHAIlICA'.CONiRACTOR ^IAPILA�Of1E55 CITY ZIP PHONE UGEIISE� <br />�U. B, <br />P!UMtl�NGC�YT?eCTOq MA:A909E55 CITY ZiP PHONE LICENSEs <br />CLASS OF WORN�� � <br />� NEW V ADDITION ✓ALTERATION � RcPAIR C'EhtOUTION WOODSTOV6FRPLINSERT �- BUILDWGRELOCATION <br />/� G/ ��+ni�� GOIlTAGiPER50NANOPHONENO <br />CONTRRCT PRiCE OF WORK �/ I, �/.y �/ '� a . � .I � %� — . <br />❑ ELECTRIC ❑ <br />M[CHANICAL PLUMBING SIGN <br />ZiP PHO'!E <br />7:�� — i.) , <br />ZiP <br />0 <br />nxya <br />L[GAl DESGFIPTI0110F PqOPERTV ISNOWI� BELOW UR ALTACH FOLIR <br />7� <br />LOi �� OL ' � OF /: —� <br />' �'.. � _ '�'�"� <br />'�,;,: � � �'�� , /r� �,� _ >i%—» -"- <br />I HEREBV CERT FY THAT I HAVE READ AND EXAMINED THIS '� <br />APPLIGATION AND KNOW THE SAME TO BE TaUE AND CORRECT. 4LL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF , <br />�- WORK WILL BE COAIPLETED VJITH WHETHER SPEGFIED HERE:tJ OR � <br />NOT THE GRANTING OF A PEF,MIT DOFS NOT PRESUME TO GIVE � <br />AUTHORITV TO VIOLATE OR CANCEL THE PROVISIONS OF ANY � <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION UR THE ', <br />--- PERFOR�dANCE OF CONSTRUCTION. THAT I AM AUTHORIZED 8Y THE ' <br />OWNER OF THIS PROPERTY TO PEPFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I GUMPLY WITH THE STATE <br />CONTRACT09S LAW 18.27 RCW ANU 296.200 WAC. <br />SiGNAiUREOFCONTRRGtOROHAUIHORRE�AGENi DATE <br />� � �� � <br />r� <br />/L � �. _ � � �' �� <br />FROJEGTADDRE55 - -'- �f�-�- <br />. ��c. •rernTr iYiw4M5 ; LiGENSE �10 Aq� El1SME55 4At�E <br />�7(.'� �� /1,�i� �(� i/� 'G'�C/.�'��� <br />PLUMBING <br />NO. TYPE OF FIXTURE OR ITEM FEE <br />� WATERCLOSET�TOILETI .'�' - <br />� BATHTUB S� — <br />"' LAVATORV (WASH BASIN� - <br />. ....�..,�.. .f � _ <br />KITCHEN SINK 8 <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASH <br />UFINAL <br />DRINKING FOU� <br />FLOOR DRAIN <br />ROOF <br />SINK ( <br />FOR OFI�ICE USE ONLY: <br />FPUNiSETeACM.r � NENiSETUACN � <br />�.5 7_ 5 <br />USEioN�j loianEn <br />I�—rj � J� '� oC <br />rvr�orco�usuiownoit irveorcor�si.acmai <br />� - <br />Si2EOFOtOG NO.OPStORIES <br />� tz 5f. AmN* <br />„N s� Gna 2 <br />occurnr�cv�ono nnEsrar:rciensnE <br />N� <br />rt�rnHi_ nv <br />Fi.m�s av)ri�oveo or <br />�1� <br />)TAL 5 <br />f S <br />FEE S <br />NO. TYPE OF <br />A'G-A�HNDLG UNf <br />FORCED AIH S`.'STI <br />UNIT HEATERS-B. <br />CLOTHES DRVERS <br />VENTiLATION FAN <br />WOOD STOVE <br />�dETAL FIREPLACE 8 <br />FIFiEPLACE INSEflT <br />HEAT PUMP <br />SNESETOACN PINICHECNNUI.IFIER �tt <br />7 5 � �% � <br />vncnrtt srte FEES <br />�� I3UILOING <br />occu:+��o xoorw.uu•..���.�e _. ___-- <br />u'° pLU1d�ING <br />3 � --- — <br />pA5C1dF:Ni MECHANICAL <br />Aju --- -- <br />i������r�i�A,,r����� ADDITIONALPUNCHE _ <br />ZC,� OTHE��-' <br />STAT[ �UILDING SUf7CHARGE <br />CI'fY OF EVEHETT runucwonKs <br />LOCALSALES <br />TAX CO�E IS 3105 TOTAL <br />B.T.U. M <br />M <br />.3 <br />TOTAL 5 <br />NIT $ <br />1i.FEE g <br />FEE <br />FEE <br />�i `l�� ; �' J� _ _ <br />