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APPLICATI�.N FOR CONSTRUCI �ON PERMIT <br />,;,,; „•„„�,,,,� everett <br />everett e <br />BUILUING DEPARTMENT <br />259-8810 TO BE COMPLETED IN INK—PLEASE PRINT <br />DEMOLITION � COMBINATION BUILDING MECHANICAL PLU ABING SIGN <br />ucru�n yu�nooness cirv ¢m m�or�E <br />?� co,vti; 3�� ���E� r� � f 49,�0�' __ ��13-as � o <br />nrin��r raer. nnonrss r.�rv zir vr�oriF <br />nq�u:FC10qDE5iGN�iR `IM.�OpflC".i CI1V IIP PHONE <br />IMARF lOW p�;�i;���y JRrK50u %,.ertF� �S.S�'3�00 <br />61.NCRM.LONi11A,^,i0fl AAlL�00REi:: LIiV zIP PIIDNE IICENSE� <br />JG CON�_��2o c����r� �� �ve�rly 9�'�D� ?43�S7o JG�oRrr�v233 �.�. <br />MIiC1UNiG\ICONiRACTOl1 A�ILPDOREiS LITV ZIP p110NF LILENSE� <br />PIUMOMGCONfR�CiOR M�IIADORElS <br />Cl �55 OP WORN <br />NEW ADDITION ALTEqATION <br />iFN�NiIMPFOIEMCNiORIN1ERIOR REMOOEI JNIV <br />CONTMCT PPICE OF WORk: <br />DFSCf1IPE WOfirc pND SOUnPf FOO*�GE INVOU'EO <br />G � �_� _ <br />Pf10POSE0 USF. OI AUil01NG <br />CITV <br />REPi\IR DEMOLITION <br />� �'1 C couur,r <br />� U �� r.�, ��� S4 <br />LCG�I DCSCFiP1iON OF PRpPERTV ISNOWN OEIOW ON ALLRC�� �OUR COPiC51 <br />�aT-i�—�—a` i� z y� .�s° -� <br />� <br />Ecr�cunEss • / <br />. . i i ,i: � 'ri � . - - <br />/ <br />TYPE OF FIXTURE OR ITEM <br />V:ATER CLOSFT �TOILET� <br />9ATHTUO <br />LAVATORV � WASH BASIN) <br />SHOWER <br />NITCHEN SINK 8 DISP <br />DISHWASHER <br />LAUNDRYTRAV <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOIiNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />ROOF DRAINS-FAINLEADERS <br />SINK (SERVICE-BAR. ETQI <br />IROM SFIBACK <br />Zo � <br />usr�i— I <br />i�rf 01 C011it �LIOW�BI[ <br />�'- ti� <br />tiV[O�BLLO <br />l 4 9 � 6� <br />i �CCUP�NCY i0�0 <br />1�I /.BON iOR $PRINNlERS <br />a�ri�rnnoHeGr, Bv <br />��1 h} <br />uIV �i� <br />V <br />G <br />0 <br />PERMIT S - l�' <br />TOTAL FEE $ <br />RERR SEIBACN SIUI SE7AACN <br />�,'d. �' �l'"y _G ' <br />l01 AREA WCA11T BRE <br />��Q�� J$�_ ✓ YES NO <br />IVP( Of C(111SI AI.lOAI MG nANC� FO IM fIWpIML1iM1 6 <br />rauo <br />�' • �, ,z . I <br />NO O� SiORiCS B�SEIAENT <br />� YES NO <br />FIRESPPNNLENSREO'0 HEiGNiLIMITApON <br />vES �'NO %J�4 � <br />ruNserrravennr CITYOFEVERETT <br />LOCALSALES <br />_y� �.✓ TAX CODE IS 3105 <br />PHUNE <br />WOODSTUVEFRPLINSEPT <br />�M1U VIION[ NO <br />, � <br />UCENSE i <br />BUILDING RELOCATION <br />I HEREBV CERTIFY THAT I HAVt READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE ANO CORRECT. ALL I <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TVPE OF '� <br />WORK WILL BE COMALETED WITH WHEiH[R SPECIFIED HEREIN OR <br />NOT. THE GfiANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHOHITV TO VIOLATE OR CANCEL THE PROVISIONS OP ANV I <br />OTHER STATf OR LOCAL LAW f7EGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHOR12EJ BV THE ' <br />OWNER OF THIS PROPERTV TO PERFORM TNE WORK FOR WHICH I <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE I <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />S�GN4IUR[OFC0IPRRCIOfiORAU1HORiZ[OAGENI pQE <br />X ����,�� <br />ni�r� ic��l•sciirpusi+�s°•uctNs[ rro aHoeu�iaEssNnue <br />N0. TVPE OF EOUIPMI <br />A C-NHNDLG UNITS-H.P. <br />� FORCFD AIR SVSTEMS-B.T <br />UNIT HEATERS-B.T.U. M <br />� CLOTHESDRVERS <br />VENTILATION FAN <br />FANGEHOOD <br />WATER HEATEP <br />WOOD STOVE <br />METAL FIREPLACE 8 CHIMNI <br />FIREPLACE INS[RT <br />HEAT PUMP <br />GAS PIPING <br />E%HAUSTFAN <br />i'UN <br />nunoiNc _ __ <br />PLUMOING <br />MECHpNICAI <br />OTHER —��J"� <br />STAiG OUILDING SURCNAfiGE <br />SfAiELNERGYSURCHARGE <br />runuc woaKs <br />TOT�L <br />Sl1B TOTAL $ /' � <br />PERMIT $ <br />TOTAL FEE E - <br />fCfi)CI �1 ��_ RELLIPiNO � <br />VALUATION FEE <br />7�J 3GZ _ ����J� <br />___ _ . _-1r.p./1��J7. <br />— _ [�' !_ <br />