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APPLICATIC� FOR CONSTRUC'T�N PERMIT P��'�e1 <br />� E,,,,o,,,,, TO BE COMPLETED IN INK—PLEASE PRINT I' � <br />CITY OF N��i <br />everett - '� <br />BUILDINGDEPARTMENT HEATINGSVSTEM: UGAS �ELECTRIC U__________— <br />259•8810 <br />DEMOLITION COMBINATION XBUILDING MECHANICAL PLUMBINO 81fiN <br />OWNFR M�R��ORESS Cliv piV PINklE <br />� NL�111QS�J�fst Mu �00%[!� ���E� L�1i �%�i� O�_� 'y� ��/ y� y <br />•Rf,wfFCLd10f.51GNF.N M�iL�DDNESS CiIV 1iP PIIONE <br />_ �A�•+ i <br />GfNEHN CONTMCiOP M�M�DDREB6 CITV IIP PNONE IICENlE• <br />MEGN�NIGLL GONTR4GTOii M�1L �DDR'e88 CITY ZIP P110NE LICENSE • <br />PLUMBIN6GdiTR11CIOR MAll11DOPE83 CITV 71P P1qNE LICEN8E1 <br />CIASS OF W011K <br />NEW XADDITION � ALTERATION HEPAIR DEMOLITION WOO�STOVE/FRPL INSERT . BUILDING RELOCATION <br />GONTRACT PRIGE Of WORN /O�l�f�{/. � <br />DESCRIBE WOPk �NO SW�AE LUOT�OE INVOIVED <br />j7E� R...., lOf J�� PT. <br />PRpP09ED USE OF9UIlDING <br />LEMI �EBCRIPTiCN Of PROPERrv �SNOWN BE/OW OR �iT�Cr1 fOUR CbPIE51 <br />ioT,�_ e�ocK O � ov Dd/f OL.I� <br />PRO.IEC� �D011ES5 <br />%ri _ <br />NO <br />� ia <br />WATEF CLOSET (101L <br />BATHTUB <br />LAVATORV�WASH BA! <br />SHOWER <br />KITCHEN SINK 8 DI°P <br />URINAL <br />DRINKING FOI <br />FLOOR DRAIN <br />BACKFLOW °I <br />ROOF ORAI <br />SINK ISE ICI <br />ETC � <br />_ SUB TOiAL S <br />PERMIT S <br />70TA1 FEE S <br />FOR OFFICE USE ONLY: <br />lRONiSFTB�CN REARSEIB�CN <br />elJ' �0' <br />USE IONE LOt �RE� <br />.I` <br />rva[or Wxrs `iow�elt n�n1 torys�iey <br />/J v �J <br />SIIE[�B1�10 N00%SiOqiES <br />uC� 7Q F t' <br />OCCUPN/CY IOAD iIRE 9PRMCLE'15 RE00 <br />PEA90K <br />SIOE 9ETB�CN <br />�, <br />arur�r:r i Nnaowuimurn�s <br />11Eq11T 1NA11�TKN1 <br />2�1 <br />INi�1tE Bv a• �vvrmv�ne. CITY OF EVERET7 <br />{� LOI;AL SAI.ES <br />� � / `� '�'� TAX CODE IS 3105 <br />CONT�CT PER90N �N� PMONE NO <br />I HEREBV CEFTIFV THA? I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND OFDINANCES 60VERNINO THIS TVPE OF <br />WORK WILL BE COMPlETEO WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE ORANTINO OF A PERMIT OOES NOi PRESUME TO OIVE <br />AUTHORITV �f0 VIOLATE OR CANCEL THE PROVISIONS OF ANV <br />OTHER STATE OR IOCAL LAW HEQULATINO CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THA7 I AM AUTHORIZED BV THE <br />OWNER OF T111S PROPEFlTV TO PERFORM THF. WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTOfiS LAW 18.27 FCW �ND 296200 WAC. <br />5iGN�TIIFE OF CONiR�LiOR OR 1tITHORITED A6EN1 D�tE <br />�PPI.IC�N15 CITV BIISINESSI ICEN9E NO �ND <br />SYSTEMS--B.TU. M E.A. <br />IS—B.T.U. M <br />RANGE HOOD <br />WATER HEATER <br />WOODSTOVE <br />METAL FIREPLACE 8 <br />FIREPLACE INSERT <br />HEAT PUMP <br />QAS PIPING <br />E%HAUST F <br />PLUMBING <br />MECHANICAL <br />1100iTION�I PUN CHECN <br />OTHER <br />STATE BUILDING SURCM�R6E <br />PUAIIf WORNS <br />TOTAL <br />FEE <br />SUB TOTAL S <br />PERMIT S <br />TOTAI FEE E i_ <br />REGEIPI NO <br />�+ 05 �f57o/ _ <br />VALUATION FEE <br />I � UJJ T <br />.._�._____ �—�� <br />